The following are the 3 common causes of unsteady gait in elderly patients, which I have observed in my practice.

1. Lumbar spinal canal stenosis: Very often, symptoms and signs of paraesthesia along with aches and weakness of the legs on exertion, the patients mention unsteadiness of legs while walking.
   
   In my experience, majority of patients whose symptoms are not very advanced, refuse to accept surgery as treatment and continue to live happily
   1) By using a walking stick.
   2) By losing weight.
   3) By learning exercises from a physiotherapist to reduce lumbar lordosis.
2. It is very interesting to note that even in our country, which has lot of sunshine, many old patients have vitamin D deficiency. Due to defective absorption of ultraviolet sun-rays through skin, patients can develop Vitamin D deficiency. Such patients may have bone pains of osteomalacia, and off and on, complain of unsteadiness, while walking. Response to Vitamin D treatment is heartening in such cases.
3. Multiple lacunar infarcts, specially in the brain stem, are the common cause of unsteady gait in the elderly patients against the background of diabetes, hypertension, hyperlipidaemia, smoking and alcoholism. The aetiology is small vessel disease of the brain.