Mobility Assistive Device Use in Older Adults

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.