What is the appropriate management for a geriatric patient with a history of falls, likely due to conditions such as osteoporosis or Parkinson's disease, who requires a walker glider with wheels for stability during ambulation or standing?

Walker Glider Prescription for Geriatric Patient with Fall History

For a geriatric patient with a history of falls requiring ambulatory support, prescribing a walker glider with wheels (rollator) for 365 days with one refill is appropriate, provided the patient has sufficient balance, upper body strength, and cognitive function to safely operate this device. 1

Device Selection Rationale

A four-wheel rolling walker (rollator) is suitable for higher-functioning individuals who do not need to fully off-load a lower limb and who need rest breaks for cardiopulmonary endurance reasons, though it is the least stable type of walker. 1 This device provides:

• A large base of support for patients with poor balance or bilateral lower limb weakness 1
• Greater functionality and easier maneuverability compared to standard walkers without wheels 1
• The ability to support patients who cannot always bear full weight on their legs 1

Critical Safety Assessment Before Prescribing

Before finalizing this prescription, you must verify the patient can safely use this device:

• Perform the "Get Up and Go Test" to assess gait stability and patient safety 2
• Evaluate if the patient has sufficient balance, upper body strength, and dexterity to safely operate the device 1, 3
• Assess cognitive function, as walkers require greater attentional demands than canes 3

If the patient cannot pass the Get Up and Go Test or demonstrates significant instability, consider a more stable two-wheel rolling walker or standard walker instead of a four-wheel rollator. 2, 1

Proper Sizing and Patient Education

The top of the walker should be the same height as the wrist crease when the patient stands upright with arms relaxed at their sides. 3

• Proper sizing is essential to avoid musculoskeletal strain and maintain safety 3
• Most patients with assistive devices have never received proper instruction and often have devices that are inappropriate, damaged, or incorrectly sized 3
• You must provide hands-on training or physical therapy referral for proper device use 1, 3

Comprehensive Fall Risk Management

Prescribing the walker alone is insufficient—you must implement multifactorial fall prevention interventions simultaneously:

Mandatory Medication Review

• Review and modify all medications, particularly if the patient takes ≥4 medications or any psychotropic drugs 2, 4
• High-risk medications requiring special attention include vasodilators, diuretics, antipsychotics, sedative/hypnotics, benzodiazepines, and antidepressants 2

Exercise and Physical Therapy

• Offer long-term exercise and balance training, which reduces fall risk by 23% 4
• Balance and functional exercises, gait training protocols, and lower extremity strength training are essential 4

Underlying Condition Management

For patients with osteoporosis:

• Check vitamin D levels and ensure adequate supplementation (≥800 IU daily) 5, 4
• Consider whether bisphosphonate therapy is appropriate based on fracture risk and life expectancy 5
• Order DEXA scan to assess bone mineral density and fracture risk 4

For patients with Parkinson's disease:

• Recognize that these patients have major reduction in bone mass density compared to age-matched controls 6
• Implement both fall prevention strategies and osteoporosis treatment, as randomized trials show anti-osteoporotic drugs significantly reduce fractures in PD patients 6

Environmental Assessment

• Arrange home safety assessment to identify hazards such as poor lighting, loose carpets, and lack of bathroom safety equipment 4
• Environmental modification alone without other interventions is not beneficial 4

Common Pitfalls to Avoid

• Do not discharge or prescribe the walker without performing the Get Up and Go Test 2
• Do not overlook medication review, especially in patients on four or more medications 2
• Do not prescribe a four-wheel rollator for patients who need to fully off-load a lower limb—they require a more stable two-wheel walker 1
• Do not assume the patient knows how to use the device properly—most have never received instruction 3

Follow-Up Requirements

• Arrange expedited outpatient follow-up within 1-2 weeks 4
• Routinely evaluate the assistive device to ensure proper height, fit, and maintenance 3
• Conduct annual fall risk reassessment 4
• Screen for depression using PHQ-2 and cognitive impairment if not already performed 4