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Balance and mobility in geriatric patients

Assessment and treatment of neurological aspects

Gleichgewicht und Mobilität bei geriatrischen Patienten

Beurteilung und Behandlung neurologischer Aspekte

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Zeitschrift für Gerontologie und Geriatrie Aims and scope Submit manuscript

Abstract

Background

Personal autonomy in advanced age critically depends on mobility in the environment. Geriatric patients are often not able to walk safely with sufficient velocity. In many cases, multiple factors contribute to the deficit. Diagnostic identification of single components enables a specific treatment.

Objective

This article describes the most common neurological causes of imbalance and impaired gait that are relevant for a pragmatic approach for the assessment of deficits in clinical and natural environments taking into account the physiology of balance and gait control, typical morbidities in older people and the potential of innovative assessment technologies.

Material and methods

Expert opinion based on a narrative review of the literature and with reference to selected research topics.

Results and discussion

Common neurological causes of impaired balance and mobility are sensory deficits (reduced vision, peripheral neuropathy, vestibulopathy), neurodegeneration in disorders with an impact on movement control and motoric functions (Parkinsonian syndromes, cerebellar ataxia, vascular encephalopathy) and functional (psychogenic) disorders, particularly a fear of falling. Clinical tests and scores in laboratory environments are complemented by the assessment in the natural environment. Wearable sensors, mobile smartphone-based assessment of symptoms and functions and adopted strategies for analysis are currently emerging. Use of these data enables a personalized treatment. Furthermore, sensor-based assessment ensures that effects are measured objectively.

Zusammenfassung

Hintergrund

Der Erhalt der Autonomie im Alter hängt wesentlich von den Möglichkeiten der selbstbestimmten Mobilität in der jeweiligen Lebensumgebung ab. Die Fähigkeit, mit ausreichender Geschwindigkeit und Sicherheit zu gehen, ist bei geriatrischen Patienten oft beeinträchtigt, und mehrere Faktoren tragen zu dieser Einschränkung bei. Die Komponentendiagnostik alltagsrelevanter Defizite erlaubt eine spezifische Behandlung.

Ziel der Arbeit

Auf Basis der Kenntnis der Physiologie der Gleichgewichtserhaltung und der typischen Morbidität älterer Menschen, sowie den aktuellen Innovationen im Bereich der diagnostischen Technologien wird ein pragmatisches Vorgehen bei der Erfassung von Mobilitätsdefiziten in Klinik und Alltagsumgebung vorgeschlagen.

Material und Methoden

Expertenmeinung mit Recherche und Einbeziehung von Literatur und Forschungsthemen.

Ergebnisse und Diskussion

Besonders häufige neurologische Komponenten der Störung von Mobilität und Gleichgewicht sind sensorische Defizite (Visusminderung, Polyneuropathie, Vestibulopathie), neurodegenerative Erkrankungen mit Auswirkungen auf Bewegungskontrolle und motorische Funktion (Parkinson-Syndrome, Kleinhirnataxie, vaskuläre Enzephalopathie) sowie die funktionellen (psychischen) Komponenten, insbesondere die Angst zu stürzen. Zur Erweiterung der Untersuchung in Klinik und Praxis ist das Erfassen von Einschränkungen in der Alltagsumgebung wichtig. Tragbare Sensoren und mobile, Smartphone-basierte Symptom- und Funktionserfassung, sowie digital unterstützte Auswertungsstrategien werden derzeit entwickelt. Die Therapie kann damit auf die alltagsrelevanten Einschränkungen zugeschnitten und objektiv bewertet werden.

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Author information

Authors and Affiliations

  1. Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Schoen Clinic Bad Aibling, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany

    Klaus Jahn

  2. Institute for Biomedicine of Ageing, Friedrich-Alexander-University, Erlangen, Germany

    Ellen Freiberger

  3. Machine Learning and Data Analytics Lab, Friedrich-Alexander-University, Erlangen, Germany

    Bjoern M. Eskofier

  4. Department of Geriatrics, RWTH Aachen University, Aachen, Germany

    Cornelius Bollheimer

  5. Molecular Neurology, University Hospital, Erlangen, Germany

    Jochen Klucken

  6. Digital Health Pathways, Fraunhofer-IIS, Erlangen, Germany

    Jochen Klucken

  7. Medical Valley Digital Health Application Center, Bamberg, Germany

    Jochen Klucken

Authors
  1. Klaus Jahn
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  2. Ellen Freiberger
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  3. Bjoern M. Eskofier
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  4. Cornelius Bollheimer
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  5. Jochen Klucken
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Corresponding author

Correspondence to Klaus Jahn.

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Conflict of interest

K. Jahn, E. Freiberger, B.M. Eskofier, C. Bollheimer and J. Klucken declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Jahn, K., Freiberger, E., Eskofier, B.M. et al. Balance and mobility in geriatric patients. Z Gerontol Geriat 52, 316–323 (2019). https://doi.org/10.1007/s00391-019-01561-z

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  • DOI: https://doi.org/10.1007/s00391-019-01561-z

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