From the Guidelines
Elderly gait abnormalities require a comprehensive assessment and multifaceted treatment plan to address underlying causes and prevent falls, with a focus on physical therapy, medication review, and home modifications. The most recent and highest quality study 1 emphasizes the importance of assessing sensory and motor function, particularly vision, hearing, gait, and balance, in the evaluation and management of elderly gait abnormalities. Key components of the treatment plan include:
- Physical therapy focusing on strength, balance, and gait training exercises performed 2-3 times weekly for at least 8-12 weeks
- Assistive devices such as canes or walkers properly fitted by a physical therapist
- Medication review to identify and adjust medications that may worsen gait problems, such as benzodiazepines, antipsychotics, and certain antihypertensives
- Vitamin D supplementation (800-1000 IU daily) if deficiency is present
- Targeted treatments for specific conditions, such as carbidopa-levodopa for Parkinsonian gait, memantine or cholinesterase inhibitors for cognitive impairment-related gait disorders, and physical therapy with pain management for arthritic conditions
- Home modifications, including removal of tripping hazards, installation of handrails, and adequate lighting, to prevent falls
- Regular vision and hearing assessments to address sensory deficits that contribute to gait instability. These interventions address the multifactorial nature of elderly gait disorders, which often result from age-related changes in proprioception, muscle strength, and central processing combined with specific pathologies affecting neurological, musculoskeletal, or cardiovascular systems.
From the Research
Causes of Elderly Gait Abnormalities
- Gait and balance disorders in older adults are often caused by multiple contributing factors, including arthritis and orthostatic hypotension 2
- Neurological gait disorders in the elderly population can be caused by underlying diseases, and are not an unpreventable consequence of ageing 3
- Balance and gait problems in the elderly can be caused by disorders of balance and gait, which compromise independence and contribute to the risk of falls and injury 4
Diagnosis and Assessment
- The Timed Up and Go test is a fast and reliable diagnostic tool for assessing gait and balance disorders in older adults 2
- A clinically oriented approach to neurological gait disorders in the elderly population involves assessing the complex and typically multifactorial pathophysiology underlying geriatric gait disorders 3
- A practical three-step approach to categorise gait disorders can be used, based on clinical signs and symptoms 3
Treatment and Intervention
- Exercise and physical therapy are effective options for patients with gait and balance disorders 2
- Tai Chi intervention can benefit postural balance in patients with gait disorders, with a common intervention period of 12 weeks and a frequency of twice a week 5
- A multifactorial evaluation followed by targeted interventions for identified contributing factors is the most effective strategy for falls prevention 2
- Preservation of mobility is important in itself, and also because the ability to walk is closely correlated with cognitive performance 6