# 004 Assessing Gait in Elderly Patients
Authors: Steve Denson, MD, Catherine Tsufis, Judi Rehm, Diane W. Braza, MD, Judith Kosasih, MD, Bambi Wessel
Objectives: List and describe phases of the basic gait assessment cycle.
ACGME Competencies: Patient Care, Practice Based learning and improving
Context: Geriatric Patient Clinic Visit
Action: Describe gait qualitatively and determine how that gait impacts function and safety.
Incidence/Prevalence: The incidence of gait abnormalities in older adults has been estimated at over 15% over age 64, to more than 35% in those over age 70 [Verghese J et al] and more than 40% above age 85. Gait abnormalities are commonly linked to falls and subsequent injury risks in elderly populations and gait should be assessed at each clinic visit.
1. Basic Gait Cycle: The gait cycle is composed of 2 phases, with7 components.
a. Stance phase: body weight is shifted to a single limb as the contralateral limb is in the swing phase and swings through. Subcomponents of this include initial contact, loading response, mid stance, and terminal stance.
b. Swing phase: the limb leaves the stance phase and enters the swing phase as the contralateral limb enters the stance phase. This is composed of the initial swing, mid swing, and terminal swing.
From: Williams, Mark. Geriatric Physical Diagnosis.
A Guide to Observation and Assessment.
McFarland & Co. Jefferson NC. 2008.
2. Clinical Assessment Tools:
Timed Get Up and Go Test (TGUAGT): One of the most commonly used tests of gait and balance. The TGUAGT begins by observing the patient rising from the chair to stand. The patient walks at their usual pace 3 meters, turns around, walks back to the chair and sits down. Time of <20 seconds = independent for transfers and mobility; while times of >30 seconds suggests increased risk for falls and dependence.
o Preliminary evaluation: To assess gait, begin with a general neurologic test looking at cranial (including visual fields and acuity), cerebellar (heel to shin, Rhomberg), and peripheral nervous systems, paying additional attention to foot sensation, proprioception (great toe position sense, 10g monofilament, vibratory), and function. Look for musculoskeletal abnormalities and deformities, particularly of the foot and lower extremities and the spine.
o Standing and balance: Observe how the patient rises (need to use arms to push off, or balance problems rising) and stands (with or without support). Ask the patient to stand with eyes closed, and to turn 360 degrees.
o Walking: Observe how the patient begins to walk (i.e. hesitancy or multiple attempts), the step height for both feet, foot clearance (looking for foot drop), step symmetry between right and left sides, and the speed of the gait. Look for signs of path deviation and need to use adaptive equipment to maintain a straight path. Look at the posture and trunk for evidence of swaying, flexion, arm swing, and stability. Assess tandem and heel walking gaits.
o Endurance: Observe the patient for signs of fatigue or for comorbid problems that compromise walking.
· Links to common tools in gait assessment:
Tinetti Gait and Balance Instrument http://geriatrics.uthscsa.edu/tools/TINETTI.pdf
Dynamic Gait Index http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=898
Gait Speed (preferred and maximal) Test Protocol http://web.missouri.edu/~proste/tool/Gait-Speed.doc
TGUAGT-Timed get Up and GO Test (rise form chair and walk/transfer), Diane Podsiadlo, BSc PT, Sandra Richardson, MD,
The Timed “up and go”: A Test of basic functional mobility for frail elderly persons. J Am Ger Soc, 39:142-148, 1991.
POMA (Performance-Oriented Mobility Assessment) http://www.hospitalmedicine.org/geriresource/toolbox/pdfs/poma.pdf
Verghese J, Holtzer R, Lipton R, Wang C. Quantitative gait markers and incident fall risk in older adults. J Gerontol A Biol Sci Med Sci. 64(8):896-901, 2009.
Williams, Mark. Geriatric Physical Diagnosis. A Guide to Observation and Assessment. McFarland & Co. Jefferson NC. 2008.
Author Affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin.
Geriatric Fast Facts are edited by the faculty of the Geriatric Education Teams (GETS) program funded by the Reynolds Foundation, Kathryn Denson, MD, Steven Denson, MD, & Edmund Duthie, MD from the Division of Geriatrics, Medical College of Wisconsin, and are published by the Geriatric Fast Facts Website at the Medical College of Wisconsin. For more information write Kathryn Denson, MD. More information, as well as the complete set of Fast Facts, available at www.mcw.edu/Geriatric-Fast-Facts.htm
Copyright/Referencing Information: Users are free to download and distribute Geriatric Fast Facts for educational purposes only. Citation: Steve Denson, MD, Catherine Tsufis, Judi Rehm, Diane W. Braza, MD, Bambi Wessel - Fast Fact #4: Assessing Gait in Elderly Patients. February 2012, Geriatric Fast Facts, available at www.mcw.edu/Geriatric-Fast-Facts.htm
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