Content area
Full Text
Introduction
Virtually all who encounter older people in their clinical practice know that many of them have disorders of gait and balance. However, this is often accompanied by a lack of diagnostic curiosity as to aetiology and frequently a therapeutic agnosticism, or even nihilism.
This is a pity because a gait disorder is always an indicator of usually undetected illness, or illnesses, and therefore presents a double opportunity: to treat the underlying condition, as well as the gait abnormality. In addition, advances in classification of gait disorders, as well as increasing recognition of higher-level gait disorders of vascular origin (or vascular gait dyspraxia),1 facilitate a more practical and scientifically valid approach to gait disorders in this population.
The prevalence of gait abnormality is 35% among people aged >70 years.2 Such disorders are a marker for increased vigilance for frailty and are associated with reduced quality of life and risk of entry to nursing home.3 As with many chronic disease and geriatric syndromes, the improvements gained through focused diagnosis and treatment may appear modest, but may make a significant difference to function and quality of life for the older person.
The safest clinical point of departure is that, if an older patient cannot walk in a reasonably nimble fashion without a walking aid, then he or she has a gait disorder that you as a doctor are likely to be able help to alleviate. As with some geriatric syndromes, such as incontinence, the physician may need to proactively broach the subject. All those who present with falls should be screened for a gait disorder.
A further challenge is that older people often unconsciously adapt to, and develop, an acceptance of gait and balance disorders, particularly those that develop slowly: a significant minority may not admit to, or recognise, having a gait disorder.4 Unlike pain or dyspnoea, older people may not see problems with walking as a symptom worth bringing to their doctor's attention, or believe that it is possible to do much about it.5 Indeed, it is remarkable how they normalise their compensatory strategies, such as 'furniture crawling', a classic response to more severe levels of gait disorder.
Advances in classification
The most helpful classification of gait disorders is that of Liston et al which...