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Gait Disorders in Older Adults
Author(s) -
Alexander Neil B.
Publication year - 1996
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1996.tb06417.x
Subject(s) - veterans affairs , geriatrics , medicine , geriatric rehabilitation , gerontology , citation , center (category theory) , library science , rehabilitation , family medicine , psychiatry , physical therapy , chemistry , computer science , crystallography
Both aging and diseases that are more prevalent with aging affect how older adults walk. 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. GAIT AND DISABILITY From 8 to 19% of noninstitutionalized older adults have difficulty walking or require the assistance of another person or special equipment to walk. J,2 Walking disability increases with age. For example, 6% of female East Boston respon dents aged 65 to 69, compared with 38% of those aged 85 and older, need assistance in walking.:' Limitations in walk ing can be seen in as many as 63% of nursing home resi dents." In older adults with diseases such as arthritis, 35% admit to difficulty in walking one-quarter mile:' Measures such as gait speed provide an index of func tional status. Even in those who report no difficulty in walk ing one-half mile, a timed 8-foot walk, in addition to other lower-extremity function tests, ultimately predicts mobility related and ADL disability at 4-year follow-up." Self-selected gait speed predicts self-perceived physical function, as mea sured by the Sickness Impact Profile (SIP), better than other physical measures such as balance and grip strength, partic ularly among frail nursing home residents." Prolonged 50 foot walk time relates to increased arthritis activity, although improvements in symptoms and signs predict walk time im provement inconsistently.v" Walking speed is particularly important for crossing traffic intersections safely. In a 1994 study, 27% of 592 older adult pedestrians were unable to reach the opposite curb before the light changes to allow cross traffic to enter the intersection.!" Finally, faster gait speed on admission predicts success in rehabilitation, 11 and slow gait speed on discharge predicts institutionalization. 12 Fifty-four percent of those requiring skilled care compared with none of those discharged home or to nonskilled levels of care have discharge walking speeds below 0.15 m/sec.'? Gait speed assessment is particularly useful in patients with cardiopulmonary disease.Pv'" Self-paced 6-minute walking distance discriminates between NYHA levels of con gestive heart failure l5-17 and predicts hospitalization rates