Falls and Gait Disorders

Intrinsic Causes

•    Sarcopenia

o    Age-related decline in muscle mass and strength

o    Leads to impaired balance, slow reflexes

•    Visual impairment

o    Cataract: reduced acuity, glare sensitivity

o    Macular degeneration: central vision loss → difficulties with depth perception

o    Glaucoma: peripheral visual field loss

•    Peripheral neuropathy

o    Common in diabetes, B12 deficiency, alcohol use

o    Reduced proprioception → unsteady gait

•    Parkinson’s disease

o    Festinant gait (short, shuffling steps), reduced arm swing

o    Freezing episodes at turns or narrow spaces

o    Postural instability

•    Cerebellar ataxia

o    Wide-based, unsteady gait

o    Associated with dysarthria, intention tremor, nystagmus

Extrinsic Causes

•    Medications

o    Sedatives (e.g., benzodiazepines, z-drugs)

o    Antihypertensives (e.g., alpha-blockers, diuretics → orthostatic hypotension)

o    Polypharmacy increases cumulative risk

•    Environmental hazards

o    Poor lighting, loose rugs, clutter

o    Uneven flooring, lack of handrails

Assessment Tools

•    "Get Up and Go" test

o    Stand from chair, walk 3 metres, turn, return, and sit

o    12 seconds suggests increased risk of falls

•    Postural (orthostatic) blood pressure

o    Significant if ≥20 mmHg systolic or ≥10 mmHg diastolic drop within 3 minutes of standing

o    Symptoms: dizziness, lightheadedness

•    Gait speed

o    <0.8 m/s (measured over ~4 m) → marker of frailty and predictor of morbidity

•    Other objective tests

o    Balance tests (e.g., tandem stance, single-leg stand)

o    Romberg test (sensory ataxia)

Other Checks

•    Footwear

o    Loose or poorly fitting shoes → trip hazard

o    Check for non-slip soles

•    Foot deformities

o    Bunions, hammertoes, ulcerations

•    Cognitive screen

o    Delirium, dementia → impaired judgement, misinterpretation of environment

Clinical Implications and Management

•    Multifactorial intervention most effective

o    Strength and balance training (e.g., physiotherapy programmes)

o    Medication review and deprescribing

o    Home hazard assessment and modifications

o    Vision correction

•    Vitamin D supplementation

o    Consider if deficient; some evidence suggests reduced falls risk

•    Assistive devices

o    Walking aids, grab rails

•    Emergency planning

o    Alarm systems, fall detectors for high-risk individuals

Extra Revision Pearls

•    Fear of falling → can lead to activity restriction → further deconditioning → "frailty spiral"

•    Hip protectors: controversial but may reduce fracture risk in institutionalised older adults

•    Recurrent falls: defined as ≥2 falls in 12 months → triggers comprehensive geriatric assessment