Postural and Gait Changes in Older Adults

What are the 4 functions of normal gait ?

• Shock Absorption

• Stance Stability

• Propulsion 

• Energy Conservation 

Name at least 3 typical gait changes in older adults

• decreased self-selected gait speed

• decreased step and stride length 

• increased stance time and double limb support 

• increased variability of gait 

• decreased excursion of movement LE 

• decreased reliance on ankle kinetics and power 

• less upright posture 

T/F: Falls occur predominantly during short distance movements and transitional tasks

True

T/F: Balance strategies in older adults are distal → proximal 

False - balance strategies are proximal → distal 

ex: Hip strategy used first before ankle strategy 

Name 3 fall risk factors

• Polypharmacy 

• Cognitive decline 

• hx of falls 

• Visual impairments 

• Environmental risks

• Decreased Activity 

• Postural Sway 

• LE and lumbopelvic weakness 

What 3 systems contribute to postural control age changes ?

• Somatosensory

  • decrease in light touch, proprioception, vibration

    • neuropathy, MS, spinal stenosis  

• CNS 

  • decrease in coordination 

    • PD, CVA, cerebellar ataxia 

• Neuromuscular 

  • Decrease in muscle timing, strength, ROM 

    • DM, OA, scoliosis

Name 3 other intrinsic fall risk factors 

• Vision (<20/60 acuity) 

• Hearing 

• Cognition 

T/F: If pt has >2 risk factors → 78% had falls

• False - if >4 risk factors → 78% had falls

What are 2 main causes of falls in LTC facilities ?

• Weight shifting erros (41%)

• Trip (21%)

Give 2 examples of extrinsic fall risk factors in the community 

• uneven pavement 

• cracks 

• tree roots 

• obstacles in walkways 

• rain, snow, ice 

• stairs, steps, curbs 

Name 3 medication side effects that are associated with falls

• blurred/ impaired vision

• hypotension

• sedation

• confusion, impaired judgement

• delirium

• impaired neuromuscular function

• anxiety

• dizziness

What are 4 Fall Screen questions

• >/= 2 falls in last 6 months? 12 months ?

• recent falls ?

• gait/ balance problems ?

• Fear of Falling ? (ABC Scale)

If “yes” to any question then assess:

• possible OH

• visual acuity

• assess gait, balance, strength

• appropriate AD? Home assessment ?

• medication review

• cognition