Gait and balance disorders are common in older adults and are a major cause of falls in this population. They are associated with increased morbidity and mortality, as well as decreased level of function., loss of independence and decreased quality of life. Common causes include arthritis, orthostatic hypotension and general weakness, although most gait and balance disorders involve multiple factors. Early identification of gait and balance disorders, along with appropriate intervention may prevent dysfunction and loss of independence.
Determining what an abnormal gait is can be challenging since there is no clearly accepted standard to define normal gait in an older adult. Studies comparing healthy persons into their 70s with healthy persons in their 20s demonstrate a 10-20% decrease in gait velocity and stride length. Other characteristics of gait that commonly change with aging include an increased stance width, increased time spent in the double support phase (both feet on the ground), bent posture, and less force development when the foot leaves the ground.
Up to 20% of older adults maintain normal gait patterns into very old age, demonstrating that aging is not inevitably accompanied by disordered gait.
Medical conditions may contribute to gait and balance disorders for a variety of reasons, such as pain, dyspnea, imbalance, diminished strength, limited range of motion, poor posture, decreased sensory perception, fatigue, deformity, and decreased awareness of and ability to adapt to the environment.
Some of these medical conditions include:
A multifactorial evaluation followed by targeted interventions for identified contributing factors can reduce falls by 30-40% and is the most effective strategy for fall prevention. Because most gait and balance disorders in older adults are multifactorial in origin, they usually require several modes of treatment to restore, maintain, or improve functional capacity.
A thorough examination will help determine the underlying cause(es) of gait and balance disorders, which will help direct the treatment and plan of care.