Bettina Von Kampen, Alison Douglas, Carrie McAiney and Shelley Wright
Background: A recent review of the literature reveals an absence of standardized measures to assess mobility in persons with advanced dementia. Persons with moderate to severe dementia have significant difficulty adhering to instructions. The aim of the study was to develop an identical measure of gait and balance to be used with persons with dementia. We chose to switch the ‘Tinetti Assessment Tool for Balance and Gait’ because many of the things are supported by observation. Modification of test items requires analysis of reliability before establishing validity. Objective: To see the inter-rater and test-retest reliability of ‘Tinetti Assessment Tool for Balance and Gait-Dementia’ Methods: Inter-rater reliability: Participants were observed and scored simultaneously by two raters conversant in the written instructions (physiotherapy, physiatrics, or nursing staff). Test-retest reliability: The test was re-administered after 10 to half-hour. Results: a complete of n=20 participants were recruited and included. The mean age of participants was 75 with the bulk being female (n=11, 55%). All were diagnosed with dementia or cognitive impairment. Secondary diagnoses include heart condition, diabetes, and Parkinson’s disease. The mean cognitive assessment (SMMSE) score was 8.5/30 (n=12). Inter-rater reliability of the overall score was high (r=0.90) as was test-retest reliability (r=0.92). Discussion: These results are like the established reliability of the initial Tinetti tool (r>0.8). The results indicate that the modified measure has sufficient reliability to commence validity testing. Developing a measure that assesses functional changes during this population is vital for determining the impact of mobilization and least restraint programs for people with dementia in future care. Further study will establish the validity of the cut score for predicting fall risk. Falls in frail elderly are a typical problem with a rising incidence. Gait and postural instability are major risk factors for falling, particularly in geriatric patients. As walking requires attention, cognitive impairments are likely to contribute to increased fall risk. Objective quantification of gait and balance ability is required to spot persons with a high tendency to fall. Recent studies have shown that stride variability is increased in the elderly and under dual-task conditions and may be more sensitive to detect fall risk than walking speed. within the present study, we complemented stride-related measures with measures that quantify trunk movement patterns as indicators of equilibrium ability during walking. The aim of the study was to quantify the effect of impaired cognition and dual tasking on gait variability and stability in geriatric patients.
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