Assessment of the Geriatric Patient: Gait and Balance

Mark E. Williams, MD; Angela Gentili, MD


November 16, 2009

In This Article


Balance and gait assessment is difficult to teach, especially when using only text. There is more reality to an image than a word -- and this is one area where video images are worth thousands of words. Sequential logic works, but seems cumbersome. Pattern identification is difficult to communicate because of the nuances and subtleties of the observations. In addition, multiple neurologic and musculoskeletal conditions can occur in the elderly patient, often producing a more complex clinical picture. This Clinical Update will provide a systematic approach to the assessment of gait and balance, highlight abnormalities commonly seen among elderly patients, and provide video clips demonstrating some of these abnormalities.

Key Components of the Evaluation

In overview, there are 3 parts to the assessment of balance and gait in the elderly patient. First, the lower-extremity examination is focused on mechanical issues. Then, the complete (toe-to-head) neurologic examination looks for muscle weakness, impaired proprioception, cerebellar signs, basal ganglion dysfunction, and frontal lobe disease. Finally, the functional evaluation assesses the person's fall risk. Elements of the functional examination include the Tinetti variation of the "up and go" test with sitting, standing, walking, and turning; the functional reach test, and toe tapping.[1,2]