Walking Aid and Locomotion Knowledge in Emergency Rooms (WALKER 1) for Elderly People (WALKER 1)

Walking Aid and Locomotion Knowledge in Emergency Rooms (WALKER 1): Training and Provision of Walking Aids to Promote Autonomy and Mobility of Elderly People in Emergency Care - a Randomized Clinical Trial

Older adults have higher rates of emergency department admissions when compared to their younger counterparts. Mobility is the ability to move around but also encompasses the environment and the ability to adapt to it. Walking aids can be used to improve mobility and prevent falls. According to international guidelines, they must be available in Geriatric Emergency Department. This study aims to evaluate the effectiveness of a program of training and provision of walking aids (WA), associated or not with telemonitoring, on mobility, quality of life, fear of falling, and risk of falls up to 3 months in older adults cared for in an emergency department.

A randomized clinical trial will be carried out in the emergency department of Hospital Sírio-Libanês. Participants will be randomized and allocated into three intervention groups, as follows: A) Walking aid group; B) Walking aid and telemonitoring group; C) Control group. Patients will undergo a baseline evaluation encompassing sociodemographic and clinical data, mobility in life spaces (Life Space Assessment), gait speed, muscle strength, functionality (Barthel Index, Katz index, and Lawton-Brody Scale), quality of life (Euro Quality of Life Instrument-5D), fear of falling (Falls Efficacy Scale International), history of falls, cognition (10-Point Cognitive Screener) and mood (15-point Geriatric Depression Scale) before the intervention. Gait time and fear of falling will be assessed again after the intervention. Finally, mobility in life spaces, functionality, quality of life, fear of falling, history of falls, cognition, and mood will be assessed 3 months after discharge from the geriatric emergency department through a telephone interview.

This study will be blind for the researchers involved in the post-telemonitoring assessments. Also, the data will be analyzed by a researcher who is not involved in the interventions or the assessments.

Participants will receive the walking aid and training in the use of the device associated with telemonitoring.

A physiotherapist will identify the mobility needs and will indicate the most appropriate walking aid (cane or walker).

Telemonitoring will occur every two weeks for three months after the emergency department discharge, through video call (about 15 minutes). On these opportunities, the importance of using mobile devices and the guidance on safe gait will be reinforced.

Participants will receive verbal guidance and printed material with guidance on safe walking and fall prevention.

LSA is a scale which allows the characterization of mobility in life-spaces specifically frequency, need for mobility aids and the help of third party in the last 4 weeks

Functional capacity assessment by sit and stand completely in a chair (as often as possible during 1 minute)

EQ-5D evaluate quality of life in five health dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, and self-rated health on a visual analog scale

10-CS consists of a brief cognitive screening which evaluate temporal orientation, verbal fluency and three-word recall

Fall history evaluate occurrence of falls (including data location, associated injuries, need for special care after the fall) and the total number of falls

Inclusion Criteria: 65 years or older Admitted to the Geriatric Emergency Department of Hospital Sírio-Libanês Willing and able to give informed consent Least one of the following for indication and training of mobility aids: reduction of postural instability; improvement of motor control; increase of somatosensory feedback; reduction of biomechanical overload; safe promotion of autonomy; fall history (in the last six months). Exclusion Criteria: Altered level of conscience need for supplemental oxygen (≥3L/min) respiratory distress hemodynamic instability postural instability with a tendency to fall backward cognitive impairment that limits the use of walking aids hospitalization after Emergency Department evaluation Delirium

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