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Background: Higher-level gait disorders (HLGDs) are slow, unsteady neurological GDs in older people. GDs can reduce quality of life (QoL) and cause depression. This has not been investigated in HLGD even though some HLGD causes are treatable, potentially affecting associated problems. We aimed to investigate gait and balance confidence, depressive symptoms and QoL in HLGD.

Methods: In a population (n=3769, 65-84y), 798 reported gait impairment (questionnaire) and were clinically examined together with 249 age- and sex-matched controls. Gait property groups were formed: 'HLGD', 'other neurological GD', 'non-neurological GD' or 'no GD'. Swedish Falls Efficacy Scale (FES(S)), Modified Gait Efficacy Scale (mGES), Euro Quality of Life 5-Dimension 5-Level index, Euro Quality of Life Visual Analogue Scale (EQ VAS) and Geriatric Depression Scale-15 (GDS-15) were compared.

Results: In the general population, 38% had GDs, of which 16% (n=87/561) were HLGDs, giving an HLGD prevalence of 5.8%; 26% (n=145/561) were other neurological GDs; and 59% (n=329/561) non-neurological GDs. HLGD had more depressive symptoms than non-neurological GD and no GD (GDS-15 HLGD, 3.9 +/- 3.4; non-neurological GD, 2.5 +/- 2.8; no GD, 1.4 +/- 2.0; p<0.05), lower EQ VAS (HLGD, 63 +/- 17; non-neurological GD, 71 +/- 18; no GD, 82 +/- 14; p<0.001), lower gait confidence (mGES HLGD, 60 +/- 22; non-neurological GD, 74 +/- 21; no GD, 90 +/- 13; p<0.001) and lower balance confidence (FES(S) HLGD, 93 +/- 32; non-neurological GD, 111 +/- 25; no GD, 124 +/- 13; p<0.001).

Conclusions: HLGDs are common and associated with reduced QoL, reduced confidence in gait and balance, and depressive symptoms, emphasising awareness of mental health among older people with slow unsteady gait.