Difficulty walking in older adults

What causes difficulty walking in older adults?

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Difficulty in walking is a common problem in older adults and it contributes to loss of functional mobility and independence which often lead to higher rates of morbidity. As the person ages, changes occur in walking ability, speed and pattern which are likely the result of multiple factors such as changes in different body systems.

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The loss of motor skills and decreased energy expenditure is a major factor in the age-related decline in physical function and activity for older adults. When an individual experiences difficulty in walking, typically the biomechanics of lower extremities are altered and the movement control is disrupted leading to an abnormal walking pattern.

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Common types of walking abnormalities in older adults 

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Walking abnormalities, also known as gait abnormalities, can manifest in various ways among older adults due to a combination of age-related changes and underlying health conditions. Some common types of walking abnormalities in older adults include:

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• Shuffling Gait: Characterized by short steps, minimal lifting of the feet, and a forward-leaning posture. This gait is often seen in individuals with Parkinson's disease.
• Ataxic Gait: This gait appears uncoordinated and wobbly, with a wider base of support. It can be caused by neurological conditions such as multiple sclerosis or cerebellar dysfunction.
• Antalgic Gait: Individuals with pain, often due to conditions like osteoarthritis or fractures, may adopt an antalgic gait to minimize weight-bearing on the affected limb, leading to shorter steps on one side.
• Trendelenburg Gait: Seen when the hip abductor muscles (muscles that move the lower extremity out to the side) are weak, causing the pelvis to drop on the unsupported side during walking. 
• Scissor Gait: Characterized by legs crossing over each other while walking, resembling a scissor-like movement. This can occur in conditions like cerebral palsy or other neuromuscular disorders.
• Cautious Gait: Often seen in individuals with a fear of falling, this gait involves slow and deliberate steps with a wider base of support to maintain balance.
• Propulsive Gait: Individuals with Parkinson's disease or certain medications may exhibit a forward-leaning posture, with the head and neck extended, and take small, shuffling steps.
• Steppage Gait: Seen in cases of foot drop, where the foot doesn't lift properly due to weakness or nerve damage, leading to lifting the leg higher than normal to clear the toes while walking.
• Waddling Gait: This gait is characterized by a side-to-side swaying motion of the hips while walking and is often associated with muscular dystrophy or hip conditions.
• Hemiplegic Gait: Individuals who have experienced a stroke or have hemiplegia (paralysis on one side of the body) may have a gait with a circumduction pattern, where the affected leg swings out to the side to avoid dragging the toes.
• Parkinsonian Gait: In addition to shuffling steps, individuals with Parkinson's disease may also have reduced arm swing, stooped posture, and difficulty initiating movements.
• Spastic Gait: Often seen in conditions affecting the upper motor neurons, this gait is characterized by stiff, jerky movements with increased muscle tone and decreased coordination.
• Wide-Based Gait: Some neurological conditions can lead to instability, causing individuals to adopt a wider stance while walking to enhance balance.

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It's important to recognize that walking abnormalities can have a range of underlying causes, including neurological, musculoskeletal, cardiovascular, and systemic conditions. Addressing the specific cause of the abnormal gait is essential for implementing appropriate interventions and treatments to improve mobility and overall quality of life. Consulting a healthcare professional or a specialist can help diagnose the underlying condition and develop a tailored treatment plan.

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Risk factors for difficulty walking

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Several risk factors can contribute to difficulty walking in older adults. These factors can be related to both individual characteristics and lifestyle/environmental factors. Some common risk factors include:

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• Age: As people age, the natural physiological changes in muscles, bones, and joints can lead to reduced strength, flexibility, and balance, making walking more challenging.
• Chronic Health Conditions: Conditions such as osteoarthritis, rheumatoid arthritis, Parkinson's disease, stroke, multiple sclerosis, and other neurological disorders can significantly impact mobility and walking ability.
• Muscle Weakness: Sarcopenia, the age-related loss of muscle mass and strength, can result in reduced power for walking and maintaining balance.
• Balance and Coordination Issues: Inner ear problems, visual impairments, and decreased proprioception can contribute to balance difficulties and increase the risk of falls.
• Previous Falls: A history of falls can lead to fear of falling again, causing older adults to modify their walking patterns and movements, leading to reduced mobility.
• Medications: Certain medications can cause dizziness, drowsiness, or other side effects that affect balance and coordination.
• Cognitive Impairment: Memory problems, confusion, and cognitive decline can lead to difficulties planning and executing movements, impacting walking.
• Foot Problems: Issues like bunions, corns, calluses, and foot deformities can cause pain and alter the mechanics of walking.
• Cardiovascular Health: Heart conditions, peripheral artery disease, and poor circulation can result in reduced endurance and difficulty walking longer distances.
• Respiratory Conditions: Lung diseases like chronic obstructive pulmonary disease (COPD) can limit oxygen intake, leading to fatigue and breathlessness during walking.
• Obesity: Excess body weight can strain joints and make walking more difficult, especially for individuals with joint problems.
• Deconditioning: Sedentary lifestyles can lead to muscle atrophy, decreased cardiovascular fitness, and reduced overall physical capacity for walking.
• Nutrition: Poor diet and inadequate nutrient intake can contribute to muscle weakness and overall reduced energy levels.
• Hydration: Dehydration can lead to fatigue, dizziness, and weakness, affecting walking abilities.
• Vision Changes: Age-related vision changes can affect spatial awareness and increase the risk of tripping or stumbling.
• Environmental Hazards: Poorly designed living spaces, uneven surfaces, clutter, and inadequate lighting can increase the risk of falls and difficulties while walking.
• Social Isolation: Lack of social engagement and physical activity can lead to physical deconditioning and reduced motivation to stay mobile.
• Psychological Factors: Anxiety, depression, and low self-confidence can influence a person's willingness to engage in physical activities like walking.
• Lack of Assistive Devices: Not using canes, walkers, or other assistive devices when needed can lead to instability and difficulties while walking.
• Lack of Physical Activity: A lack of regular exercise and physical activity can contribute to muscle weakness, decreased balance, and reduced walking capacity.

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Addressing these risk factors through regular exercise, proper medical care, a healthy diet, fall prevention strategies, and creating a safe living environment can help older adults maintain and improve their walking abilities and overall mobility.

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How can physical therapy help? 

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Physical therapy can play a crucial role in helping older adults improve their difficulty with walking. A skilled physical therapist can assess an individual's specific needs and develop a personalized treatment plan to address the underlying issues causing the difficulty while enhancing overall mobility and quality of life. Here's how physical therapy can help:

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• Assessment: A physical therapist will perform a thorough assessment of the individual's gait, balance, strength, flexibility, and overall functional abilities. Special tests may also be conducted to help the therapists to rule in and rule out other possible health conditions. These assessments help identify the specific factors contributing to the difficulty in walking.
• Strengthening Exercises: Physical therapists will prescribe strengthening exercises as tolerated by the patient to improve muscle strength, endurance and performance of the lower extremity muscles which are necessary to obtain a normal walking pattern. 
• Balance and Coordination Exercises: Loss of balance and coordination during walking can lead to falls. Physical therapists usually prescribe balance and coordination exercises for elderly patients to help improve static and dynamic balance control as well as to develop coordinated movements which are essential in performing daily activities which require standing and walking, reducing the risk of falls and injury. 
• Flexibility and Range of Motion Exercises: In the first phase of rehabilitation, range of motion exercises such as active range of motion with or without assistance are prescribed to prevent muscle stiffness and maintain the available range of motion. As the patient improves, manual and self-stretching exercises are utilized to increase muscle flexibility and range of motion of the lower extremities. 
• Gait Training: Physical therapists can prescribe and teach  appropriate gait patterns,  helping individuals walk more efficiently and with reduced strain. Emphasizing proper postural alignment, step length and timing to reestablish normal/functional gait patterns. 
• Functional Training: A final component of an individualized rehabilitation program involves practicing activities that simulate the physical demands of a patient’s desired recreational or daily activity. Simulated activities and drills enable a patient to practice under supervised conditions to receive feedback on correct mechanics. 
• Pain Management: For individuals with pain-related difficulties, physical therapists can employ modalities such as; heat/cold therapy, ultrasound, and electrical stimulation to reduce pain and improve comfort during walking.
• Use of Assistive Devices: Physical therapists can recommend and teach how to properly use assistive devices such as canes, walkers, or orthotics to provide support and enhance stability while maintaining functional mobility.
• Education and Home Exercises: Physical therapists educate patients about difficulty in walking, its causes and effects, as well as the role and importance of rehabilitation programs. They also teach the patients about proper body mechanics, and fall prevention strategies which are an important part of the program. The therapists also provide a specialized home exercise program and teach patients how to incorporate it into their daily routine to reinforce the intervention and for optimal recovery.
• Monitoring and Adjustments: Physical therapists continually assess progress and adjust the treatment plan as needed, ensuring that the interventions are effective and aligned with the individual's goals.
• Motivation and Support: Physical therapists provide encouragement and support, helping older adults stay motivated to engage in their treatment plan and work towards improved walking abilities.
• Functional Independence: The ultimate goal of physical therapy is to enhance an individual's functional independence. This means enabling them to walk more comfortably and confidently, promoting a better quality of life.

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Physical therapy is a valuable resource for older adults experiencing difficulty with walking. It can help them regain lost mobility, prevent further decline, and increase their overall physical well-being. If you or someone you know is struggling with walking difficulties, consulting a physical therapist for an assessment and personalized treatment plan is recommended.

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