Many Injuries Occur With Walking Aids

Keith Haglund is managing editor of Caring for the Ages.

The Centers for Disease Control and Prevention wanted to know how elderly people get around using walkers and canes. Not so well, CDC researchers found out—at least according to emergency department data.

After investigating 3,932 emergency department visits for fall-related injuries from 2001 to 2006, CDC researchers estimated that each year, 47,312 people aged 65 years and older go to EDs in the United States for mishaps associated with use of canes or walkers. One-third of those people are hospitalized. The estimated yearly injuries total 17,856 fractures, 14,106 contusions or abrasions, 6,590 lacerations, 3,213 strains or sprains, 3,003 internal injuries, and 2,544 other.

“Injuries and hospital admissions for falls associated with walking aids were frequent in this highly vulnerable population,” Judy A. Stevens, PhD, and her CDC colleagues wrote in the Journal of the American Geriatrics Society (2009;8:1464–9). In an interview, she said the CDC looked into the topic because falls are the leading cause of injuries in older adults. The researchers suggested that the design of walkers and even canes could be improved. They also called for research into the physical and cognitive demands that walking aids put on users.

The team estimated fall injuries in both nursing homes (annually, 6,713 with walkers and 544 with canes) and public places (3,426 with walkers and 749 with canes). But, by far, the most falls associated with aids occur at home: 25,144 with walkers and 3,289 with canes, making up about 60% of all such injuries. About 12% of injuries occurred at unknown locations.

Older women appear to be particularly susceptible. Although they constitute 59% of the 65-and-older population, they suffered 77% of the fall injuries in the study. Most of those involved walkers. Women and men also suffered different injuries: Women most often damaged lower-trunk areas, whereas men had more head and neck injuries.

The researchers wrote that other studies support the perception that walkers and canes help elderly people with balance and mobility, but the team added that some studies “suggest that they can be associated with greater fall risk because they can cause tripping or interfere with a person's balance control.”

The numbers of injuries associated with the aids seem “higher than they should be,” said Dr. Stevens. She suggested that many times walkers and canes aren't fitted to an individual's size and capability and that too often, users receive no instruction.

Even simple devices call for fitting and proper instruction, she said. For instance, a cane user needs to learn which side of the body needs the support an how tall the device should be, but canes “bought at the corner drugstore” don't come with such instructions, she said.

On walkers, features such as wheels and seats can be inappropriate. Dr. Stevens said that falls commonly occur when a walker rolls away from a user or the person moves too far into a lightweight device and loses control of his or her center of gravity. “People need to be aware that these are not one-size-fits-all devices,” said Dr. Stevens.

“Older adults who use such assistive devices often have problems with balance, muscle weakness, stiff joints, or coordination,” said Dr. Hosam Kamel of the department of geriatrics at the University of Arkansas, Little Rock, who coauthored AMDA's a clinical practice guideline on falls (see sidebar). “In addition, such individuals are often frail, which increases their risk of sustaining an injury as a result of a fall.”

Dr. Kamel said that, when used properly, the aids can greatly improve elders' quality of life but added, “If not used appropriately, they can cause more harm than benefit.” He stressed the necessity of fitting each elderly person with the proper assistive device and then periodically reassessing the person's physical and cognitive abilities to handle that device.