Walking aids: which one, and who should fit it?

The person who settles it is a physiotherapist or an occupational therapist. They watch your relative walk, stand up out of a chair and turn round, and they choose from that rather than from a description over the phone. Guy's and St Thomas' falls guidance tells people to ask a physiotherapist what would suit them, and the NHS page on walking aids and wheelchairs says to ask for advice on the correct height and fit.

Pain in one hip, weakness down one side, poor balance and running out of stamina after fifty yards all look like unsteadiness from the kitchen doorway, and each points at a different aid. Parkinson's is the clearest case: Parkinson's UK states that the wrong walking aid can make freezing worse, which is why freezing and falls with Parkinson's is worth reading before anything is ordered.

If a fall has already happened, what to do after a fall comes first. The NICE guideline on falls in older people sets out what should follow one: a falls prevention exercise programme, and a home hazard assessment that NICE says an occupational therapist should carry out wherever possible.

Two rows deserve saying out loud. A frame with no wheels is the steadiest walking aid made, and it asks somebody to lift it and set it down for every step, which is slow enough that people give up and hold the furniture instead. A rollator is the opposite. It will walk to the postbox and back, and it moves whether the person is ready or not, so it suits somebody with the hand strength for the brakes. South Tees Hospitals note that wheeled frames are designed for indoor use, which is why a house often ends up with two aids rather than one.

The condition usually narrows it before the therapist does. Weakness down one side changes which hand can hold anything, and transfers with one-sided weakness covers the getting up and sitting down. Somebody recovering from a hip fracture is usually sent home with a frame and moved down to sticks as the leg takes weight again, so the first aid is a stage rather than a verdict.

1. 1

   Set the height against the wrist

   Every aid

   Standing up straight with shoes on and arms hanging loose, the top of the handle should come level with the crease of the wrist, which is how Guy's and St Thomas' put it. Check every leg is on the same notch.
2. 2

   Put a single stick in the opposite hand

   Sticks

   NHS Lanarkshire guidance is to hold the stick in the hand opposite the weak or painful leg, so the stick and that leg meet the ground together. Where the problem is balance rather than pain, the same guidance says use whichever hand is more comfortable.
3. 3

   Move the aid, then the weaker leg, then the other

   Walking

   The stick or frame goes forward about one step length, then the weaker leg comes level with it, then the stronger leg. With a frame, step into the middle and leave a gap at the front bar.
4. 4

   Going up, the good leg leads

   Stairs

   Up: the good leg onto the step, then the affected leg to the same step, then the stick. Down: the stick onto the lower step first, then the affected leg, then the good leg. Hold the handrail with the free hand. Frames and rollators do not go on stairs at all.
5. 5

   Stand up from the chair, never from the frame

   Chairs

   Push up on the arms of the chair and take hold of the aid once you are standing. Pulling up on a frame tips it, and South Tees Hospitals say plainly not to stand holding the handles.

NHS Lanarkshire's guidance on the four-wheeled walker is worth following closely. Lock the brakes before sitting, hold the handles while lowering yourself, and push up on the handles to stand. Keep your fingers near the brakes while walking so the frame cannot run away downhill, and do not hang shopping bags from the handles, because the weight on the back tips it when the person lets go.

If the worry underneath this is what happens when nobody is in the house, an aid is only part of the answer. Pendant alarms and sensors covers the rest, and the right equipment to aid the elderly covers the rails, raisers and bathroom equipment beside it.

The council route is the one families skip, and it is the one that brings an occupational therapist into the house. How to ask for a care needs assessment sets out what to say on the phone. If your relative is in hospital, raise the walking aid with the ward before discharge, and hospital discharge explained has the order things happen in. If they are over State Pension age and need help with personal care or supervision, Attendance Allowance is paid in cash and can be spent on equipment.

If you want somebody alongside while your relative gets used to a new frame, you can search for carers near you and compare their rates and message the ones you like before committing to anything. Carers on PrimeCarers charge around £18 to £25 an hour with our fee included, against £28 to £35 an hour for an agency visit. Every carer has had an identity check, a right to work check and an enhanced DBS check on the Update Service, and has been interviewed online, and they hold insurance while they work. We do not check qualifications or training, so ask a carer what experience they have of helping somebody walk with a frame.

People refuse aids because of what a stick says about them rather than what it does. Naming the thing they want to keep doing, the Sunday walk or the bus into town, usually goes further than talking about safety, and companionship visits built round that walk are a different booking from personal care.