As we age, blood vessels become stiffer and less efficient, which may affect blood supply to tissues, including the brain and muscles, says Dr Mathew Abraham, senior consultant neurologist at Aster Medcity, Kochi, in an interview with Anna Jose. Edited excerpts:
Why do elderly people walk slowly?
As we grow older, there is generally a physiological slowing in all activities, though not necessarily in all cases. Communication between nerve cells becomes less efficient with age, resulting in slower processing of sensory information and motor responses. Other factors such as orthostatic hypotension, a sudden drop in blood pressure when you stand up after sitting, reduced efficiency of various organs, habits like drinking alcohol, side effects of higher doses of medicines, etc. also affect gait. Also, as we age, blood vessels become stiffer and less efficient, which may affect blood supply to tissues, including the brain and muscles. In some cases, a previous fall may lead to fear of falling and loss of balance, causing slower movement and reduced physical performance. In critical cases, these difficulties will be obvious.
Do issues with sensory organs affect the condition?
Yes. The body constantly sends sensory information from the feet, joints, eyes and inner ear to the brain, and the brain makes automatic adjustments according to the information. In some patients, nerve function becomes less efficient and the body’s adjustments may be delayed, creating a feeling of imbalance. Movement is regulated through sensory inputs from the feet, joints, eyes and inner ear. Even if a person is completely normal, these issues will be present as we age, so there will be slowness in walking. The vestibular system in the inner ear, which helps maintain balance and spatial orientation, becomes less efficient with age, leading to a feeling of imbalance.
How can the presence of other conditions cause slow movement?
Several medical conditions can affect walking speed and gait. When there are neurological conditions, peripheral neuropathy, hypertension, diabetes, and deficiencies affecting the nerves and the neurological conditions, Parkinson’s, and minor strokes, can affect automatic movements and reduce overall efficiency. Parkinson’s, in particular, causes a loss of dopamine-producing nerve cells in the brain and patients may experience starting trouble leading to slowness of movement, stiffness, tremor, and difficulty initiating movement. Dementia can affect the brain’s ability to coordinate and plan movements, resulting in slower and less stable walking.
How are the conditions and the causes identified? How can slow walking be managed?
Some patients present with a combination of symptoms or conditions and experience difficulty in walking. So we need to identify the cause first. We check the way they walk, the history, other issues, diseases, and medicines. Scan and other tests are done to start the treatment — it can be physiotherapy, assistance, psychological support, etc. Strength exercise and drug adjustments can also help compensate to a great extent.