Ladies and Gentleman, as we have discussed over this year together, fall prevention programs often focus on strategies to improve your gait and balance. Many medical, functional, and physical reasons can result in gait and balance changes, some of which are modifiable and others permanent. Mobility devices, such canes and walkers, are assistive devices that, when used and appropriate to your need, will improve your gait and balance, along with proprioception, safety and independence. Canes help redistribute weight from a lower leg that is weak or painful, improve stability by increasing your base of support, and provide tactile information about the ground to improve your balance. In contrast, walkers improve your gait and balance by providing a wider base of support, improving your balance and making you a lot more stable. A walker also allows you to take some weight off your legs and use your arms to assist with bearing weight. You may use one or more of these devices. However, I know from my practice seeing patients with gait and balance problems, fall risks and fall history, that many older people do not consistently use their devices. For years, researchers have tried to understand why older adults, when they know a mobility device will help them, choose not to use them. Here is what they have learned.
Researchers (Hill, et al., 2013) uncovered two factors that affect older adults’ use of walking devices. The first factor is older person’s lack of knowledge about fall prevention strategies that includes proper use of canes and walkers. The second fact is that older adults often reject to use these devices.
Other researchers further investigated older adults’ non-use of these devices. As you read these results, are these concerns for you? Older adults consider the devices to be a threat to their identity, creating a stigma, and do not think they need these devices (Dollard, et. al., 2012). Other reasons for non-use included forgetting to use them, improper height, or inaccessibility at the time.
Even more was learned when researchers talked with older adults who did fall and were prescribed a mobility device. Luz, et al., (2017) surveyed community-living adults 60 years and older who were current users of a cane or a walker with a history of falls, which I will refer to as “fallers”. From the 262 out of 800 persons who returned their survey, the researchers learned that 68% of older adults received their device from a medical supply company, hospital, physician or therapist. However, 18% received their device from a family member, and 17% purchased their own from a pharmacy, drug store, or supermarket. Among these fallers, 64% stated they used their device only when needed or for specific circumstances, such as when leaving the house or standing for longer periods of time. Another 20% of the respondents felt that they did not need the device to steady themselves, so they held onto furniture, the walls or someone’s arm. Holding onto someone else’s arm is really dangerous, because if one starts to lose balance and fall, the second person often falls too.
Another major reason for non-use was the device was not within reach or accessible. Seventy-two percent of the older adults who fell were NOT using the device at the time of their fall, even when they thought that their device could reduce their fall. You may want to read this finding again! Seventy-two percent of the older adults who fell were NOT using the device at the time of their fall, even when they thought that their device could reduce their fall. 162 of the older adults suffered injuries when they fell, from head trauma to surgery. Of most concern, all 19 older adults whose injury was so severe to require surgery, they were NOT using a walker when they fell.
So, even though most older adults believed their canes and walkers would reduce their falls, they chose not to use them, did not keep the device within reach, or left the device in another room. Your Harmony Team does not want this to be you.
- If you have new or changing balance and gait problems, concerns about falling, tell your primary provider, get evaluated for the right device for your short and long distance mobility needs.
- If you are prescribed a mobility device, use it and keep it within reach.
- Know that your safety, preventing your falls and resulting injury, are more important to you, your family and friends, your Harmony Team, than your worry about stigma.
As always, stay safe, strong, active, and connected with your healthcare team.
Your Harmony Team is here to help you!
Thank you for reading this message.
Season’s Greetings to you and yours,
Dollard J. Barton C. Newbury J. Turnbull D . (2012). Falls in old age: A threat to identity. Journal of Clinical Nursing, 21, 2617–2625. doi:10.1111/j.1365-2702.2011.03990.x
Hill A. M. Hoffmann T. Beer C. McPhail S. Hill K. D. Oliver D.,… Haines T. P . (2011). Falls after discharge from hospital: Is there a gap between older peoples’ knowledge about falls prevention strategies and the research evidence? The Gerontologist, 51, 653–662. doi:10.1093/geront/gnr052
Luz, D., Bush, T., & Shen, X. (2017). Do canes or walkers make any difference? Nonuse and fall injuries. The Gerontologist, 57, Issue 2, 1 April 2017, Pages 211–218, https://doi.org/10.1093/geront/gnv096