Se­nior Care

Un­der­stand why gait mat­ters

Health & Nutrition - - CONTENTS -

Like al­most ev­ery­thing else, the way we walk changes as we age. Maybe you’ve no­ticed it in your­self or a friend: A slower step, a slight stag­ger, or a limp, a shuf­fle, a tilt. But how do you know what’s nor­mal and what’s not? While many peo­ple ex­pe­ri­ence some slight changes in their gait as they age, for oth­ers this doesn’t hap­pen un­til they are ex­tremely old. How­ever, walk­ing dif­fi­culty should not be ac­cepted as an in­evitable con­se­quence of ag­ing. It can sig­nal an un­der­ly­ing con­di­tion that needs med­i­cal at­ten­tion and whose ad­verse im­pact on mo­bil­ity and in­de­pen­dence can be avoided if rec­og­nized and treated early enough. A study es­ti­mated that about 10% of peo­ple aged be­tween 60 and 69, and nearly 62% among peo­ple aged be­tween 80 and 97, have a gait, or walk­ing pat­tern, dis­or­der. Ab­nor­mal gait changes can sig­nal a ner­vous sys­tem con­di­tion, such as Parkin­son’s dis­ease; a bone, mus­cle, or joint dis­or­der, such as arthri­tis; psy­cho­log­i­cal fac­tors, such as anx­i­ety or de­pres­sion; or drug side ef­fects. Some gait dis­tur­bances are as­so­ci­ated with an in­creased risk of de­vel­op­ing de­men­tia and car­dio­vas­cu­lar dis­ease. Any type of gait change pre­dis­poses adults to falls and se­ri­ous in­juries. If you no­tice a change in gait in your­self or a loved one, have the change checked out by a doc­tor to de­tect the un­der­ly­ing causes and pre­vent falls and fu­ture im­mo­bil­ity.


Sev­eral dis­tinct el­e­ments de­ter­mine whether gait is nor­mal in healthy older adults: Speed. Most adults walk more slowly as they age. In peo­ple who don’t have sig­nif­i­cant health prob­lems, gait speed de­clines by about 0.2% a year up to age 63, and up to 1.6% each year af­ter that. A rea­son for a slower gait may be de­creased strength in the calf mus­cles, which you use to pro­pel your­self for­ward. Cadence. For most peo­ple, cadence, or rhythm, doesn’t change as they age. Cadence is

re­lated to leg length: Tall peo­ple take longer steps at a slower cadence, and short peo­ple take shorter steps at a faster cadence. The ap­pear­ance of de­cel­er­a­tion is not due to cadence but to shorter steps as a per­son ages. Dou­ble stance time. The length of time a per­son has both feet on the ground while walk­ing can dou­ble with age. A per­son with a longer dou­ble stance time may look as if he or she is walk­ing on ice. Walk­ing pos­ture. An up­right walk­ing po­si­tion is nor­mal in healthy older adults, al­though some peo­ple may tilt their pelvis for­ward with an in­ward curve in the lower back (known as lum­bar lor­do­sis) be­cause of tight hip-flexor mus­cles, weak ab­dom­i­nal mus­cles, and in­creased ab­dom­i­nal fat. Joint mo­tion. Be­cause an­kle flex­i­bil­ity may be re­duced, gait may change slightly as the back foot lifts off the ground when walk­ing. Older adults also have a limited range of mo­tion in the hips. Age-re­lated gait changes can re­sult from a gen­eral re­duc­tion in fit­ness, in­clud­ing stiff­ness, loss of limb strength, a de­clin­ing sense of bal­ance, and less lung and heart ca­pac­ity. On av­er­age, peo­ple with stronger legs or more range of mo­tion in their an­kles and hips walk faster. Walk­ing speed has been linked to over­all health and life ex­pectancy: Fast walk­ers (de­fined as 1 meter per sec­ond, or 2.5 mph, or more) are more likely to out­live slower walk­ers. And hav­ing to stop walk­ing while talk­ing is a pre­dic­tor of fu­ture falls. The fear of fall­ing can cause a gait change. Called cau­tious gait, this change in gait oc­curs in older adults who have al­ready taken a stumble or who have poor vi­sion. A per­son with cau­tious gait may have ex­ag­ger­ated agere­lated gait changes and walk with care­ful, wide-legged move­ments and min­i­mal arm move­ment. If a cau­tious gait isn’t cor­rected, and fear of fall­ing be­comes ob­ses­sive, it can lead to a pho­bic gait dis­or­der in which a per­son be­comes com­pletely un­able to walk.


A sud­den change in gait with no ap­par­ent cause is not nor­mal and needs to be eval­u­ated by a doc­tor right away. Of­ten, how­ever, gait changes are more sub­tle and de­velop grad­u­ally as a re­sult of a chronic med­i­cal con­di­tion. An ab­nor­mal gait is rarely due to one sin­gle fac­tor. Most gait dis­or­ders in­volve mul­ti­ple con­tribut­ing fac­tors. For ex­am­ple, it’s not un­com­mon for one per­son’s gait to be im­paired by a com­bi­na­tion of joint pain,

a vis­ual im­pair­ment, and the side ef­fects of med­i­ca­tion. To de­ter­mine what’s caus­ing your gait change, your doc­tor will per­form a com­pre­hen­sive his­tory and a phys­i­cal exam and re­view your me­di­a­tions. Rea­sons for ab­nor­mal gait change in­clude: Parkin­son’s dis­ease. Quick, short steps or shuf­fling, with the knees, hips, and spine bent, could sug­gest Parkin­son’s dis­ease or parkin­son­ism. Parkin­son­ism is a con­di­tion with symp­toms sim­i­lar to Parkin­son’s dis­ease that also af­fects gait. Arthri­tis. Knee or hip arthri­tis can force you to change your gait, of­ten in an ef­fort to re­lieve pain as you walk. You may ap­pear stiff; take short, slow steps; or seem un­able to beat your body’s weight. Back and neck prob­lems. Lum­bar spinal steno­sis, which is a nar­row­ing of the canal through which the spinal cord trav­els in the ver­te­brae of the lower back, can af­fect gait. Spinal cord com­pres­sion in the neck re­gion (cer­vi­cal spondy­lotic myelopa­thy) can in­ter­fere with gait and cause loss of bal­ance and co-or­di­na­tion and also re­sult in ‘foot drop’, a weak­ness in the an­kle mus­cles that causes the toe to drag while walk­ing. Foot drop is some­times ac­com­pa­nied by a high lift­ing of the leg to avoid catch­ing the toe on the ground. Other or­thopaedic prob­lems. Lower-ex­trem­ity surgery or trauma, such as a frac­ture, can cause a de­vi­a­tion from nor­mal gait. A vi­ta­min B de­fi­ciency. A stag­ger or an un­steady

gait can be a sign of a chronic vi­ta­min B de­fi­ciency, which can lead to a de­gen­er­a­tion of the nerves in the spinal cord and brain. Early de­tec­tion is cru­cial: By the time a B de­fi­ciency gives rise to dif­fi­culty walk­ing, the nerve dam­age may be ir­re­versible. Pe­riph­eral neu­ropa­thy. Dam­age to sen­sory nerves in the feet can cause numb­ness, tin­gling, or pain in the feet and re­sult in an in­abil­ity to walk prop­erly. Di­a­betes is a com­mon cause, but many other med­i­cal con­di­tions that are amenable to treat­ment can also cause neu­ropa­thy. Other neu­ro­logic dis­or­ders. Many brain and ner­vous sys­tem dis­or­ders can trig­ger a wide range of gait changes, in­clud­ing un­steadi­ness; slow, small steps; lack of co­or­di­na­tion; feel­ing as if your feet are stuck to the ground; or dif­fi­culty ini­ti­at­ing leg move­ment. Brain tu­mours, mul­ti­ple scle­ro­sis, and Hunt­ing­ton’s dis­ease are ex­am­ples of the many neu­ro­logic dis­or­ders that can cause gait dis­tur­bances. Strokes are a com­mon cause of gait dis­or­der. The term ‘silent strokes’ refers to the fact that a sin­gle stroke might not have any symp­toms, but mul­ti­ple small strokes can ad­di­tively lead to gait prob­lems. Nor­mal pres­sure hy­dro­cephalus is a buildup of cere­brospinal fluid in the fluid-con­tain­ing sacs of the brain due to an in­abil­ity of the fluid to flow nor­mally. Hall­mark symp­toms in­clude

dif­fi­culty ini­ti­at­ing walk­ing, the feet be­com­ing frozen in place, and in­con­ti­nence. It can of­ten be re­versed if iden­ti­fied early. Pe­riph­eral artery dis­ease (PAD). PAD can cause calf, thigh, and foot pain, which oc­curs when the ar­ter­ies to the legs can’t de­liver suf­fi­cient blood flow, re­sult­ing in leg pain af­ter walk­ing short dis­tances. Men­tal health dis­or­ders. A de­pressed mood may cause you to walk more slowly and shuf­fle, and anx­i­ety may cause you to walk more cau­tiously. Drug side ef­fects. Some med­i­ca­tions can di­rectly im­pair walk­ing by caus­ing a Parkin­son-like gait dis­or­der. An­tipsy­chotic drugs and meto­clo­pramide are com­mon causes. Drugs that cause blurry vi­sion, con­fu­sion, drowsi­ness, and low blood pres­sure upon stand­ing – and there are many – can ad­versely im­pact gait. Footwear. Don’t over­look your shoes as a pos­si­ble con­trib­u­tor to an un­steady gait. Ill-fit­ting shoes with no sup­port can cause you to shuf­fle your feet. High heels and crepe soles can im­pair gait. War sturdy, low-heeled shoes in­stead.


Many causes of the gait dis­or­ders listed above can be im­proved, and treat­ment can help pre­vent in­juries from falls and im­prove mo­bil­ity. Drug ther­apy can im­prove symp­toms of many con­di­tions that af­fect gait and surgery may help in con­di­tions such as arthri­tis and hy­dro­cephalus. Many con­di­tions, such as arthri­tis and Parkin­son’s dis­ease, im­prove with ex­er­cise. For­mal phys­i­cal ther­apy can lead to dra­matic im­prove­ments; group ac­tiv­i­ties, such as a tai chi class, can have good re­sults. Re­sis­tance ex­er­cises, bal­ance train­ing, and walk­ing can help. Phys­i­cal ther­apy rou­tines aimed at strength­en­ing and length­en­ing spe­cific mus­cles are of­ten ef­fec­tive. Us­ing a cane or a walker can help pre­vent falls. A phys­i­cal or oc­cu­pa­tional ther­a­pist can de­sign a pro­gramme spe­cific to your needs. Con­sider in­stalling grip bars and brighter lights, and re­move trip­ping haz­ards like elec­tri­cal cords and throw rugs. A change in gait or walk­ing dif­fi­cul­ties is not an in­evitable con­se­quence of ag­ing. Weak­ness, un­steadi­ness, slow­ness, pain, or stum­bling while walk­ing should be as­sessed by your doc­tor.

Newspapers in English

Newspapers from India

© PressReader. All rights reserved.