Geriatric Issues

The gait changes with advancing age. A typical constellation includes gait slowing, shortening of the stride, and widening of the base. This results in the appearance of a guarded gait, that is, the gait of someone about to slip and fall. Many patients are aware of the loss of speed and adaptive balance and acknowledge the need to be careful. The nature of this senile gait is not fully understood but may represent a mild degree of neuronal loss, failing proprioception, slowing of corrective responses, or weakness of the lower extremities. Senile gait disorder is thought to exist in up to one-quarter of the elderly population. Some authorities divide this disorder into components of gait ataxia with mild truncal instability and widened gait, and gait slowing with diminished spontaneous arm swing and bradykinesia. 7 However elements of the senile gait are also found in neurodegenerative diseases, and caution is urged to consider the possible presence of a neurodegenerative disorder such as Parkinson's disease in elderly patients with gait impairment. 7

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