Are Canes and Walkers Safe?

By Rein Tideiksaar Ph.D., PA-C

Walking aids (canes and walkers) are commonly used by elders. But are they safe? According to the CDC (Centers for Disease Control and Prevention), falls involving walking aids  are responsible or an increasing number of serious injuries (broken hip and pelvic bones) and visits to the emergency room. Canes and walkers help elders to maintain their balance and mobility, yet at the same time they can also be a fall hazard. Seems counterintuitive doesn’t it?  There are several reasons for this inconsistency. Elders who use canes and walkers may be likely to fall because they are:

• Using their walking aid incorrectly or have never been instructed on their safe use.
• Using the wrong type or size walking aid.
• Using a walking aid that is no longer appropriate or safe; as their health and walking aid needs have changed.

To avoid falling with a cane or walker, it’s important to:

• Choose a cane or walker that suits you in both design and fit.
• Learn how to use your cane or walker safely/properly.

Walking Aids

Certain physical disabilities can make walking very difficult or even an impossible task. To overcome these obstacles doctors and physical therapists recommend various walking aids for elders to use. Canes and walker are mainly used to add stability and improve balance. But a cane or walker can also make an elder feel much more confident, which helps to reduce any fear of instability or falling.

Canes

A cane is the simplest device for walking. Canes are generally indicated for elders whose ability to walk is limited by leg pain or weakness and/ or who may require minimal balance support.

Types of Canes

A variety of cane designs are available:

• Wooden canes are often preferred by elders, however, these canes are non-adjustable in length, and as a result, if the cane is either too short or long for the individual it can result in balance loss and falling. Also, wood canes may splinter or fatigue with prolonged use.
• Aluminum canes are lightweight, sturdier than those constructed with wood, and are adjustable in length (altered by a push button pin mechanism), so that the cane can be quickly adjusted to the user’s height.  Aluminum canes come in different colors such as black or bronze.
• Pedestal-based or quad canes offer more support than single-tip canes. The quad cane has four prongs or tips, and is constructed with an aluminum shaft, which is height-adjustable in design. The downside of quad canes is that when walking quickly, the “rocking” back and forth motion between the legs of the quad cane can also lead to instability. In general, elders utilizing a quad cane need to have good judgment. If the quad cane is held improperly, the device becomes extremely unsteady and increases the risk of falling.
• The Flex Stick, designed by physical therapists, is a good alternative to avoiding many of the problems associated with quad canes. The Flex Stick (www.flexsticks.com) uses 3 spring-loaded legs (that act as shock absorbers) to maintain constant contact with the ground.

Walkers

Walkers are designed to provide more support than canes, and are indicated for elders whose ability to ambulate is limited by weakness in both legs and/ or poor balance. However, as opposed to canes, walkers have a major drawback; they are difficult to use in space-limited areas, such as bathrooms.

Types of Walkers

• The traditional standard walker (“pick-up walker”) provides a wide base of balance support, and good stability.  The legs are equipped with rubber tips to prevent the walker from sliding away. Pick-up walkers, although, may not be useful for all elders with poor balance, as the user must “pick-up and place-down” the walker when walking.   As a result, the walker is actually providing support only about 50% the time (when the walker’s four legs of support are in contact with the floor), requiring the elder to maintain balance on one or both feet while moving the walker along. Elders with poor arm strength or pain due to shoulder arthritis are not good candidates for standard walkers, as they may find it burdensome to repeatedly pick up and move the walker forward.  Sometimes, rather than picking the walker up, individuals will push the walker along the floor, which can increase the risk of falls, as the walker may suddenly come to a screeching halt or tip over if uneven floor surfaces are encountered.  Pick up walkers can easily be converted into 2-wheeled walkers; the addition of wheels allows the user to walk by pushing or rolling the walker forward.
• The 2-wheeled walker is a “rolling” walker. Rolling walkers are easier for elders to use and provide good balance control. Rolling walkers are equipped with:
• Four wheels; the front two wheels are on swivel casters for easy maneuverability. The wheels are designed to turn, pivot and maneuver in a way that standard walkers can’t, which makes it much easier to get around.
• Hand braking systems (caliper brakes, much like a ten-speed bicycle) prevent the walker from rolling away. The user squeezes the hand brakes to lock the wheels in place, or release them to continue walking. For those individuals with arthritis or other ailments making hand brakes difficult to use, some rolling walkers are equipped with automatic braking systems, which prevents the walker from suddenly rolling away.
• Foldable, padded seats and back rests built into them. If an elder gets tired while walking, they can fold the seat down and rest on it. This feature is especially beneficial for those individuals with arthritis and heart conditions who tire easily and need to frequently rest while walking.
• Lastly, rolling walkers are aesthetically more appealing than conventional walking aids; thereby, improving the elder’s acceptance of a walker.

Cane/Walker Safety

Many elders are aware that their balance is not as good as it once was and they look for devices that help them maintain their mobility. In response, elders may purchase canes/walkers on their own without a doctor’s order or without any instructions in their use. Some elders may even borrow walking aids from friends and family. Both situations can result in using the wrong type of cane/walker and the risk of injury. To ensure that canes/walkers are safe:

• It’s important that canes/walkers fit properly. The walker or cane should be about the height of your wrists when your arms are at your sides. In addition, it’s essential that you are using your cane or walker properly.
• Periodically check the rubber tips at the bottom of the cane or walker (or walker wheels, hand brakes, etc.). Be sure to replace them if they are worn or damaged so that your cane/walker is in good working condition.

About the Author

Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician’s assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Doctor’s professional profile on LinkedIn:http://www.linkedin.com/pub/dr-rein/6/759/592. If you have any questions about preventing falls, please feel free to email Dr. Tideiksaar at drrein@verizon.net.

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