An elderly person’s fear of falling can actually exacerbate underlying physical conditions, creating a “vicious circle,” which could lead to a greater risk of falling, according to a new report.

Gait disturbances, or difficulty walking as a result of old age, often have many causes, according to the researchers from the Neurological Hospital and Health Center of the Ludwig Maximilians University in Germany. These can include visual defects, neurodegeneration of the motor cortex, taking medication or drinking alcohol, and anxiety over falls. Those elderly individuals who are afraid of falling typically restrict their own movements, inadvertently worsening the physical conditions they may have, and contributing to a greater risk of falls. The prevalence of anxiety-related gait disturbances in elderly patients could be as high as 85%, according to the report.

When treating the elderly for gait disturbances of any kind, it is important to correctly identify the underlying cause of the disturbance and tailor any therapies to that cause, researchers say. Their paper, “Gait Disturbances in Old Age: Classification, Diagnosis, and Treatment From a Neurological Perspective,” outlines diagnostic and treatment techniques, and is available online in the current issue of Deutsches Ärzteblatt International.