Abstract
Falls are the main cause of morbidity among older adults. In this context, assistive gait devices are used to improve function and safety. However, inadequate selection and use can result in poor gait and risk of injury.
All patients admitted to our emergency department (ED) undergo a medical evaluation in which, based on their clinical condition, the protocol for indication and training in the use of walking aids can be triggered. Patients need to be clinically stable and have enough physical and cognitive function to benefit from it. Once the patient is deemed able, the next step is an assessment of needs and potential benefits. After the patient and his proxy agree to undergo specific evaluation and training, the physician or the ED nurse calls the physical therapy team to carry out a broader assessment that includes the Timed Up and Go (TUG) test.
Following the functional evaluation, the physical therapist identifies the mobility needs of the patient and indicates the most appropriate walking device. The TUG test is performed again with the use of the mobility aid device and the results are compared to confirm the improvement in the patient’s performance regarding balance and mobility. Finally, the physical therapist refers the patient to the rehab center of our hospital for further rehabilitation, if applicable, and provides a written document with the type of the suggested device and possible purchase locations.
Hospital Sírio-Libanês is a leading philanthropic tertiary hospital in São Paulo, Brazil. It has 474 beds, 33 specialized centers, and is certified by the Joint Commission International. Its Emergency Department (ED) receives more than 90,000 visits every year, and, since 2017, it has housed a geriatric ED program (Pronto Atendimento Geriátrico Especializado [ProAGE]). ProAGE is an initiative designed to provide high-quality, specialized care to older adults in the ED. In 2019, ProAGE received the Level III geriatric ED accreditation (GEDA) of the American College of Emergency Physicians (ACEP) and became the first of its kind in the southern hemisphere. In 2022, ProAGE joined the Geriatric Emergency Department Collaborative (GEDC) and to this day remains its only center in South America.
This manuscript will discuss the institutional protocol for the indication of mobility aids and training older patients to use them safely which was devised to adhere to international guidelines and comply with GEDA.