The fear of falling
One in four people over the age of 70 suffers from gait disturbance. To prevent falls, specific treatment should be given. In the current issue of Deutsches Ärzteblatt International, Klaus Jahn and colleagues describe methods of differential diagnosis and therapy (Dtsch Arztebl Int 107: 306-16). Gait disturbance is defined as unsteadiness during walking that is worse than the normal slowing of old age. It often has multiple causes; in elderly patients, fear is often a precipitating or aggravating factor. A vicious circle often arises in which fear of falling leads to avoidance of movement, and in turn to reduced fitness, lower confidence in one's own balance, increased fear, and increased danger of a fall. Depression and a markedly impaired quality of life can result.
In order for the treatment to be as effective as possible, the type of gait disturbance and its causes must be precisely analyzed. In their article, Jahn et al. present effective diagnostic methods. For example, the observation of parameters such as step length, speed, body posture, and variability while the patient walks a given distance, once with eyes open and once with eyes closed, enables classification of the type of gait disturbance.