Balance and Gait Disorders in the Aged Population. Causes, Assessment and Management: A Literature Review

Abstract

With aging, compensatory mechanisms and physiological reserve may become insufficient to maintain balance and gait (BG), particularly when associated with stroke, Alzheimer's disease, diabetes, osteoarticular diease, vestibular disorders, orthostatic hypotension (OH), heart rhythm disorders, or drug side effects. This leads to poorer postural-motor function and increased risk of falling (RoF). This review aims to highlight recent scientific advancements relative to BG disorders (BGDs) for gerontology professionals. When assessing older adults (OAs) with BGDs, a thorough assessment of patient history is needed to identify the origins. This should include the history of falls, an inventory of medications, and an analysis of the home environment. A comprehensive clinical examination is also required to guide etiological diagnoses. A clinical suspicion of cardiac arrhythmia/conduction disorders, for example, will be confirmed by electrocardiogram (ECG)/Holter ECG, whereas suspected OH (on questioning) will be confirmed by an OH test, and, in the presence of confusion, epilepsy will be confirmed by the electroencephalogram. Several tools, ranging from simple and quick to more complex and thorough, have been validated to evaluate BGDs in OAs. These tests involve activities of daily living tasks required to preserve independence. Emerging technologies for RoF assessment (ie, surface electromyography, force platforms, three-dimensional motion capture systems) while not yet used in routine geriatric practice, can improve early detection, monitoring, and rehabilitation. Optimal BGD management requires the implication of several health professionals. Rehabilitation programs such as the "Otago exercise programme" and "falls management exercise" have been validated. Assistive technologies (canes, walkers, grab bars, and orthopedic footwear or automated alert systems), and new technologies (virtual reality) can also be used. Additional steps include medication review and deprescribing, occupational therapy and home environment adaptations. Understanding and managing BGDs in OAs remains a major public health issue, and is vital for preserving independence in later life.

Keywords: balance; central nervous system; gait; older adult; posture.

Figure 1

Sensory receptor involved in kinesthesia. From Berthoz A., *Le Sens du Mouvement* © Odile Jacob, 1997.