In the elderly community, the prevalence of gait disorder is 35% in persons over age 70. Gait disorders consist of a number of factors, such as slowing of the gait speed, loss of balance or coordination of movement. For elderly, speed of walking, time to get up from sitting and the ability to balance the body are important predictors of the ability to carry out activities of daily living e.g. shopping, driving, cooking etc. Ability to walk independently requires adequate attention, muscle strength and effective motor control in order to coordinate sensory input and muscle contraction.

Causes of gait disorders

Gait disorders in the elderly are often multi-factorial in origin. There are a number of disorders that can lead to gait dysfunction or unsafe gait, for example:

• Neurodegenerative disorders e.g. Parkinson’s Disease, stroke, cerebellar disorder and dementia.
• Musculoskeletal problems e.g. degenerative changes of ankle, knee or hip and kyphosis.
• Sensory deficits e.g. visual impairment.
• Toxic factors e.g. adverse effects of certain medications and alcohol.
• Anxiety disorder e.g. fear of falling.
• Other causes e.g. trauma.

Diagnosis

The doctor will try to  identify as many potential contributing factors to gait disorders as possible. Diagnosis will be approached as follows:

• The doctor will discuss with you regarding your sconcern, fears and goals to achieve; related to mobility.
• Observation of gait with and without an assistive device (if possible and safe).
• Assess all components of gait.

Thorough evaluation includes:

• History – Gait-related issues in addition to the standard medical history will be asked including history of previous falls, difficulty in climbing stairs or rising from sitting position. Postural giddiness is an important part  to query. Significant drug history is important; example anti-psychotic may cause Parkinson like gait.
• Physical examination – A thorough physical examination is performed with special emphasis on the musculoskeletal, neurologic and cognitive examination.
• Gait assessment – Routine gait assessment can be performed by a primary care doctor but complex gait disorders need to be assessed by an expert.
• Imaging – Imaging is sometimes indicated e.g. CT or MRI of the brain is performed to identify the underlying brain pathology.

Complications of gait disorder

Reducing mobility due to the underlying gait disorders can impair the quality of life, and increase the morbidity and mortality secondary to falls.

Treatment

Treatment is directed against the underlying problems that are identified and consists of physiotherapy, medications, and behavioral therapy. Some interventions can lead to improvement in gait and functions, for example:

• Strength training – Elderly people with mobility problems can achieve improvements with exercise programs. Resistance exercises can improve strength and gait speed, especially in elderly patients with slowed gait. However this should be done cautiously and gradually as the elderly may have comorbid including ischemia heart disease.
• Balance training – Elderly patients with balance problem can benefit from balance training.
• Assistive devices – Assistive devices can help the elderly to maintain mobility and their quality of life. Occupational therapists should be involved in the choice and training of the use of assistive devices e.g. the canes and walkers.

Prevention

For the elderly, increasing physical activity can help to maintain mobility. The patients should be advised to increase their gait speed and duration over several months. Prevention can also include resistance and balance training.