Why falls occur

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Gait and balance impairment

Gait is defined as manner or style of walking. Humans require two major abilities to walk: the ability to take an upright posture and maintain balance (equilibrium), and the ability to initiate and maintain rhythmic stepping (locomotion). In addition we need intact bones and joints, muscle strength and vision. Vision gives us information for the movement of the head and the body in relation to the surroundings as well as any obstacles on the surface.

The normal gait is characterised by a smooth cycle of having one foot on the ground while the other is lifted from the floor or just touching the ground. The image to the left shows the phases of a normal gait.

With age the gait of people changes. Some of these changes are 'normal'; others are abnormal and occur in medical conditions (e.g. Parkinson's disease). As a result of decreased muscle strength, and flexibility, as well as some loss of vision older people often walk slower and with shorter steps/strides. Some also tend to 'shuffle' because they do not use the heel and toes to touch and lift the foot from the floor. Many deviate (swerve) when walking on a straight line and feel unstable and sway, even when standing.

Gait impairment and imbalance are strong risk factors for falling. Some older people have trouble walking quickly (e.g. crossing the street), on uneven surfaces, in crowds, or in darkness. Others have trouble transferring from one surface/level to another e.g. getting out of a chair or into a bed.

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