Why should GPs measure gait in the context of dementia?
There is no implication these people have dementia.
“Many people think that gait is impaired only in the later stages of dementia, but it actually starts to slow many years before diagnosis. We not only need to build cognitive reserve, but also physical reserve so older people can remain independent for as long as possible and reduce the risk of falls.” – Associate Professor Michele Callisaya.
Gait speed, cognition, and dementia prevention. How are they linked?
National Centre for Healthy Ageing lead researcher, Associate Professor Callisaya explained how in a recent Dementia In Practice Podcast, hosted by GPs, Dr Marita Long and Dr Hilton Koppe.
Click HERE to listen to the Dementia in Practice podcast.
With a background in physiotherapy and more than 20 years working in the field of rehabilitation, Michele is passionate about promoting the role of physiotherapy for people living with cognitive impairment and dementia. Her work has led to a better understanding of the role of cognition on older people’s physical functioning and adverse events such as falls. More recently her work has focused on reducing stigma and improving access to reablement and rehabilitation interventions for disability related to dementia.
Discover more about key NCHA projects Associate Professor Callisaya is involved in that will assist people with dementia increase their physical activity and tackle stigma.
Podcast co-host, Dr Marita Long asked Associate Professor Callisaya why GPs should look for an abnormal gait in patients?
“If you walk slower than one metre per second, it seems to be a good marker of increased risk of falls, institutionalisation, hospitalisation, and a whole range of adverse events. So, measuring walking speed (of a person) is important, we sometimes call it the sixth vital sign,” Associate Professor Callisaya said.
“It's easy to do, you just need a stopwatch and measured distance. It can also be useful to watch someone walk into the consult room and talk to them at the same time. If they can walk and talk, then they're doing well. But a lot of people will stop walking and concentrate because they can't do two things at once. And that's a good indication that cognition is starting to affect their physical function.”
Why is cognition important for walking?
“A lot of people think that walking is an automatic activity. But when we're walking, we’re often dividing our attention, using judgement, and planning to go around or over an obstacle, and then we’ve also got to remember the route down to the coffee shop. We're using our memory and navigational skills to get somewhere. We're using our cognition the whole time,” Associate Professor Callisaya said.
“But what we often don't realise is that when we get older, and balance gets worse, we need to concentrate even more on walking. And so you see a lot of older people looking at their feet when they're walking, looking down, instead of around them. When someone has cognitive decline or dementia as well, they will have reduced cognitive capacity to concentrate on their balance, so walking is going to become quite an effort for that person and the risk of falls increases.
“You also see that people are not going out and socially interacting because they are either fatigued or embarrassed about their cognition. People become deconditioned. And so, we really need to get in there early and build up people's physical function and capacity, so that when cognition declines further, they've got physical reserve so that they can continue to walk and do the things they want to do.”
What can be done to keep older people with dementia independent and involved in activities they enjoy for as long as possible?
“Rehabilitation in dementia is not two words that are commonly put together. But there are a lot of interventions now that will either slow, maintain or improve functioning for people with dementia, particularly if they have targeted activities that are meaningful to them,” Associate Professor Callisaya said.
“Exercise is one effective intervention for improving balance, strength and gait in people living with dementia.”
Find out more listen to the podcast.
Find out more about the projects underway at NCHA
Thanks to the GPs involved in the Dementia in Practice podcast series who gave NCHA permission to reproduce this edited content.