Dr. Susan Hunter

Associate Professor in the School of Physical Therapy, University of Western Ontario

Dr. Susan Hunter is an Associate Professor in the School of Physical Therapy at the University of Western Ontario. Her clinical and research interest is in older adult health.

Marguerite Oberle Thomas, RN., BScN.

Consultant Liaison, Fall Prevention Community of Practice sponsored by Parachute

Marguerite Oberle Thomas, RN., BScN., is the Consultant Liaison for the Fall Prevention Community of Practice sponsored by Parachute. She is also a senior devoted to preventing injuries and a former caregiver.

Helping Caregivers determine if their loved one needs a gait aid

Sep 23, 2021 | Blog, Knowledge Exchange

October 2021 blog post written by Dr. Susan Hunter and Marguerite Oberle Thomas, RN., BScN.

Do you work with caregivers of loved ones with dementia? Dr. Susan Hunter has worked extensively with this population and the use of the gait aids. Please share this article with your clientele.

Nobody ever said caregiving is easy. It is especially not easy when your loved one has dementia. You worry about them falling but are uncertain as to what is to be expected and when to take action. Research has shown that people with dementia can learn new skills like exercises or using a mobility aid through repetition and practice, which is frequent training with positive feedback. November is the seventh national Fall Prevention Month and this year we are featuring gait aids

There are changes in balance and walking that occur from the underlying disease process of dementia that make people more unsteady. Balance and gait deficits are common and present early in the disease.

People with dementia have an annual fall risk of 60-80%, (Allan et al. PloSONE 2009) twice that of the cognitively healthy and have a higher risk of serious fall-related injuries, such as hip fractures (Asada et al. Age Ageing 1996).

People with dementia tend to walk slower, take shorter steps and will have difficulty recovering their balance when unsteady. They may also have problems multitasking, such as walking and talking at the same time. Thinking, balance and walking problems are common and progressive in dementia, leading to impaired mobility, falls and fall-related injuries. The mechanisms for the increased risk of falls in people with dementia, are not fully understood, yet balance and walking problems and leg weakness are prominent risk factors. The severity of the dementia also increases risk as the changes in the brain directly affect a person’s ability to control movement.

A common treatment option for balance and walking problems is the use of a gait aid, such as a 4-wheeled walker, as it increases stability for the person. The good news is that many people with dementia can be assessed and effectively trained to use gait aids (e.g., cane or walker), especially early in the disease process.

Studies have found that changes in gait precede progression to dementia.

While it can increase mobility, the use of gait aids by people with dementia can also result in increased falls risk. The increased risks are due to increased demands on the brain to use the gait aid or to do multi-tasking. It can be difficult to use the aid and do another task such as carrying something. People may start use of the aid late in the disease and thus may have more trouble learning how to use it correctly and may lack insight on safety (e.g., forget to put on the brakes). Since many people obtain mobility aids without consultation with health care professionals, there can be unsafe use and maintenance of equipment.

Healthcare professionals with special training in the assessment, prescription and training in use of gait aids include physical and occupational therapists. The therapists will meet with people individually to take a history, perform a physical assessment for balance, walking and leg strength. The therapists determines the most appropriate gait aid. As balance, walking and leg strength problems are progressive it is good to have re-evaluations. The healthcare professional will determine the type of aid, appropriate size and training.

Used gait aids may be available commercially, but please consult with a professional before purchasing.

Therapists will work to avoid errors and minimize inaccurate performance during the learning process to reduce frustration and increase participation of the person with dementia. Therapists will continue training and encourage exercises to keep muscles strong.

Conclusion: If you notice your loved one is no longer walking with the same skill or seems to stumble more or has actual falls, please have him or her professionally assessed. People with dementia can and do learn to use mobility aids effectively. Professionals also help with ongoing assessment of your loved one and with the ongoing maintenance of the aid.

In interviews on the experiences of people with dementia and their care partners acquiring and using a gait aid we learned the following valuable information. (Hunter et al. Disabil Rehabil 2020)

Gait aid use is regarded as increasing independence by people with dementia and their care partners.
Falls risk associated with gait aid use was not well known and care partners perceived gait aids as a means to reduce falls.
Most people do not see a healthcare professional when they acquire a gait aid, yet there is a role for healthcare professionals to be involved in the prescription, provision and training of people living with dementia in the use of gait aids in order to increase the uptake of aids and their safe use.
There can be numerous challenges associated with the use of a gait aid, from different terrains and crowds, space to use inside homes, to size and weight of the equipment so please discuss with your health care provider.

Dr. Susan Hunter is an Associate Professor in the School of Physical Therapy at the University of Western Ontario. She has been a physical therapist for 30 years and completed her PhD in 2009 evaluating fall risk in community-dwelling older adults. Dr. Hunter’s research interests are the rehabilitation of older adults and their experience of falls, frailty and mobility decline. She is the Vice-President of the International Association of Physiotherapists Working with Older People (IPTOP).