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Problems with walking increase with age and are commonly associated with falls and disability in older adults. At least 20% of older adults living in the community have problems with walking. This increases to approximately 50% in adults 85 years old and older. Most of these problems are associated with underlying diseases, especially severe diseases. Common risk factors for severe problems with walking include advanced age (older than 85), multiple chronic disease conditions (eg, arthritis, dementia, etc), and diseases such as stroke, hip fracture, or cancer.
Causes of Walking Problems Problems with walking are not an inevitable consequence of older age. Rather, they usually reflect the overall effects of other conditions that become more common and severe with age. Often, more than one disease or condition contributed to walking problems. Common symptoms and conditions that contribute to walking disorders include the following:
Factors that contribute to slow walking speed (eg, poor fitness, heart disease, etc) also contribute to walking problems. Improvements in these underlying conditions can often greatly improve walking and mobility. Evaluation of Walking Problems Your health care provider will need a careful medical history to understand health factors that may be contributing to problems with walking and mobility. He or she will ask about pain, dizziness, or other symptoms directly related to mobility. He or she will also ask about indirect factors such as past medical problems, symptoms related to heart disease, thyroid problems, episodes of acute illness, poor vision, or other conditions that can affect stability, coordination, strength, or posture. As in any health condition, it is important to tell your health care provider about all the medications you are taking in case of potential side effects or drug interactions that might cause dizziness, weakness, or lack of coordination. A complete physical examination may uncover problems with blood pressure, vision, limbs, joints, neck, or spine. The examination may include specific tests of balance, coordination, strength, tone, sensation, body position, and gait. Depending on your history and physical examination, your health care provider may recommend additional laboratory and diagnostic tests. Blood work can help eliminate certain disease conditions (eg, anemia, problems with blood chemistry, etc) from the diagnosis. X-rays may be needed to diagnose joint or bone problems. Sophisticated imaging studies (eg, CAT scan or MRI) may be warranted if brain disease is suspected. Your health care provider may also perform specific tests to evaluate walking speed, motion, balance, and similar problems that increase the risk of falls (see also Health Assessment). A simple test that can be done during an office visit is the "Timed Get Up and Go" test. This test measures how long you take to get up from a chair, walk about 10 feet, turn around, and return to the chair. A more complex approach that can be very useful for evaluating mild disabilities is the Functional Ambulation Classification scale. This tests how well you can use assistive devices (eg, canes or walkers), the amount of assistance you need from other people, the distance you are able to walk, and the types of surfaces (eg, rugs, slippery floors, etc) that you are able to walk on. Treatment of Walking Problems Many conditions that cause walking problems are only partially treatable, ie, usually, you won’t be able to walk as well as you did before. The goal of treatment is usually an improvement in function. Of course, this all depends on the number, type, and severity of the conditions that are contributing to your walking problems. Medical therapy can greatly improve some walking problems, such as those related to vitamin B12 or folic acid deficiency, thyroid problems, knee arthritis, Parkinson’s disease, or nerve inflammation. Physical therapy for knee arthritis or stroke can result in modest improvements. Certain exercise programs can increase walking speed in older adults with knee arthritis, Parkinson’s disease, or stroke. Generally, the most consistent effects are from programs that combine a variety of different exercises such as leg resistance training, balance, and flexibility exercises. Surgery can also result in modest improvement for people who have spinal disc problems or arthritis of the knee or hip. Many older adults with compressed discs in the lower back have less pain and can walk longer distances after surgery, although usually some level of disability remains. Older adults with arthritis can also experience substantial improvements in pain relief, walking speed, and joint motion after joint replacement surgery. The use of orthoses such as "lifts" (to correct for different leg lengths), ankle braces, and various shoe inserts or modifications can help reduce walking problems. In general, well-fitting walking shoes with low heels and relatively thin, firm soles help maximize balance and improve walking. Other mobility aids such as canes and walkers can take the load off painful joints and increase balance and stability. Even lightly touching firm surfaces like walls, or "furniture surfing," while walking can help with balance. (See also Rehabilitation and Disorders of the Foot.) |
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Published: 3/15/2005