The effect of walking sticks on balance in geriatric subjects (2024)

Abstract

[Purpose] Guidelines and clarity regarding the information for deciding the need forwalking sticks and the suitability of these sticks is insufficient. This study aimed toevaluate the suitability of walking stick and its effects on the balance in the elderly.[Subjects and Methods] A total of 39 elderly subjects aged between 65–95 years (mean age,76.15 ± 8.35 years) and living in the Residential Aged Care and Rehabilitation Center wereincluded. Sociodemographic data of the individuals, the material of the walking stick, whomade the decision of usage and length of walking sticks were questioned. The Berg BalanceScale (BBS) scores were used to evaluate balance. [Results] Subjects’ BBS scores whileusing the walking stick were higher than that without the walking stick. A significantdifference was observed in BBS scores obtained with the stick and without the stick,according to body mass index parameters. Majority of the subjects also started to usewalking sticks by themselves. No significant difference was observed between the ideallength and actual length of the walking stick was used. [Conclusion] Our studydemonstrated that the elderly generally decide to use walking stick by themselves andchose the appropriate materials; which improves their balance.

Keywords: Walking stick, Balance, Geriatric

INTRODUCTION

Balance is the result of control of the center of gravity on the boundaries ofstabilization¹⁾. In literature, theconcepts of balance reactions, posture, postural reactions, and postural control are used todescribe balance²⁾. Balance is required forthe locomotor system to exhibit its optimal function, to perform activities of daily living,to protect the stability position while passing from one position to another and to liveindependently in the community^3,4,5). To maintain balanceand body posture, there has to be a continuous flow of information about position andmovement from every part of the body, including the head and eyes. Meanwhile, balanceinvolves complex interactions of various systems, particularly the musculoskeletal andneuronal systems³⁾. Additionally, posturalbalance is achieved through the collaborative work of the muscle, bone, ligament,physiological system, and the nervous system. Motor and sensory loss with aging, observed inthese systems, affects postural balance negatively.

In recent years, the elderly population is growing both numerically and proportionally⁶⁾. With ageing and modernization, theincidence of many diseases has been increasing²⁾. In addition, the cost incurred because of the disease affect theleast developed countries¹⁾. In 2025, it isestimated that 70% of all elderly people will be living in the least developedcountries⁷⁾.

External support is needed to increase the sensory input and psychological support inphysical disabilities while walking. The elderly start using a walking stick because ofbalance and postural disorders and to prevent falling because of these disorders. A walkingstick is the most preferred walking aid, because it is easy to use and is accepted by thesociety⁸⁾. In literature, it has beenindicated that the walking stick is used to improve postural stability and to decrease theload on the weak side of the lower extremities⁹⁾. These sticks are usually held by the stronger side of the body.Therefore, it has been discussed that it may have negative effects on the balance of theelderly since they usually fall on their weak side¹⁰⁾.

In addition, it has been stated that walking symmetry of the walking stick users worsensand causes decreased walking cadence and stride length.

In literature, the guidelines and clarity regarding information for deciding the need forwalking sticks and the suitability, advantage, and disadvantage of these sticks areinsufficient. This study aimed to evaluate the suitability of the walking stick for theelderly using it. For this reason, the effects of using traditional walking sticks forbalance was investigated.

SUBJECTS AND METHODS

In our study, 39 elders aged between 65–95 years (mean age=76.15 ± 8.35 years) and livingin the Residential Aged Care and Rehabilitation Center were included. The ethics committeeof Mustafa Kemal University approved the study. Each subject was informed about the studyand gave their written informed consent to participate. The purpose and test procedures wereexplained to all subjects who were included in the study prior to enrollment.

Sociodemographic data of individuals, the material of the walking stick, person who madethe decision of usage, length of walking sticks and advantages and disadvantages of usingwalking sticks were questioned. The length of the walking sticks used was measured using atape measure. The ideal length of a walking stick was determined when the elbow was in20–30° flexion and the bottom part of the walking stick was 15 cm from the feet⁸⁾.

Standardized Mini-Mental State Examination (MMSE) was also used to evaluate the cognitivelevel of the individuals, and Berg Balance Scale (BBS) was used to measure the effects ofthe walking stick on balance.

The MMSE is a popular test used in clinical practice to identify cognitive impairments andto monitor dementia syndromes and response to treatment, and has been used in the field forepidemiological studies. The MMSE is a short, convenient, and standard application that canbe used to assess the cognitive functions of the elderly.

MMSE consists of 11 items and is evaluated over 30 points. It has five main domains namely:orientation, memory, attention and calculation, recall and language¹¹⁾.

The Berg Balance Scale (BBS) is used to evaluate balance disorders and risk of falling¹⁰⁾. The scale consists of 14 items. Balancefrom sit to stand, unsupported standing, unsupported sitting, stand to sit, transfers, eyesclosed standing, standing with feet together, leaning forward while standing, picking anobject from the ground, looking back, turning 360°, tandem and single leg standingactivities have been evaluated. High scores indicate good balance, and the maximum scorethat can be achieved is 56. Scores between 0 and 20 show 100% risk of falling, while scoresbetween 21 and 40 indicated that support was needed while walking due to the increased riskof falling, and finally, scores between 41 and 56 showed that there was no need for supportwhile walking since the risk of falling is very little^{5, 12)}.

All analyses were conducted using the IBM SPSS Statistics program with version 20.0software. An alpha p value<0.05 was considered statistically significant. All data wereevaluated for normality using the Shapiro-Wilk test. Descriptive statistics were used toshow the characteristics of the participants and their mean scores with SD. Wilcoxon Testwas used for dependent measurement; Kruskal-Wallis and Mann-Whitney U Test were used forindependent measurements.

RESULTS

The age of subjects ranged from 63 to 95 years and their average age was 76.15 ±8.35 years. Demographic characteristics of subjects are shown in Table 1.

It was found that 92.1% of subjects’ dominant extremity was right and 76.9% were using thewalking stick with the right extremity, while only 7.9% of subjects’ dominant extremity wasthe left and 23.1% were using the walking stick with the left extremity.

The materials of the walking sticks were plastic, wood, or metal. There was no significantdifference between the materials of the walking stick and the BBS scores that were evaluatedwhile the subjects were using the walking stick (p>0.05). The patients were asked “howthey started to use the walking stick”, and it was found that most (79.5%) of them startedby self-decision. The person that decided about using the walking stick did not affect theBBS scores (p>0.05). There was no significant difference between the length of idealwalking sticks and the length of walking sticks used by the subjects (p>0.05), (Table 2).

The BBS scores obtained while using the walking stick were significantly higher than thatobtained without the walking stick (p<0.05). Subjects were found to be mostly overweight(20.5%) and obese (25.6%). The elderly were categorized into 4 groups according to their BMIscores. It was found that there were significant differences between the scores of the BBSwhile using and while not using the walking sticks in all groups according to BMI scores(p<0.05, Table 3).

There was also a significant difference in the BBS scores between the evaluation scores ofthose with and without walking sticks depending on the body mass index parameters (Table 3), (p<0.05).

DISCUSSION

In the present study, the effects of using walking sticks for balance in the elderly wereinvestigated. According to the average results of the BBS, the risk of falling was very lowwhile they were using a walking stick, and the risk increased to a moderate level when theywere not using a walking stick. There was a significant difference between balance scoreswhile using and when not using a walking stick. It was recorded that they preferred to use awalking stick to support their balance and independence while walking, by self-decision(79.5%). Since there was no significant difference between the ideal and preferred length ofthe walking sticks length, it was thought that the elderly could make the best decision andcould choose an appropriate walking stick for themselves.

In a study conducted by Gerev et al., it has been determined that the body mass index mayaffect the balance and it becomes more difficult to maintain postural stability as the BMIincreases¹³⁾. It was found that therewas a significant difference in BBS scores between those with and without walking sticksaccording to BMI in our study.

Maintaining the balance during walking is quite different from the posture in standing.While standing, the purpose is to keep the center of gravity within the support surface.However, walking disturbs the stability of the body and adaptation is required according toalterations in the gravity line¹⁴⁾. Gaitdisturbances generally start from the age of 60 years, but more significant changes areobserved in the 75–80 years age group.

Civi et al. reported that gait disorders increase in the older age group according to theirphysical disability measurement. The dependence on daily living activities increases andadditional physical disabilities accumulate¹⁵⁾. There is a folded accumulation in physical disabilities in olderages.

According to the results of Tinetti et al.’s study on the elderly living in the community,the risk of falling increased by 8% in 1 year in those who had no risk at that moment andthe risk of those who had at least 4% at that moment increased up to 78% in 1 year¹⁶⁾. It has been observed that the elderlyindividuals begin to use a walking stick due to the decrease in the ability to maintainbalance and increase in the rate of falling and need of psychological and physicalsupport¹⁷⁾. In general, walking aidsticks are preferred more than any other walking aids because they have supportive featuresand carry approximately 15–29% of the weight other walking aids have. In Gunduz’s study, itwas stated that various aids such as walking sticks, crutches, and walkers are used tosupport walking activity and balance, while tripods or quadripods increase thestability¹⁸⁾. According to literature,it was found that the elderly who participated in the study preferred to use a walking stickas an aid. Moreover, a consideration may be that sociocultural sights limit them to usetripods or quadripods, despite having been given more stability.

Beauchamp et al. investigated the effect of walking sticks on walking symmetry. It wasfound that the use of walking sticks improved walking symmetry¹⁹⁾. Similarly, Bateni et al. analyzed the possible effects ofa supportive tool on walking and balance, they obtained that such tools increased balanceand mobility²⁰⁾. In our study, similarresults were obtained. It was observed that the use of a walking stick improved the balanceand the independence level while reducing the risk of fall. Therefore, it has been concludedthat using a walking stick should be recommended to the elderly individuals who have balancedisorders and the risk of falling.

Another important issue related to the using a walking stick in the elderly individuals wasusing them in an appropriate and correct manner. It was also stated that when the elderlyindividuals are trained for using walking sticks, they use them correctly.

Laufer et al. stated that the type of walking stick affects the stability⁹⁾. In our study, although most of theparticipants were using wooden sticks (69.2%), it was recorded that the material of thewalking aid did not affect the balance; although when deciding on one, the type, itslightness, and appropriateness must be considered. It has been concluded that the materialhas no effect on the balance; however, it is important to use a light and suitable walkingstick.

In an aging society, the number of people is continuously increasing, and the need formethods to prevent falls from the elderly and enhance their balance has been made clear²¹⁾. Walking sticks should be considered whena person is unable to maintain his balance such trying to hold on to objects and, even fordoing certain activities and loosing independence. A person who experiences repeated fallsalso needs to be considered as a person who should use a walking stick. In spite of these,walking stick shouldn’t be deemed as a necessity for an elder without balance problems.Additionally, neither should it be seen as an accessory. If the elder is in need of awalking aid, a health professional should suggest it for independence and confidence.However, many elders decide by themselves on when they want to start using walking sticks,but there has been little research on this perspective²²⁾.

Because of this need, our study fulfills this incomplete area despite the study’slimitations. One of which was the limited number of participants preventing a comparisonaccording to the participant age and the walking aid material. In future studies, theduration of usage of the walking stick could also be questioned and its effect on balancecould be analyzed with more participants.

In our study, it was observed that the elderly generally decided to use walking stick bythemselves and chose the appropriate material. In doing so, their balance improved.

In light of these results, to help our elderly community members while making a decision onthe usage of walking aid, health staff must take consider their sociocultural and economiclevels and preferences. In addition, community-based rehabilitation perspectives, seminars,conferences, or any type of education about balance, self-confidence, walking aids, andtheir usage should be provided beginning from the adult age.

Acknowledgments

The authors state that, the study had funding sourced from The Scientific and TechnologicalResearch Council of Turkey, Tubitak.

REFERENCES