Mobility Assistive Device Use in Older Adults

 

Am Fam Physician. 2021 Jun 15;103(12):737-744.

  Patient information: See related handout on using canes and walkers, written by the authors of this article.

Related FPM article: Durable Medical Equipment: A Streamlined Approach

Author disclosure: No relevant financial affiliations.

Many individuals need a mobility assistive device as they age. These devices include canes, crutches, walkers, and wheelchairs. Clinicians should understand how to select the appropriate device and size for individual patients (or work with a physical therapist) and prescribe the device using the patient's health insurance plan. Canes can improve standing tolerance and gait by off-loading a weak or painful limb; however, they are the least stable of all assistive devices, and patients must have sufficient balance, upper body strength, and dexterity to use them safely. Older adults rarely use crutches because of the amount of upper body strength that is needed. Walkers provide a large base of support for patients who have poor balance or who have bilateral lower limb weakness and thus cannot always bear full weight on their legs. A two-wheel rolling walker is more functional and easier to maneuver than a standard walker with no wheels. A four-wheel rolling walker (rollator) can be used by higher-functioning individuals who do not need to fully off-load a lower limb and who need rest breaks for cardiopulmonary endurance reasons, but this is the least stable type of walker. Wheelchairs should be considered for patients who lack the lower body strength, balance, or endurance for ambulation. Proper sizing and patient education are essential to avoid skin breakdown. To use manual wheelchairs, patients must have sufficient upper body strength and coordination. Power chairs may be considered for patients who cannot operate a manual wheelchair or if they need the features of a power wheelchair.

As individuals age, many develop chronic, complex illnesses, including deconditioning, and may need to use a mobility assistive device. Assistive devices such as canes, crutches, walkers, and wheelchairs can help to alleviate the effects of mobility limitations, providing improved independence.1 According to data from the National Health and Aging Trends Study, 29.4% of adults 65 years and older reported using assistive devices within the previous month when outside the home, and 26.2% reported using them inside the home.2 Clinicians should understand how to select the appropriate assistive device (Figure 135) and size for individual patients and prescribe the device using the patient's health insurance plan.3

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

The use of assistive devices can improve balance, reduce pain, increase mobility and confidence, and decrease the risk of falls.9,10

B

Expert opinion and systematic review of observational studies

Because many patients obtain assistive devices without recommendations or instructions from a medical professional, clinicians should evaluate these devices for proper fit and use.13,14

C

Observational studies and patient surveys on how they use the devices

When only one upper limb is needed to aid in balance or weight-bearing, a cane is preferred. If both upper limbs are needed, crutches or a walker is more appropriate.4

C

Clinical review article

Wheelchairs can provide patients with improved mobility and quality of life, but proper sizing and patient education are required to avoid injury to bony prominences and skin breakdown due to seat pressure.5

C

Expert opinion


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

The use of assistive devices can improve balance, reduce pain, increase mobility and confidence, and decrease the risk of falls.9,10

B

Expert opinion and systematic review of observational studies

Because many patients obtain assistive devices without recommendations or instructions from a medical professional, clinicians should evaluate these devices for proper fit and use.13,14

C

Observational studies and patient surveys on how they use the devices

When only one upper limb is needed to aid in balance or weight-bearing, a cane is preferred. If both upper limbs are needed, crutches or a walker is more appropriate.4

C

Clinical review article

Wheelchairs can provide patients with improved mobility and quality of life, but proper sizing and patient education are required to avoid injury to bony prominences and skin breakdown due to seat pressure.5

C

Expert opinion


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

The Authors

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MANDI SEHGAL, MD, is director of the Geriatric Medicine Fellowship Program at Cleveland Clinic Florida, Weston. At the time this article was written, Dr. Sehgal was director of the Geriatrics and Healthy Aging Curriculum Thread, director of the Geriatrics and Palliative Care Clerkship, and an associate professor of geriatric medicine at Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton....

JEREMY JACOBS, DO, is program director of the Physical Medicine and Rehabilitation Residency Program at Memorial Healthcare System, Hollywood, Fla.

WENDY S. BIGGS, MD, is director of the Comprehensive Community Clerkship and a professor in the Department of Family Medicine at Central Michigan University College of Medicine, Saginaw.

Address correspondence to Mandi Sehgal, MD, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331 (email: sehgalm@ccf.org). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

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2. Gell NM, Wallace RB, LaCroix AZ, et al. Mobility device use in older adults and incidence of falls and worry about falling: findings from the 2011–2012 National Health and Aging Trends Study. J Am Geriatr Soc. 2015;63(5):853–859.

3. Centers for Medicare and Medicaid Services. National coverage determination (NCD) for mobility assistive equipment (MAE). Accessed March 23, 2020. https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=219

4. Bradley SM, Hernandez CR. Geriatric assistive devices. Am Fam Physician. 2011;84(4):405–411. Accessed February 2, 2021. https://www.aafp.org/afp/2011/0815/p405.html

5. Cuccurullo S. Physical Medicine and Rehabilitation Board Review. 3rd ed. Demos Medical; 2015.

6. Panel on Prevention of Falls in Older Persons. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59(1):148–157.

7. Moncada LVV, Mire LG. Preventing falls in older persons. Am Fam Physician. 2017;96(4):240–247. Accessed February 2, 2021. https://www.aafp.org/afp/2017/0815/p240.html

8. Centers for Disease Control and Prevention. Stopping elderly accidents, deaths, and injuries. Older adult fall prevention. Accessed March 29, 2020. https://www.cdc.gov/steadi

9. Bateni H, Maki BE. Assistive devices for balance and mobility: benefits, demands, and adverse consequences. Arch Phys Med Rehabil. 2005;86(1):134–145.

10. Faruqui SR, Jaeblon T. Ambulatory assistive devices in orthopaedics: uses and modifications. J Am Acad Orthop Surg. 2010;18(1):41–50.

11. U.S. Centers for Medicare and Medicaid Services. Durable medical equipment (DME) coverage. Accessed May 20, 2021. https://www.medicare.gov/coverage/durable-medical-equipment-dme-coverage

12. de Oliveira Cruz A, Santana SMM, Costa CM, et al. Prevalence of falls in frail elderly users of ambulatory assistive devices: a comparative study. Disabil Rehabil Assist Technol. 2020;15(5):510–514.

13. Liu HH. Assessment of rolling walkers used by older adults in senior-living communities. Geriatr Gerontol Int. 2009;9(2):124–130.

14. Liu HH, Eaves J, Wang W, et al. Assessment of canes used by older adults in senior living communities. Arch Gerontol Geriatr. 2011;52(3):299–303.

15. Warees WM, Clayton L, Slane M. Crutches. In: StatPearls. StatPearls Publishing; 2020. Accessed February 19, 2021. https://www.ncbi.nlm.nih.gov/books/NBK539724/

16. Van Hook FW, Demonbreun D, Weiss BD. Ambulatory devices for chronic gait disorders in the elderly. Am Fam Physician. 2003;67(8):1717–1724. Accessed February 2, 2021. https://www.aafp.org/afp/2003/0415/p1717.html

 

 

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