If choosing between a cane or a walker isn't a choice you ever dreamt of making, know that one roughly 1 in 4 adults over 65 uses one of these mobility devices, and significantly more older adults use them today than 15 years ago.
Also know this: “Not all canes or walkers are created equal,” says Lindsey Yourman, an internist and geriatrician in La Jolla, California, affiliated with the University of California San Diego Health Jacobs Medical Center, who adds that choosing the wrong device can be a detriment to your mobility.
Pick-up walkers, for instance, which take a lot of energy to use, aren't necessarily a good choice for someone with congestive heart failure or chronic obstructive pulmonary disease who gets winded easily. Such walkers can actually lead to a decrease in activity, Yourman says, if someone finds them too hard to use. A walker with wheels, on the other hand, requires a certain level of balance to use safely. “And with a cane, you want to be sure it's the right height,” she says.
Here's what else to consider in such a device — starting with the all-important initial assessment by a physical therapist or other health care pro.
What's in an assessment
Yes, someone can decide that they need a mobility aid, then go a pharmacy or medical supply store and buy a cane or walker right off the shelf. “But the more serious the mobility problems, the more likely input from a rehabilitation doctor or physical therapist would be helpful,” says geriatrician Helen Hoenig, chief of physical medicine and rehabilitation at the Durham Veterans Affairs Health Care System.
Indeed, research has shown that 70 percent of canes are used incorrectly or are the wrong height or design for the user. The wrong choice can affect stability and increase the risk of falls. “If someone has a device set at the wrong height — say, it's too high — that can put strain through their neck, shoulders and through their arms,” says Diana Palm, a Fargo, North Dakota, physical therapist. “If it's too low, it can cause them to stoop forward, which can lead to impaired posture and back pain.”
A physical therapist can do a gait assessment, make sure that your device fits you correctly, and also train you on how to use it. “It's not always obvious,” says Hoenig. “For example, if you've got a painful knee or hip, some people think you should use a cane on the side that hurts. But you should use it with the hand opposite to the painful joint.” That way, it shifts weight onto the cane and away from your weaker side to keep you steady.
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Cane or walker?
Whether you use a cane or walker depends on how much support you need and whether you need it for one or both limbs. Hoenig says mobility problems tend to fall into one or more of these three categories: weight-bearing (due to weakness or pain); balance (due to a coordination or sensory problem, such as numbness or low vision); and endurance (due to heart or lung problems). The category that describes your issue influences the best type of gait aid.
If you have mild leg weakness — say, a creaky knee — a cane can give you one-sided support by reducing the weight on the joint. A cane is also appropriate in dealing with mild sensory changes, such as changes in vision, hearing or balance. For example, a cane might be more helpful for someone with a mild balance problem due to peripheral neuropathy or low vision, says Hoenig, because they can pick up where the floor is by feeling it through the arm holding the cane.
Features to consider in a cane
Single-point base: The single contact with the ground helps those with early balance problems, who need just a little support to steady themselves and don't need to push down a lot on the cane.
Quad base: The quad cane, with its four-pronged base, is for those who need a wider base of support for balance. “It offers a little more stability on that side,” says Palm. “For example, someone who has had a stroke and needs to be able to lean farther in that direction to clear their leg.” But there's a trade-off. For one thing, a quad base is heavier and clunkier to use. Also, notes Palm, “it usually requires a slower gait pattern because you need to make sure that all four points of that quad cane hit the ground with each step.” On other hand, it can stand on its own — a nice feature if you need to put it down while sitting at a restaurant or in a restroom.
With any handle, you'll want the right height. “With your elbow bent at a 10- to 30-degree angle, the top of the cane would come to your wrist. If it's taller than that or a lot lower, it can throw off the mechanics of how you're walking,” Yourman explains.
Two more considerations when deciding on your type of grip: comfort and the amount of weight you're going to be putting on it.
Rounded (or tourist) handle
Someone who isn't putting a lot of weight on the cane will do fine with this type, Hoenig says. (It's also a plus to be able to hang it over your arm when you're opening a door.) But if you have to really grip and lean hard, this curved handle is going to hurt your hand.
There are a lot of variations, including a Fritz or derby handle. The horizontal grip allows for even distribution of weight across the palm and is especially kind to those who have arthritic hands or fingers.
With its unique shape — similar to a question mark or shepherd's staff, with the area just beneath the handle sticking out slightly — “the transmission of force is directly perpendicular to the ground,” says Susan Rocha, lead physical therapist at the University of California San Diego Health Koman Family Outpatient Pavilion. That puts your weight directly over the cane shaft for more comfort when walking.
Features to consider in a walker
If your balance is poor, or if you have weakness or arthritic pain in both legs or hips, you're going to get a much larger base of support from a walker. (Some can support up to half your weight.)
"The decision on the type of walker a person obtains may have to do with their upper extremity strength and ability, the location that they will be using it in, and personal preference,” says Barbara Resnick, professor of organizational systems and adult health at the University of Maryland School of Nursing. Standard walkers, without wheels, which need to be picked up and moved forward, are seldom used anymore. Today's options have two, three or four wheels.
Two-wheel (or front-wheel) walkers are the most common, with wheels in the front and posts in the back. The benefit here: It's really stable. “A two-wheel walker could be a good choice for a person who's got a more severe balance problem, such as Parkinson's, because it won't run away from you,” Hoenig says.
Rollators can be easier to use because they have wheels at the bottom of each leg. They usually have brakes on the handles — squeeze them and they lock — similar to a bicycle, though, notes Palm, good coordination is key: “Some people aren't quick enough to lock the brakes and the walker can get away from them.”
Three-wheeler walkers are a little like a tricycle, with one wheel in front and two in back. They're pretty easy to maneuver but less stable than two-wheel walkers, and don't provide as much support for overall balance or weakness. “Some people who have a smaller apartment or narrow doorways like them because they're easier to fit through smaller spaces,” says Palm. A drawback? They cause you to lean farther forward.
Four-wheeler walkers are wider than three-wheelers and are usually easier to push over uneven surfaces, such as sidewalks. “A four-wheel walker is easy to propel and gives some support,” says Hoenig. “But it's not as good as a two-wheel walker for people with major balance problems.” They usually have a seat with a basket underneath to hold groceries or personal items. “The seat makes them ideal for patients who have decreased endurance or are easily fatigued or get short of breath,” says Rocha. “A lot of cardiac patients use them so they can take a break and rest, especially when walking long distances.”