Canes, walkers linked to higher risk of falls

Walkers and canes can be lifesavers for older people, but a new study highlights the downside of using them without training.

“A lot of older adults seem to struggle with their walking aids . . . they often drag along their walking aids like a burden with a difficult gait pattern as a result, possibly increasing the risk of falling,” said the study’s lead author, Tine Roman de Mettelinge of Ghent University in Belgium.

Older people need to be able to function independently, but gait problems can undermine that, even leading to nursing home admission, Roman de Mettelinge and her coauthor point out in the Journal of Geriatric Physical Therapy.

The study followed 43 adults, ages 63 to 94, in a residential care facility in Belgium. Twenty-two used walking aids (most used a four-wheeled walker, two used a two-wheeled walker, one used a walker without wheels and one used a cane).

Researchers tracked their falls, as well as factors that might have contributed to the accidents, such as cognitive problems, fear of falling, use of psychotropic drugs or age.

They also measured residents’ muscle strength, walking speed, and how much their arms were swinging as they moved.

Altogether, 22 residents (15 using walking aids and seven not using walking aids) had at least one fall.

After accounting for psychotropic drug use, falls in the previous years, older age, slower walking, longer periods spent standing still and less arm swinging, people who used walking aids were still nearly four times more likely to fall than those who did not.

Those who fell walked much more slowly and took smaller steps than those who did not fall.

“A substantial proportion of the relationship between using walking aids and future falls” could be explained by altered gait, older age and use of psychotropic drugs, Roman de Mettelinge said in an email. The factors with the greatest effect seemed to be cadence, stance and swing percentage, she added.

Such results are “common knowledge to many researchers,” said Thurmon E. Lockhart, a professor in the School of Biological and Health Systems Engineering at Arizona State University, who called the study “very, very important.”

But the take-home message isn’t as simple as avoiding walking aids, said Lockhart, who was not involved in the study.

“It gives kind of a mixed message but the bottom line is the device in itself may not cause future accidents, but at the same time since there’s a relationship between fall risk and the device use, we need to watch out for that a little in the future,” he said.

While a cane might help with mobility, it could also make it more difficult for people to stabilize themselves during a fall, Lockhart noted.

“It’s almost all about how we recover” from loss of balance, he said.

Lockhart has developed a “slip simulator,” where an individual walks on a shifting linoleum floor controlled by a computer. The person wears a harness and learns to regain a sense of balance as the floor shifts.

“They’re learning about themselves, about their limits of balance and stability . . . the only way to train that is to slip and fall,” Lockhart said.

Roman de Mettelinge said doctors and therapists should consider an individual’s physical and mental abilities and living conditions before prescribing a walking aid.

Someone who needs a walking aid should be given balance and gait exercises and then be trained to safely use a walker or cane, including proper gait patterns and ways to avoid falls, she said. The training should also include complicated maneuvers like opening and closing doors with the aid.

Roman de Mettelinge cautioned that the results of the study applied to individuals in assisted care facilities, who tend to be older and in poorer health than people still living at home.

SOURCE: Journal of Geriatric Physical Therapy, online January 15, 2015.