Skip to main content
SpringerLink
Log in

Gangstörungen im Alter

Gait disorders in the elderly

  • CME Zertifizierte Fortbildung
  • Published:
Der Nervenarzt Aims and scope Submit manuscript

Zusammenfassung

Gangstörungen sind eines der häufigsten gerontoneurologischen Symptome überhaupt. Stürze mit mitunter gravierenden Verletzungen sind hochrelevante Folgeerscheinungen. Im Zentrum des diagnostischen Prozesses stehen die klinisch-neurologische Untersuchung und die inspektorische Ganganalyse, welche Hypothesen bezüglich der gestörten Strukturen und eine gezielte Zusatzdiagnostik ermöglichen. Das ergänzende motorische Assessment quantifiziert die resultierende Mobilitätseinschränkung und Sturzgefahr mithilfe etablierter Instrumente. Charakteristisch für die Gangstörung im Alter ist ihre multifaktorielle Genese. Die Herausforderung besteht in der möglichst vollständigen Identifikation, korrekten Priorisierung und adäquaten Behandlung aller beitragenden Teilursachen. Das Therapiekonzept ist multiprofessionell und beinhaltet neben der möglichst kausalen Behandlung zugrunde liegender Erkrankungen u. a. physiotherapeutische Trainingsprogramme, Hilfsmittelverordnungen und ernährungstherapeutische Interventionen. Übergeordnete Bedeutung kommt der Identifikation und Beseitigung von – auch iatrogenen – Risikofaktoren für Gangstörungen und Stürze zu.

Summary

Gait disorders are one of the most common gerontoneurological symptoms. Falls that occasionally cause severe injuries are highly relevant consequences. A clinical neurological examination and inspectoral gait analysis are the core investigations of the diagnostic process, which yields hypotheses with respect to the impaired structures as well as to specific diagnostic measures. The supplemental motor assessment quantifies the resulting impairment of mobility and risk of falling with the help of well-established instruments. Characteristic of gait disorders in the elderly are the multifactorial causes which make the complete identification, correct prioritization and adequate treatment the biggest challenges. The therapeutic concept is multiprofessional and includes the causal treatment of underlying diseases, physiotherapeutic training programs, prescription of medical aids and nutritional interventions. Identification and modification of risk factors (including those that are iatrogenic) are of superior importance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Verghese J, LeValley A, Hall CB et al (2006) Epidemiology of gait disorders in community-residing older adults. J Am Geriatr Soc 54:255–261

    Article  PubMed Central  PubMed  Google Scholar 

  2. Sudarsky L (2001) Gait disorders: prevalence, morbidity, and etiology. Adv Neurol 87:111–117

    CAS  PubMed  Google Scholar 

  3. Stolze H, Klebe S, Baecker C et al (2005) Prevalence of gait disorders in hospitalized neurological patients. Mov Disord 20:89–94

    Article  PubMed  Google Scholar 

  4. Ferrandez AM, Pailhous J, Durup M (1990) Slowness in elderly gait. Exp Aging Res 16:79–89

    Article  CAS  PubMed  Google Scholar 

  5. Nutt JG, Marsden CD, Thompson PD (1993) Human walking and higher-level gait disorders, particularly in the elderly. Neurology 43:268–279

    Article  CAS  PubMed  Google Scholar 

  6. Camicioli R, Wang Y, Powell C et al (2007) Gait and posture impairment, parkinsonism and cognitive decline in older people. J Neural Transm 114:1355–1361

    Article  CAS  PubMed  Google Scholar 

  7. Bloem BR, Gussekloo J, Lagaay AM et al (2000) Idiopathic senile gait disorders are signs of subclinical disease. J Am Geriatr Soc 48:1098–1101

    CAS  PubMed  Google Scholar 

  8. Cesari M, Kritchevsky SB, Penninx BW et al (2005) Prognostic value of usual gait speed in well-functioning older people – results from the health, aging and body composition study. J Am Geriatr Soc 53:1675–1680

    Article  PubMed  Google Scholar 

  9. Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156

    Article  CAS  PubMed  Google Scholar 

  10. Jankovic J, Nutt JG, Sudarsky L (2001) Classification, diagnosis, and etiology of gait disorders. Adv Neurol 87:119–133

    CAS  PubMed  Google Scholar 

  11. Podsiadlo D, Richardson S (1991) The timed „Up and Go“: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148

    CAS  PubMed  Google Scholar 

  12. Guralnik JM, Ferrucci L, Pieper CF et al (2000) Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 55:M221–M231

    Article  CAS  PubMed  Google Scholar 

  13. Alexander NB (1996) Gait disorders in older adults. J Am Geriatr Soc 44:434–451

    CAS  PubMed  Google Scholar 

  14. Bohannon RW, Williams Andrews A (2011) Normal walking speed: a descriptive meta-analysis. Physiotherapy 97:182–189

    Article  PubMed  Google Scholar 

  15. Guralnik JM, Ferrucci L, Simonsick EM et al (1995) Lower extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 332:556–561

    Article  CAS  PubMed  Google Scholar 

  16. Guralnik JM, Simonsick EM, Ferrucci L et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:M85–M94

    Article  CAS  PubMed  Google Scholar 

  17. Lundin-Olsson L, Nyberg L, Gustafson Y (1997) „Stops walking when talking“ as a predictor of falls in elderly people. Lancet 349:617

    Article  CAS  PubMed  Google Scholar 

  18. Yogev-Seligmann G, Hausdorff JM, Giladi N (2008) The role of executive function and attention in gait. Mov Disord 23:329–342

    Article  PubMed  Google Scholar 

  19. Stolze H, Kuhtz-Buschbeck JP, Drucke H et al (2001) Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson’s disease. J Neurol Neurosurg Psychiatry 70:289–297

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Iersel van MB, Hoefsloot W, Munneke M et al (2004) Systematic review of quantitative clinical gait analysis in patients with dementia. Z Gerontol Geriatr 37:27–32

    Article  PubMed  Google Scholar 

  21. Calandre L, Conde I, Bermejo Pareja F (2005) Gait and stability disorders of the elderly. Clinical analysis of a series of 259 patients older than 70 years. Neurologia 20:232–239

    CAS  PubMed  Google Scholar 

  22. Tideiksaar R (1997) Falling in old age: its prevention and management. Springer, New York

  23. Snijders AH, Warrenburg BP van de, Giladi N et al (2007) Neurological gait disorders in elderly people: clinical approach and classification. Lancet Neurol 6:63–74

    Article  PubMed  Google Scholar 

  24. Salzman B (2010) Gait and balance disorders in older adults. Am Fam Physician 82:61–68

    PubMed  Google Scholar 

  25. Sherrington C, Whitney JC, Lord SR et al (2008) Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 56:2234–2243

    Article  PubMed  Google Scholar 

  26. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB et al (2009) Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 339:b3692

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults (2014) Recommendations abstracted from the American Geriatrics Society consensus statement on vitamin D for prevention of falls and their consequences. J Am Geriatr Soc 62:147–152

    Google Scholar 

  28. Holt S, Schmiedl S, Thürmann PA (2010) Potentially inappropriate medication in the elderly – PRISCUS list. Dtsch Arztebl Int 107:543–551

    PubMed Central  PubMed  Google Scholar 

  29. The American Geriatrics Society 2012 Beers Criteria Update Expert Panel (2012) American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60:616–631

    Google Scholar 

  30. Velde N van der, Stricker BH, Pols HA, Cammen TJ van der (2007) Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study. Br J Clin Pharmacol 63:232–237

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. K. Amadori, R. Püllen und T. Steiner geben an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Neurologie, Klinikum Frankfurt Höchst, Gotenstr. 6–8, 65929, Frankfurt am Main, Deutschland

    K. Amadori & T. Steiner

  2. Medizinisch-Geriatrische Klinik, Agaplesion Frankfurter Diakonie Kliniken, Frankfurt am Main, Deutschland

    R. Püllen

Authors
  1. K. Amadori
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Püllen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Steiner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Amadori.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Amadori, K., Püllen, R. & Steiner, T. Gangstörungen im Alter. Nervenarzt 85, 761–772 (2014). https://doi.org/10.1007/s00115-014-4084-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00115-014-4084-9

Schlüsselwörter

Keywords

Search

Navigation