One in four people over the age of 70 suffers from gait disturbance, that leads to falls. About 30% of persons over age 65 living at home fall at least once per year; among nursing home residents, the corresponding figure is about 50%. That’s according to a report from Ludwig-Maximilians Universität München and Germany’s Integrated Research and Treatment Centers.
To prevent falls, specific treatment should be given. In the current issue of Deutsches Ärzteblatt International, Dr. Klaus Jahn and colleagues describe methods of differential diagnosis and therapy (Dtsch Arztebl Int 107[17]: 306-16). Increasingly avoidant behavior further lessens the patient’s confidence in his or her own balancing ability; thus, the symptoms worsen in a downward spiral, the study warns.
Gait disturbance is defined as unsteadiness during walking that is worse than the normal slowing of old age. It often has multiple causes; in elderly patients, fear is often a precipitating or aggravating factor. A vicious circle often arises in which fear of falling leads to avoidance of movement, and in turn to reduced fitness, lower confidence in one's own balance, increased fear, and increased danger of a fall. Depression and a markedly impaired quality of life can result.
Reduced mobility markedly impairs quality of life, and the associated falls increase morbidity and mortality, say the authors.
In order for the treatment to be as effective as possible, the type of gait disturbance and its causes must be precisely analyzed. In their article, Jahn et al. present effective diagnostic methods. For example, the observation of parameters such as step length, speed, body posture, and variability while the patient walks a given distance, once with eyes open and once with eyes closed, enables classification of the type of gait disturbance.
Gait disturbances in the elderly are often of multifactorial origin. The relevant pathogenetic factors include sensory deficits (visual, vestibular, somatosensory), neurodegenerative processes (cortical, extrapyramidal motor, cerebellar), toxic factors (medications, alcohol), and anxiety (primary or concerning falls).
A clinically oriented classification of gait disorders is proposed, which, on the basis of the characterization of gait and the accompanying clinical findings, enables identification of the etiological factors and points the way to rational therapy. Current research topics in the study of gait disturbances are also discussed, including quantitative gait analysis, interactions between locomotion and cognition (dual tasking), and functional imaging approaches.
The study concludes that the evaluation of elderly patients whose chief complaint is a gait disturbance should be directed toward the identification of specific deficits. This is the prerequisite for rational therapy, even when the problem is of multifactorial origin. The preservation of mobility is important in itself, and also because the ability to walk is closely correlated with cognitive performance.
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Contacts and sources:
Neurologische Klinik und Poliklinik der Ludwig-Maximilians-Universität München und Integriertes Forschungs- und Behandlungszentrum für Schwindel, Gleichgewichts- und Okulomotorikstörungen (IFBLMU): PD Dr. med. Jahn, Dr. med. Zwergal, Dr. med. Schniepp
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