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"Most old(er) people are young people in old bodies."

—Bernard Isaacs


By the end of this chapter, readers will be able to:

  1. Discuss the effects of aging on posture, coordination, balance, and gait.

  2. Explain assessment considerations for the older adult and the specific procedures used for assessing posture, coordination, balance, and gait.

  3. Discuss the relationship between older adult function and balance, coordination, and gait.

  4. Identify interventions that may be used to prevent or lessen age-related neuromusculoskeletal changes in posture, coordination, balance, and gait in older adults.

Clinical Vignette

Mrs. Boupha Voeum is a 92-year-old widow who lives with her adult son (age 67), his wife (age 73), and 30-year-old grandson. Mrs. Voeum has her own living space on the main floor of the house, which includes a bedroom, four-piece bath, kitchen, and small den. Mrs. Voeum has osteoporosis, macular degeneration, and diabetes. She uses a cane in her right hand to walk because she has a severe thoracic kyphosis and hip flexion contractures. Mrs. Voeum is originally from Cambodia and continues to volunteer at her local church and the local immigrant community center. Both are located within 2 miles of the home, and Mrs. Voeum either walks or takes the bus to the church and volunteer center. Lately Mrs. Voeum has noticed that she is becoming increasingly unsteady on her feet and her walking is slower, such that she is rarely able to make it through the crosswalk without the crossing sign changing from "Walk" to "Don't Walk." Mrs. Voeum does not want to give up her volunteer activities, nor does she want her son to drive her to the church or community center.

  1. What changes has Mrs. Voeum experienced that would be considered "normal" age-related changes? What changes would be considered "abnormal"?

  2. What additional information would be important for you to gather from Mrs. Voeum?

  3. On the basis of the information provided about Mrs. Voeum, what issues might be the focus of your intervention(s)?

As described in Chapter 10, the variety of tissues that make up the neuromusculoskeletal system undergo normal age-related changes. These changes affect posture, coordination, balance, and gait in older adulthood. This chapter reviews:

  • The effects of aging on posture, balance, and gait and the resultant impact on the older adult's function.

  • The tests and procedures used for assessing posture, coordination, balance, and gait.

  • Interventions and specific exercise programs that may be used to prevent or lessen age-related changes in posture, coordination, balance and gait.

Age-Related Changes in Postural Alignment

Posture is the biomechanical alignment of body parts in relation to one another and the orientation of the body as a whole to the environment. Posture is typically viewed as a static process, but gravity and neural control mechanisms constantly effect subtle shifts in weight and body alignment ...

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