In this review article, orthopedic surgeons describe changes in the way older adults walk and what might be causing these changes. The way we walk is called our gait pattern. How to evaluate a patient with a gait abnormality is described. Common problems seen by the physician are outlined and discussed.
Gait changes occur in older adults, usually by age 65 and increasing by age 85. Sometimes people just slow down and shorten their stride length and speed. For other people, the fear of falling results in a wider base of support.
Muscle weakness of the hip can lead to waddling. Spinal stenosis, a narrowing of the spinal canal where the spinal cord is located, can cause a forward stooped posture during gait. Arthritis, stroke, Parkinson’s disease, and dementia are just a few of the other conditions that can lead to gait changes in the elderly.
Sometimes, but not always, it’s possible to look at how someone walks and recognize what caused the change. However, when the cause is unknown, the physician must rely on the patient history, a physical exam, and imaging studies to identify the underlying problem.
Treatment of gait disorders is the work of a physical therapist. Falls assessment and prevention is a major part of the program. Strength training, balance and sensory training, and making the home safe are important components of the program. Participation in any exercise program but especially tai chi or yoga has been shown to help improve balance and reduce falls.
Medically-induced problems are handled by the physician. Medications known to increase the risk of falling must be evaluated and monitored. Vitamin B12 deficiency can cause gait changes and is easily treated with supplements. Surgery such as hip and knee joint replacement or spine surgery to remove a disc or take pressure off a spinal nerve may be needed for some patients.