Abstract:

This review addresses the evaluation and treatment of gait disorders in older adults. The focus is on comfortable gait, the most common clinically evaluated aspect of walking. Difficulty in walking is common in older adults and can be a predictor of overall functional status. Measures of gait such as speed decline with age, but the decline is small in healthy older adults less than age 70. Factors ranging from anthropometry to cognition affect gait, and the effect of exercise is apparently modest. A number of diseases, often in combination, cause gait disorders. The categorization of these disorders becomes difficult when higher order cortical changes occur, particularly in response to cerebrovascular disease. There are few standard methods of gait disorder evaluation, other than standard clinical and radiological measures, and few data documenting the cost-effectiveness of these methods. Gait assessment ranges from simple observation to more sophisticated instrumented techniques, and yet evaluation of gait speed may be sufficient for most clinical purposes. Data on treatment and rehabilitation outcomes for gait disorders are frequently limited methodologically, particularly in the surgical literature. Gait improvements are modest, and residual disability and/or gait abnormalities are common. With new diagnostic technology and techniques available, as well as a new emphasis on cost-effectiveness, the evaluation and treatment of gait disorders in older adults will continue to evolve.