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Background: falling is a major health problem.Objective: to investigate the predictive value for falls of the maximum step length and gait speed.Design: a prospective cohort study.Setting: geriatric outpatient clinic.Subjects: three hundred and fifty-two community-dwelling older persons screened by their general practitioner.Methods: maximum step length and gait speed were recorded as part of a comprehensive geriatric assessment. One-year follow-up was performed using the fall telephone system.Results: one hundred and thirty-six (39%) of all subjects (mean age: 76.2 years, standard deviation: 4.3, 55% female), fell at least once, of whom 96 were injured. Predictive values for any falls of both maximum step length and gait speed were low (area under the curve (AUC): 0.53 and 0.50) and slightly better for recurrent falls (maximum step length AUC: 0.64 and gait speed AUC: 0.59). After adding age, gender and fall history to the prediction model, the AUC was 0.63 for maximum step length and 0.64 for gait speed, and for recurrent falls, the AUC was 0.69 both for maximum step length and gait speed. The prediction of fall-related injuries showed similar results. A higher maximum step length score indicated a lower likelihood for falls (hazards ratio 0.36; 95% confidence interval 0.17–0.78).Conclusions: maximum step length and gait speed as single-item tools do not have sufficient power to predict future falls in community-dwelling older persons. [ABSTRACT FROM AUTHOR]

Background: patients suspected of dementia frequently undergo additional diagnostic testing (e.g. brain imaging or neuropsychological assessment) after standard clinical assessment at a memory clinic. This study investigates the use of additional testing in an academic outpatient memory clinic and how it influences the initial diagnosis.Methods: the initial diagnosis after standard clinical assessment (history, laboratory tests, cognitive screening and physical and neurological examination) and the final diagnosis after additional testing of 752 memory clinic patients were collected. We specifically registered if, and what type of, additional testing was requested.Results: additional testing was performed in 518 patients (69%), 67% of whom underwent magnetic resonance imaging, 45% had neuropsychological assessment, 14% had cerebrospinal fluid analysis and 49% had (combinations of) other tests. This led to a modification of the initial diagnosis in 17% of the patients. The frequency of change was highest in patients with an initial non-Alzheimer's disease (AD) dementia diagnosis (54%, compared with 11 and 14% in patients with AD and ‘no dementia’; P < 0.01). Finally, after additional testing 44% was diagnosed with AD, 9% with non-AD dementia and 47% with ‘no dementia’.Conclusion: additional testing should especially be considered in non-AD patients. In the large group of patients with an initial AD or ‘no dementia’ diagnosis, additional tests have little diagnostic impact and may perhaps be used with more restraint. [ABSTRACT FROM AUTHOR]

Background: fear of falling (FoF) has great impact on functioning and quality of life of older people, but its effects on gait and balance are largely unknown. Methods: we examined FoF in 100 participants aged ~75 years, using the Activities-specific Balance Confidence scale. Participants with a mean score <67% were assigned to the FoF group. We quantified gait and balance during walking at the preferred velocity with and without a cognitive dual task (arithmetic task and verbal fluency), using an electronic walkway (Gaitrite®) and a trunk accelerometer (SwayStar®), Primary outcome measures were gait velocity, stride-length and stride-time variability, as well as mediolateral angular displacement and velocity. Results: gait velocity was significantly lower (P < 0.05) and stride-length and stride-time variability were significantly higher (P < 0.05) in the FoF group. However, after standardisation for gait velocity, differences became non-significant. Mediolateral angular displacement and velocity were not associated with FoF. We found no difference between the FoF and no-FoF group with respect to the dual-task effect on gait and balance variables. Conclusions: the lower gait velocity in the FoF group may be a useful adaptation to optimise balance, rather than a sign of decreased balance control. The ability to attend to a secondary task during walking is not influenced by FoF. [ABSTRACT FROM AUTHOR]

Editorial. Deals with malnutrition research. Categories of malnutrition; Reason for considering malnutrition as a geriatric syndrome; Syndromes related to malnutrition.

Presents a response by Marcel G. M. Olde Rikkert and Anne-Sophie Rigaud to a letter to the editor about their article "Malnutrition Research: High Time to Change the Menu," in the 2003 issue of the "Age and Ageing."