When the elderly start to become fearful of walking because they may have a fall, a mobility aid such as a walker can be helpful to stabilize them.
Mobility walker comparison chart:
Four point frame walker  | Two wheeled aluminum walker | Four wheeled rollator walker | |
| Seat | No seat | No seat | Yes – has a seat for resting |
| Brakes | No brakes | No brakes | Push to lock brakes are considered standard. Can be customized with auto stop brakes that need to be pulled and disengaged prior to moving. Slow down brakes can also be used to control the rolling speed of a wheel. |
| Ideal environment for use | Rehab settings and within the home | Indoors – short distances on flat smooth surfaces | Indoors and outdoors – can also be used on carpeted flooring |
| Height adjustable | Yes to some degree – tool free push pins can adjusted to raise or lower the handle height | Yes to some degree – tool free push pins can adjusted to raise or lower the handle height | Yes to some degree – models usual come in super low, low and standard height depending on the brand of rollator. Height adjustment can be completed without any tools. |
| Width | Narrow frame – easier to navigate through narrow doorways and spaces | Narrow frame – easier to navigate through tight doorways and small spaces Excellent for use in a small bathroom where a rollator does not fit. | Wider frame – harder to navigate through tight spaces and narrow doorways |
| Folding | Foldable for easy storage | Foldable for easy storage | Depending on the model, can fold side to side, or front to back for easier storage or placement into a vehicle. |
| Wheel size | N/A | 4-6 inch wheels on the front legs. Rear legs usually are points or can be customized with skis to glide better along a smooth surface. | 8-10 inch size wheels are considered standard. Smaller wheels can be obtained, however this would affect performance and decrease maneuverability on a variety of surfaces. |
While walkers are meant to increase a senior’s confidence with ambulation, they can actually increase the risk of falling if they are not used correctly or poorly fitted for someone’s body and posture.
These are some common problems that the elderly may experience with walkers:
- Impaired cognition – not remembering to use a walker can place someone at risk of falling
If someone attempts to ambulate without the support of a mobility device, they may be placing themselves at risk of falling.
For seniors with cognitive impairment and advanced dementia, they may forget to use their mobility aid and attempt to walk without any assistance.
Because these individuals may not comprehend the risk they are placing themselves at, they may need frequent cues and reminders to utilize their mobility aid when they intend to walk.
Another possible solution is repeated retraining until walker usage becomes a routine or second nature. Alternatively, caregivers can keep a watchful eye and remind someone to use their walker as they try to stand up and walk.
To best determine if a walker is a safe mobility aid for someone with poor comprehension and understanding of their cognitive and physical limitations, a mobility assessment by a trained physiotherapist or occupational therapist is required.
- Not following safe walker usage techniques – forgetting how to correctly use a walker can lead to injury or falls
A common mistake made by seniors is failing to lock the rollator walker brakes when they leave the device to sit down, or prior to an attempt to stand up to it.
By attempting to transfer to or away from the walker while the wheels are free to move, the equipment can roll away, causing someone to lose their balance. This can contribute to a fall if someone is relaying on the equipment for support.
During any transfer attempt or when using the seat, rollator wheels need to be locked to prevent them from moving.
For walker frames with four feet, transfers are less complicated as there are no wheels to allow the equipment to easily shift.
Extra caution needs to be taken when using a two wheeled walker as this equipment does not have any brakes and can roll away more easily. As a result, transfer attempts should be done by pushing off the furniture one is sitting on or by using any nearby transfer aid like a grab bar for support
Tip: The handles of a walker should never be pulled on when attempting to stand up to the device. Doing so will pull the equipment towards you, and may cause it to tilt. Instead, push off the surface you are sitting on or use a secure transfer aid for support.
- Impaired vision – poor eyesight can make it difficult to manipulate the walker brakes or maneuver safely around obstacles
Having trouble seeing can affect the ability to safely navigate the environment.
Poor vision makes it more difficult to avoid bumping into furniture and the walker may get tangled in other obstacles more easily. This can cause the walker to get tangled, tip over, and lead to a fall.
Furthermore, decreased vision can use the handles or brakes if they cannot be located easily. This can make it hard to control the walker or transfer to it from a sitting position.
A possible solution to these problems is to increase the lighting in the room with stronger light bulbs or more sources of light.
Alternatively, high contrasting tape can be placed near the handles or brakes to draw attention to them. This can help people differentiate the foreground from the background and help locate the handles of the walker that are normally similar in color to the frame.
Unless there is total vision loss, individuals with health conditions such as macular degeneration and glaucoma may benefit from improved lighting and highly reflective tape.
In fact, many people are still able to identify objects and shapes in their field of sight, even with more advanced stages of vision disease. Sometimes modifying the lighting and contrasting objects can help these individuals see their walker and environment more easily, allowing them to navigate through their home more safely.
- Decreased hand strength and grasping power – not having the necessary strength to hold the walker or use the brakes can place someone at risk of falls or injury
A common complaint amongst the eldery is that it is difficult to lock or engage the brakes on a rollator. Some walkers have brakes that are more stiff, requiring more strength to push down into the locked position.
For this reason, it is best to trial a few models of rollators to find a braking system that matches one’s strength in order to be able to safely put the brakes on and release them as needed.
This barrier may also be overcome with some upper body strengthening and conditioning exercises through a carefully guided rehab program.
For individuals with one armed or handed paralysis after a stroke or other injury, alternate mobility aids may need to be considered such as a hemi walker.
A side style hemi walker is similar to a four point walker, but it is designed for use by those that have functioning in only one hand or arm. Because it does not have wheels, this device is ideally used by those that do not require a wheeled walker, but do need a wide base of support for short distance walking.
- Cluttered environment – maneuvering an environment with obstacles and other tripping hazards can be dangerous when using a walker
Tight or small spaces can be hazardous to maneuvering with a walker. Walker frames are wider than the average person as the individual using them must fit in between the handles, so moving around a clutter setting can get the device tangled on nearby objects.
For users of mobility aids, it is best to have a clear walking path to ensure that one can safely turn and propel the walker forward as needed without running over objects on the floor or striking other surfaces when passing by.
Decluttering will reduce one’s risk of tripping and falling and can be the difference between living independently or ending up in the hospital with an injury after a fall.
- Inappropriately sized walker – a poorly fitted walker to one’s body shape and size can make it unsafe or uncomfortable to use a walker
To properly use a walker, one must ambulate while staying in between the two arm handles. This position ensures that one is not hunched over, and that one stands up tall and straight when walking.
If someone were to walk behind the walker handles, their base of support would be extended and less stable.
This position puts more forward pressure on the handles and may cause the walker to run away from someone, leading to a loss of balance and potentially a fall. Walking behind the walker also promotes poorer posture and a hunched back.
Some people walk behind the walker because they find it to be more comfortable when grabbing the arm handles. In these cases, it is likely that the handles are not at the appropriate height for its user. Ideally, handles should be at approximately wrist level when one is standing up straight with the arms down at their sides.
In order to ensure that one is appropriately fitted and matched to a walker that meets their individual needs, a mobility assessment from a physical therapist or occupational therapist will be needed. Medical vendors that sell walkers often have a roster of support staff that they can link you with to ensure that the walker you get is safe to use based on your body’s capabilities and needs.
- Poorly maintained walker – a mobility aid in a state of disrepair can be dangerous to use
Like any frequently used equipment, a walker can deteriorate over time with repeated use. For example, regular use of a walker for many years can lead to:
- Seized brake lines
- Frayed cables and wires
- Locking mechanisms that cease to function
- Worn out rubber wheels
In order to ensure one is as safe as possible, it is important to regularly inspect walking aids to ensure they are in tip top shape.
With mobility aids obtained from licensed medical equipment vendors, parts are easy to come by and can usually be swapped out without much difficulty.
For walkers obtained from a regular retailer, standardized replacement parts may be harder to come by as medical vendors may not carry them. In these situations, replacing the device entirely may need to be considered when the walker is in a state of disrepair.
- Hand deformities – deformities of the hand can make it difficult to grasp onto the handles to use a walker
Hand deformities related to arthritis or contractures can make it hard to wrap one’s hand around the walker’s handle or use the braking system. For these individuals, alternate walking aids or adaptations to the rollator may need to be considered.
Some easy adjustments that can help those with hand deformities use rollator walkers more easily include:
- Installing a one hand braking system that controls both brakes simultaneously
- Modifying the cable tension screw to loosen or stiffen the hand brake