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Am Fam Physician. 2022;105(5):online

Original Article: Mobility Assistive Device Use in Older Adults

Issue Date: June 15, 2021

To the Editor: Drs. Sehgal, Jacobs, and Biggs provided a succinct review of mobility assistive devices for older adults. The authors discussed the merits (and problems) of the standard walker, the two-wheel rolling walker, and the four-wheel rolling walker (rollator); however, they omitted a discussion of the upright walker.

Upright walkers enable the patient to stand straight because the handles and armrests are positioned higher than a rollator. The upright walker supports the patient's weight on the forearms instead of the wrists and hands. This reduces pressure and pain in the lower back, neck, arms, and wrists, which are commonly associated with using a standard or rolling walker.

There are several considerations for counseling patients on the use of upright walkers. Because the patient's center of gravity is higher than with a traditional rollator, if the upright walker does not have a wide enough base of support, it may tip forward when the walker hits a bump or crack, causing a fall. It is also important to advise the patient to select a model that most closely matches their intended location of use (indoors or outdoors). Size charts should be read carefully; many models have a weight limit of 300 lb (136 kg), and some models are only available in one size. It is important to make sure that the seat is a comfortable fit, especially if the patient is close to the weight limit of the walker.

There is a broad range of prices for upright walkers. However, caution should be used when considering economy models because they can be of questionable quality or have a potentially hazardous design. Upright walkers are covered as durable medical equipment under Medicare Part B and must pass the cost-effectiveness and medical necessity criteria outlined on the Centers for Medicare and Medicaid Services website. Medicare will pay for upright walkers only if the supplier is enrolled with Medicare.

Editor's Note: This letter was sent to the authors of “Mobility Assistive Device Use in Older Adults,” who declined to reply.

Email letter submissions to afplet@aafp.org. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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