Friend or foe? Study examines seniors' increasing use of walking aids

The proliferation of senior mobility devices is surprising considering that prior research showed a correlation between device use and falling -- the leading cause of death resulting from injury among adults 65 and older. Those who are fortunate enough to survive a fall spend more than $19 billion annually on directly related medical costs. Seniors will be happy to know that the latest National Health and Aging Trends (NHAT) study shows that those who use mobility devices are not falling more than those who do not.

"Previous research suggested that these devices may have altered the way people walk, thus contributing to falls, but those studies only looked within groups of people who used devices, who are already more likely to fall," says Nancy Gell, assistant professor of rehabilitation and movement science at the University of Vermont, whose article in the Journal of the American Geriatrics Society revealed the lack of correlation. "This study is the most in-depth since 2004 and shows no link between mobility devices and falls as previously thought."

Yet, the question remains: why do more than 25 percent of older Americans now rely on canes, walkers, wheelchairs and scooters? Is it laziness? Doctors' overprescription? Has it become more socially acceptable? Or is it just an increase in the number of senior citizens?

Why the increased reliance on walking aids?

Gell, a physical therapist with a PhD in exercise science, sought the answers in her article "Mobility Device Use in Older Adults and Incidents of Falls and Worry About Falling," based on an in-depth analysis of the NHAT study. She considered multiple factors including whether the increase is due to greater acceptability, greater longevity and a correction for unmet needs in previous decades. The main culprit could be the underlying problems leading to mobility device use in the first place such as obesity, strength deficiences or issues with balance or cognition. More research is needed, she says, to understand if greater reliance is tied to physical issues such as obesity and weakness or to social issues such as greater acceptability and access.

Regular participation in physical activity could prevent many mobility issues, according to Gell, whose primary goal is to reduce sedentary behavior and increase physical activity in older adults with chronic conditions and mobility impairments. "Understanding the determinants of greater mobility device use will provide insight into the training needs of older adults and whether current mobility device training standards are sufficient for safety and mobility, and whether use tracks appropriately with current needs." Gell says.

Gell reported for the first time that a large percentage of the older adult population uses more than one mobility device. In fact, more than nine percent now rely on multipe devices. Overall individual device use in America shows that 16.4 percent of seniors use a cane; 11.6 percent use walkers; 6.1 percent use wheelchairs; and 2.3 percent rely on scooters. "It's important that we consider why people are increasingly using more than one device and ask related questions," she says. "Are they being trained on one, but using two or three? Do people get one device paid for with insurance and then have to pay for two or three out of pocket? Are they safe on two or three devices?"

Gell found that cane-users, in particular, were more likely to report limiting activity due to fear of falling, compared to those who don't use any devices. "Staying active is a key component to staying healthy and maintaining mobility and function," she says. "For many people, a cane is the appropriate device for their circumstances to stay mobile. However, if worry about falling continues despite using a cane for support, it is worth considering a different device in order to be as active as possible. "

Weighing the risks of 'actively falling' with a 'safe sedentary' life

Despite some studies showing that active seniors are more likely to fall simply because they are creating more opportunities, Gells says the benefits of being active outweigh the negative health outcomes of being sedentary. In Vermont, for example, activity levels are high among older adults, but so are fall rates. According to America's Health Rankings, Vermont is fourth best for physical activity among seniors but is also in the top ten for most falls.

"The question is if it's better to be active or sedentary and not risk falling. We think it's better to be active," Gell says. "My work is always focused on the idea of return to function and how to help people stay active as they age."