A patient was seen and discussed in the Geriatrics Clinic. The gentleman’s age could only be best described as “old.” He had fallen down, was taken to the Emergency Room, evaluated, and when no serious injury was found, sent back home with instructions to check with his primary care provider.
And so he came to Geriatrics Clinic. By coincidence, it was the day the news media carried a story that 47,000 older people who use walkers or canes fall and need to go to the ER each year. He would be one of them.
The geriatrics team watched him walk using his walker. He picked it up and placed it down with a stumble a little in front of him. When standing, his arms were almost at his sides as he held the walker handrails. The walker looked almost too small for him.
It wasn’t too small, it was too short. The team raised the adjustable legs four inches, so his elbows were about 25 degrees up from straight down.
“How does that feel?” they asked.
“Pretty good,” the gentleman replied. He tried it out. He lifted it higher and clunked it down firmly with each step. It was a more secure looking performance.
First Error Type
The first common error with walking aids is using the wrong height. Walkers and canes should be adjusted so the user’s elbow(s) are bent 20 to 30 degrees.
Second Error Type
The second common error is improper use. Canes should be held on the strong side, the side opposite the weak or damaged leg. Walker use depends on the type, and requires individual instruction.
Walkers without wheels should be lifted clearly off the ground and placed firmly on level floor before weight is placed on them. Wheeled walkers may be scooted forward without lifting, but also must be on secure footing before weight is placed on them.
Choices
Canes can be decorative or not, heavy or light. A very functional cane is made from aluminum for strength and lightweight. It is able to withstand being dropped down a flight of stairs. Newer lightweight materials such as carbon fiber are becoming available.
Adjustable height may be an important feature. The tip of the cane should have a cap or device to provide friction with the floor, so the cane is less likely to slip. Quad canes have four short legs on the tip that are meant to help prevent slipping, but should not be used on stairs. (Regular canes may be used on stairs if the person grasps the handrail on the side opposite the cane.)
Walkers come in several styles. All should be designed to hold at least 50% of the person’s weight.
- The basic rigid walker is least expensive.
- Folding walkers are used the same as rigid walkers but may be more convenient for transportation—they can fit in the car trunk.
- Wheeled walkers take less energy to use. Two-wheeled walkers usually have automatic brakes, to hold the wheels when weight is placed on the walker.
For Parkinson’s Disease
A small study compared wheeled and standard walkers. Both were found to slow walking. Freezing (temporary inability to move) and walking time were compared. “(Parkinson’s Disease) patients walk more slowly when using them, without reducing freezing. Because the wheeled walker was intermediate for walking time and does not aggravate freezing, if walkers are used for these subjects, this type of walker should be favored,” the researchers concluded. (Parkinsonism Related Disorders. 2003 Oct;10(1):9-14 uid 14499200)
Two-wheeled vs. Three wheeled Walkers
Another small study found three-wheeled superior to two-wheeled walkers. (J American Geriatrics Society. 1992 Jul;40(7):735-6. uid 1538036)
Where To Go For Help
Physical therapists who specialize in older people will provide training and education. Physiatrists (rehabilitation physicians) are also expert, and many geriatrics physicians are knowledgeable.
More Information- Jennifer B. Weir: Helpful Products for Older Persons—Canes and Walkers. 1994
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