Health Information

Summary/Definition

In older people, gait disorders are caused by age-related declines in functions necessary for normal walking, including balance, vision, hearing, proprioception, leg muscle strength, etc. These changes result in a shortened stride length, increased distance between the legs (extended stance), and bending of the hips and knees when walking. Falls due to these gait disturbances can lead not only to primary injuries such as fractures, but also to a fear of walking, which can ultimately reduce independence in performing everyday movements.

Walking is a complex process involving the interaction of bone sensory receptors, nerve transmission systems and muscles, and depends on the interaction between the central and peripheral nervous systems. Walking can cause a variety of problems such as pain, breathing difficulties, balance problems, reduced muscle strength and restricted joint movement. It should also be noted that neurological or muscular disorders can affect walking. Some of the most common causes of walking problems in older people are pain associated with degenerative arthritis and fear of falling.

<Table: causes of gait disturbance in the elderly>

Mental and psychological problems	Depression, fear of falling, disturbed sleep
Cardiovascular disorders	Arrhythmia, congestive heart failure, orthostatic hypotension, ischemic heart disease
Infectious and metabolic disorders	Diabetes mellitus, thyroid disease, obesity, vitamin B12 deficiency
Musculoskeletal disorders	Cervical spine stiffness, lumbar spine stenosis, muscle weakness, osteoarthritis.
Neurological disorders	Dementia, multiple sclerosis, stroke, Parkinson’s disease, dizziness due to vestibular disorders.
Sensory disorders	Hearing impairment, peripheral neuropathy, visual impairment
Other	Recent history of surgery Recent history of hospitalization Adverse reactions to medication (antiarrhythmics, diuretics, antidepressants, etc.)

Symptoms

Gait disorders can manifest themselves in many different ways. Painful walking is a type of gait in which a person tends to reduce the load on the painful leg. This type of gait usually results from pain caused by arthritis in the knee or hip joint. Atactic (wobbly) gait is characterized by an attempt to maintain balance, a gait reminiscent of a rocking boat. It is most commonly associated with cerebellar dysfunction or spinal cord disease. The apraxic gait, usually seen in patients with bilateral frontal lobe lesions or in those with hydrocephalus and normal intracranial pressure, resembles a person trying to grip the ground with their feet and having difficulty initiating movement. In incomplete unilateral paralysis, the person’s arm is bent, and the leg feels as if it is trying to walk in a circle. This occurs in partial paralysis of one side due to stroke, etc. There are other types of gait disorders, such as Parkinson’s disease, steppage gait (or pigeon toes), etc.

Diagnostics

The first step is a comprehensive assessment that includes muscle strength, gait analysis, sensory assessment, reflexes, cerebellar function, autonomic nervous system and cardiovascular function. Depending on the results of this examination, imaging of the musculoskeletal system, brain, spinal cord and cardiovascular system may be required. Blood tests will be carried out to assess general health and a gait test will be carried out to assess gait patterns.

Treatment and course of the disease

The first step is to identify the specific cause of the gait disorder and develop an appropriate treatment and intervention plan. Regular aerobic and strength training and medication are recommended after full consultation with your doctor. If you have a visual impairment that may increase your risk of falling, it is important to have regular eye tests and to review your home environment to reduce the risk of injury. Walking aids, such as a walking frame, can be used if necessary. As gait disorders can lead to serious complications, it is important to see a doctor for appropriate treatment if you have difficulty walking.

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