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Community studies show that around 30% of people aged 65 and over fall each year. Only 10% to 15% of falls result in serious injury but 92% of hip fractures and 96% of wrist fractures in older women are caused by falling. There are important consequences even when no serious physical injury occurs. The anxiety caused by falling can result in loss of confidence and self imposed restrictions on activities, eventually resulting in admission to institutional care.
This book is based on an annual course held at the American Academy of Neurology on gait disorders in elderly people, and the contributors represent some of the participants, including neurologists, geriatricians, physiotherapists, and physiologists. Its stated aim is to be of use to those in clinical practice but also to those planning research.
The book is well structured. It commences with overviews on the physiology of static balance and gait, the effects of aging on them, and clinical research methodology. These are mostly excellent, apart from an overdetailed exposition of the neurophysiology of gait in cats, the relevance of which to two legged humans is difficult to grasp. All the authors are keen to stress the importance of detailed assessment, which is undoubtedly true but becomes rather repetitive.
There follow chapters on a suggested nosology of gait disorders and a clinical approach to diagnosis, both models of clarity and practicality. The detailed discussions of the common underlying diagnoses such as parkinsonism and cerebrovascular disease are generally useful with the exception of that on vestibular and cerebellar disorders. It is abundantly clear which authors deal regularly with older people and which do not, as the latter briefly mention elderly people as a “special group” leaving the reader to wonder whether the rest of the chapter has any relevance to them at all. The final six chapters discuss evaluation and intervention, including risk factor intervention, physical therapy and balance, and resistance training. The chapter on physical therapy is superb, concentrating on a sample case to illustrate how appropriate treatment is planned.
This book usefully brings together a wide and multidisciplinary literature on a complex and fascinating problem. The mistaken assumption that old age itself is a cause of poor balance and falls is still widely held and as a result many professionals display a depressingly defeatist attitude to their management. This book confirms that impaired gait and balance in an older person constitutes a syndrome with a rich differential diagnosis, and that even when a treatable cause cannot be found, much can be done to reduce disability.
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