Are Human Development Index dimensions associated with gait performance in older adults? A systematic review

Background: Because gait performance is a marker of organic integrity, and the Human Development Index (HDI) of a region impacts the organism globally, this paper aims to investigate possible associations between both HDI and HDI dimensions at individual level (i.e. education, income, or life expectancy) with gait performance in older adults. Methods: Searches were conducted on EMBASE and PubMed databases. Eligible studies included community-dwelling population aged >= 60 years, analysis of at least one quantitative gait variable, observational studies, Human Development Index or its dimensions (i.e. education, income, or life expectancy). Results: Thirty-five articles were included in this systematic review. No study directly used HDI as an independent variable, but all selected articles found relationships between gait performance and one or two HDI dimensions at individual-level in the same study. Gait speed was the most common dependent variable associated with all three HDI dimensions. Low education, poor income, and short life expectancy were associated with worse gait speed, in combination and/or independently. Conclusion: No studies were found using HDI as a main variable. Systematic evidence showed a strong relationship with all three HDI dimensions: education, income, and life expectancy, suggesting that social factors at individual level affect gait performance.