Gait in the elderly.

falls in the elderly are routinely cited in review articles. ,2 Interestingly, none of them are recent.1,2 My guess is that as the population ages, these numbers will worsen. In addition, abandonment of the "chemical straitjacket" routinely used for the demented twenty years ago which rendered poor walkers into non-walkers may have increased fall frequency. For example, data from 1988, still cited in recent articles, 1,2 state thar one third of people over age 65 fall each year, and for half of them this is an ongoing prob­ lem.J ,4 Ten percent of these falls results in significant morbidity (data from early 1990s).5 Presumably these numbers in­ crease with age. Falls are the fifth most com­ mon cause of death in the elderly. Only 25% of patients who suffer hip fractures regain their former level of function. And falls frequently induce a fear of falling, which itself contributes to the problem. Impairment in mobility affects 14% ofthose between 65 and 74 but halfofthose over 85.(' This impairment occurs for a number of reasons, including brain changes, both normal and pathological, as well as changes in muscles and the sensoty organs (eyes, vestibular apparatus, periph­ eral nerves). Normal aging produces physi­ cal changes that overlap with the signs of Parkinson's disease, except for tremor. The clinical importance of gait can­ not be overestimated. In a nursing home evaluation, every single patient seen by this author had a significant gait abnor­ mality. Ofcourse, in many cases, that was why they were not living at home. It is my hypothesis that gait abnormali­ ties are often not identified by doctors because it has not been pan of their training. In the outpatient setting, doctors, for efficiency, tend ro see patients in examining rooms, partially undressed, seated on the examining table. In the hospital, it is difficult to get patients out of bed or off their stretchers, and a lot more dif­ ficult ro get them back on them, especially in the emergency department where the stretch­ ers are quite high. The basic problem is the lack of a language for describing and classifying gait problems.