Subsystems contributing to the decline in ability to walk: Bridging the gap between epidemiology and geriatric practice in the InCHIANTI study

BACKGROUND: Older patients are often referred to geriatricians because of c omplaints of progressive difficulties in walking. The diagnostic and therap eutic approach to these patients is complex. Multiple physiologic subsystem s may influence the ability to walk, and no standard criteria are currently available to establish whether these subsystems are functioning within the normal range. To address this lack of knowledge we conducted the InCHIANTI study. OBJECTIVE: To identify measures that clinicians can use to understand the c auses of walking difficulties in older persons. DESIGN: A population-based study of persons living in the Chianti geographi c area (Tuscany, Italy). PARTICIPANTS: 1453 persons (age-range 20-102 years; 91.6% of the eligible) selected from city registry of Greve in Chianti and Bagno a Ripoli (Tuscany , Italy), using a multistage sampling method. MEASUREMENTS: Factors that influence walking ability were classified into s ix main physiologic subsystems: central nervous system, perceptual system, peripheral nervous system, muscles, bone/joints, and energy production/deli very. Measures of the integrity and functioning of each of these proposed s ubsystems were identified and administered to all participants. CONCLUSIONS: Data collected in InCHIANTI will be used to identify the main risk factors that influence loss of the ability to walk in older persons, t o define physiologic subsystems that are critical for walking, to select th e brst measures of their integrity, and to establish critical ranges in the se measures that are compatible with "normal" walking ability. The final go al is to translate epidemiological research into a geriatric clinical tool that makes possible more precise diagnosis and more effective treatment in patients with walking dysfunction.