It could be a red flag that you’ll end up in a nursing home. Here’s what to do…

Have you surprised yourself recently with a stumble or a fall? If you blamed it on your shoes…your eyesight…or an obstacle, such as a throw rug, you may not be getting at the root cause of why you stumbled or fell. The fact is, the real reason many people fall (and sometimes die from it) is the way that they walk.

A problem that goes undetected: Most people who have treatable abnormalities in their gait (the way in which a person walks) never even discuss it with their doctors.

Here’s why: When you go to the doctor, odds are that you are taken to an exam room and asked to “have a seat” until the doctor arrives. The problem is, you’ll probably stay seated during the entire visit, and your doctor may miss a symptom—a dangerous gait—that’s just as important as abnormal X-rays or blood tests.

TAKE IT SERIOUSLY

It’s never normal to shuffle, be off-balance or have an unusual posture. A gait disorder always means that something—or, in most cases, a combination of factors—is awry.

Problems with gait affect about 15% of adults age 60 and older and more than 80% of those age 85 and older. Gait disorders, which interfere with stability and balance, are not only among the most common causes of falls and subsequent hospitalizations but also can be one of the first health problems that eventually leads to nursing-home care.

My advice: Doctors should ask every patient if he/she has fallen in the last year. In addition, if you’re age 65 or older, you should ask your doctor to check your gait at least once a year.

WHAT’S BEHIND IT?

Patients often assume that problems with one’s gait are due to neurological disorders, such as Parkinson’s disease or multiple sclerosis (MS). With Parkinson’s disease, patients also experience a resting tremor or shaking of one hand, muscle rigidity and slow movements, while MS typically is accompanied by vision problems, dizziness and trouble speaking. But there are other possible causes of gait problems…

  • Arthritis. Gait problems are common in patients with arthritis, particularly osteoarthritis of the knee or hip. If you have knee or hip pain, you may favor that side and use other muscles to compensate. This throws off your posture and body mechanics, which may cause you to limp or take tentative steps.Helpful: Ask your doctor if it’s appropriate to see a physical therapist for advice on exercises to strengthen the muscles around the arthritic joint—this will help you walk normally and with less pain.

    Pain control is also very important. Apart from making you more comfortable, it will help you do the exercises that you need for a better gait. If you don’t get adequate relief from over-the-counter pain relievers, talk to your doctor about stronger forms of pain control. Stretching, massage, heating pads, cold packs and/or acupuncture are helpful to some people.

  • Back problems. A gait problem often is due to a painful back. Patients with lumbar stenosis, for example, will frequently experience nerve pressure from damaged vertebrae in the spine, affecting their ability to walk. Patients with sciatica (nerve pain that often accompanies lower-back problems) will have difficulty walking or standing. Suspect nerve problems if you have back or leg pain that gets worse when you walk or stand for more than a few minutes and gets better when you’re off your feet. See your doctor for treatment advice.
  • Balance disorders. If you sometimes feel as though you’re about to fall (even when you’re not), see a doctor right away. Problems with balance—often accompanied by dizziness, spinning sensations, etc.—are a major cause of falls. Potential causes include ear infections, inner-ear disorders, neuropathy (nerve damage) and circulatory problems.Also: Ask your doctor to test your vitamin B-12 level. Older adults often have low levels of intrinsic factor, a protein that’s needed for B-12 absorption. It’s also common for vegetarians to be deficient in this vitamin because meat is a major source of B-12. Low B-12 can make you feel light-headed, cause numbness and/or tingling in the feet and make it difficult to walk.

    Similar foot and leg symptoms are caused by diabetic neuropathy, nerve damage that may occur in patients with poorly managed (or undiagnosed) diabetes. Bunions and other foot conditions also can contribute to gait disorders.

  • Drug side effects. It’s not surprising that sedating medications such as diazepam (Valium) can increase fall risk. What many people don’t realize is that nonsedating medications also can be an issue.Example: Medications that lower blood pressure, such as diuretics, can cause orthostatic hypotension, a sudden drop in blood pressure that can make you dizzy or light-headed. Some blood pressure drugs also decrease magnesium, which can cause leg weakness or cramps. Your doctor might advise changing medications. Alcohol or drugs that lower blood sugar or affect mood or sleep also can change one’s gait.

    Important: Be especially careful after eating. Studies have shown that dizziness and gait problems tend to get worse about 30 minutes after meals—blood travels to the digestive tract after meals, sometimes lowering blood pressure.

  • Reduced brain circulation. Gait disorders are often the first sign of infarcts, areas of brain damage caused by impaired circulation. Infarcts occur in patients who have had a stroke or other problems that affect blood vessels in the brain, such as hypertension or high cholesterol.A patient who has multiple infarcts might walk very slowly…take short steps…stand with his feet wider apart than usual…and/or hesitate when starting to walk or have trouble slowing momentum when stopping.

HOW’S YOUR GAIT?

If you’ve noticed changes in the ways in which you move, see your doctor for an evaluation. He/she will give you tests that may include…

The timed get-up-and-go test. This measures the time it takes you to get up from a chair (without using your hands to push off from the armrests), walk 10 feet, turn around and walk back to the chair. You should be able to complete the sequence safely in 14 seconds or less. If it takes longer than 20 seconds, your gait is seriously impaired.