What is the safest way to aid a frail senior using a walker?

Mazuela asked...

What is the safest way to aid a frail senior using a walker?

Expert Answer

Bonita Lynn Beattie is the vice president for injury prevention for the Center for Healthy Aging, part of the National Council on Aging (NCOA). She directs the NCOA's Falls Free Initiative, which is developing and implementing a national action plan to prevent falls and fall-related injuries in older adults.

Thank you for your request seeking information to aid a frail senior who is using a walker. You are right to be concerned. While walkers seem to be simple assistive devices, between 2001 and 2006, over 47,000 Senior Citizens per year were treated in emergency rooms because of falls associated with walkers and canes, according to a Centers for Disease Control and Prevention study published in the June 2009 http://www.cdc.gov/media/pressrel/2009/r090629.htm

First and foremost, walkers (and/or canes) should be fitted to the individual with appropriate instruction and practice in its use. Most the injuries are due to inappropriate fit, lack of instruction and practice in the safe use, and/or using an inappropriate device to accommodate the need. Seniors should not borrow a walkers (or canes) from a friend or family member, that was not selected specifically for them, adjusted to the right height or size, or for which they were not instructed in the use. Usually the provider most knowledgeable in the fitting and use of walker is a physical therapist who will be happy to provide you with appropriate training as well.

The Mayo Clinic offers some slide presentations on the correct selection, fitting and use of a walker and can be found at http://www.mayoclinic.com/health/walker/HA00060. There is a series of slides on balance exercises and fall prevention on the same site.

But to your specific question on how a caregiver should aid a senior using a walker:

  • As a general rule the use of a gait belt is recommended so that you can assist with some trunk control if necessary without pulling on the arm or grabbing clothing. You can also gently cup the upper shoulder if necessary to provide even additional balance assist.
  • Place your hand under the belt from the bottom so that you have better control if necessary.
  • Although there are exceptions it's good practice to walk to the person's weaker side.
  • Walk slightly behind the person while holding onto the gait belt from behind and offer assistance only as needed.

But do note, you should not be lifting or half carrying the older adult as he/she walks...if so, this a walker is not a safe device for either of you.

Other tips for the caregiver awareness include:

  • Older adults should not pull on the walker to get up from a couch or chair. Nor should the caregiver pull on the older adult. To arise, the older adult should slide forward in the seat with the feet planted firmly on the floor and push up, or use the chair arms as necessary. An assist from the gait belt could be offered as necessary. The walker should be placed directly in front of the older adult for use upon arising, only after their balance is reestablished.

  • When using a walker and deciding to sit in a chair, the older adult should back into the chair feeling the chair edge just touching the back of the legs, let go of one arm of the walker and reach back for the chair arm. Then take the second chair arm and gently sit down. Obviously firm chairs with arms are helpful in such transfers.

  • Older Adults should not move their walkers too far ahead, which causes strain to reach it and may disturb balance. Nor should a user over step the walker, feet should never be forward of the center of the walker.

  • Users should periodically check the rubber tips at the bottom of the cane or walker. Be sure to replace them if they are uneven or worn through which can also affect stability of the walker.

  • Older adults should wear shoes or slippers that fit well and have nonslip soles, and should lift the feet not shuffle to reduce her risk of tripping.

Additional fall prevention information and home safety tips are available through the CDC at http://www.cdc.gov/HomeandRecreationalSafety/Falls/fallsmaterial.html