Involuntary movements become increasingly common with age and often lead to considerable disability, handicap and social embarrassment. Many causes of involuntary movements can be readily treated once the correct diagnosis is established. Getting the diagnosis right in older people is often challenging even for specialists. Even the identification of conditions thought easy to classify in younger people, such as Parkinson's disease, can be very difficult in older adults. This burden of movement disorder in older people reflects the increasing prevalence of neurodegenerative and vascular disease with age as well as the growing exposure to medication and the natural history of conditions such as essential tremor, which tend to worsen with age and precipitate medical presentation later in life. A complex and poorly understood relationship exists between motor control, disorders of mood and cognitive function. In older subjects involuntary movements are often associated with gait abnormalities and poor mobility and falls may be the presenting feature.