fall prevention: Safe use of canes and walkers
Each year, falls result in approximately 684,000 deaths and are the second leading cause of accidental injury death globally. Adults 60 years and older have the highest death rates from falls. Additionally, 37.3 million non-fatal falls require medical attention (WHO, 2021).
Falls can have a significant impact on a person's quality of life, whether they result in injury or not. The fear of falling can cause older adults to reduce their participation in activities and socialization, leading to physical decline, depression, social isolation, and feelings of helplessness.
As patients age, factors such as chronic illness, weakness, deconditioning, and impaired balance increase their risk of falls. Mobility assistive devices, such as canes and walkers can improve safety and reduce the risk of falls. Canes can enhance standing tolerance and gait by relieving pressure on weak, injured, or painful limbs. However, canes are the least stable of mobility assistive devices and require adequate balance, upper body strength, and dexterity to be used safely. There are three types of canes: straight, quad, and tripod. Quad canes provide more stability due to their larger base of support, while tripod canes have a smaller base than quad canes but provide more stability due to their unique tip design.
The three main types of walkers include a standard walker, two wheeled walker and four wheeled walker. The standard walker is typically used for someone just starting to walk after an injury or being immobile for an extended period of time and has four non-skid rubber tip legs and is typically for going slow, lifting slightly forward, placing it and taking small controlled steps. A two wheeled walker is the same as the standard with two wheels on the front and ready for more continuous motion/walking and is more able to slide on a smooth surface. You might see this type with tennis balls on the back feet/tips which are used to reduce the friction for sliding on smooth surfaces. The four wheeled walker is designed for someone with poor balance but strong lower and upper body strength and device typically has hand brakes similar to a bicycle.
One of the most important aspects of using a cane or walker is to ensure a proper fit. This fit should be done in conjunction with a health care provider. The patient should wear their normal shoes and let their arm hang loosely by their side. The distance should be measured from their wrist to the floor. The walker or cane should be adjusted so that the top of the assistive device is the same distance as the measurement from the patient's wrist to the floor. When the length of the assistive device is correct, there should be a 20 to 30-degree bend in the patient's elbow.
Five steps to safe cane use:
When using a cane, hold it on the side opposite your injury, pain, or weakness (unless directed otherwise by a healthcare provider).
Bear weight on your unaffected leg.
Advance the cane a comfortable distance forward with your affected leg.
Let the cane support your weight and then step forward with your unaffected leg.
Before taking a step, make sure the cane is firmly on the ground and not too far ahead
Five steps to safe walker use:
To use a walker, stand with your toes positioned halfway between the front and back wheels/tips.
Move the walker ahead one step length by either rolling or lifting it.
Plase the walker on the ground firmly and ensure it is not too far ahead.
Slightly lean forward, using the walker for upper body support. Take a step.
Repeat the process.
Stair navigation can be difficult for those using assistive devices. When ascending the stairs with a cane, step up first with the stronger or uninjured leg and then the weaker or injured leg, while pushing down on the cane. When descending, put the cane down on the step first, then step down with the weaker or injured leg followed by the stronger one. The phrase "up with the good, down with the bad" may help with remembering this process. If there's a railing nearby, using it for added support is recommended. Note that quad canes may need to be positioned sideways on the stairs. To prevent falls, ensure the assistive device is in good condition with rubber tips, avoid slippery surfaces such as throw rugs or waxed floors, take extra care on wet or slippery surfaces, and wear supportive low-heeled shoes.
Patient safety is a shared responsibility among all members of the healthcare team. Preventing falls is critical to maintaining a person's health and wellbeing, as falls can result in serious injury or death, as well as financial and quality of life implications. Fear of falling can also lead to social isolation and further decrease in mobility, heightening the risk of future falls. Assistive devices such as canes and walkers are meant to enhance patient safety and reduce the risk of falls, but proper use must be taught to avoid any potential safety hazards.
I hope this information is helpful. If I can be of support, do not hesitate to reach out.
In support,
Ryan
