title: Use of a cane for ambulation: marker and mitigator of impairment in older people who report no difficulty walking.
abstract: OBJECTIVE
  To measure disability, patients are often asked whether they have difficulty performing daily tasks. However, recent work suggests that functional problems may be detected earlier by inquiring about modifications in the way tasks are performed. We sought to describe the characteristics of older people who deny difficulty walking but nevertheless have modified the manner in which they walk, by use of a cane. We also tested the hypothesis that, among older people who deny difficulty walking, those using a cane have more mobility problems and are at greater risk for future mobility problems than those not using a cane.
  
  
  METHODS
  Longitudinal survey study, with measures at baseline and 2-year follow-up.
  
  
  METHODS
  Population-based survey of urban older people.
  
  
  METHODS
  One thousand two hundred fifty-one community-dwelling older persons without severe cognitive impairment who reported no difficulty walking at baseline.
  
  
  METHODS
  Self-reported health, activities of daily living (ADL), and mobility status.
  
  
  RESULTS
  Among older people who denied difficulty walking, those who used a cane at baseline (7 of subjects) were older and more likely to have taken medication for a heart condition or arthritis, to have an ADL deficit, and to have been hospitalized in the past year. They were less likely to have walked for pleasure in the past month and more likely to report difficulty crossing roads or intersections. Moreover, those using a cane at baseline were more likely to develop new mobility problems at follow-up. For example, 15 of those who used a cane at baseline reported new difficulty walking at follow-up, compared with 2 of those who did not use a cane.
  
  
  CONCLUSIONS
  Older people who deny difficulty walking but who use a cane are at greater risk than those who do not use a cane for the development of difficulty walking and other new mobility problems. Asking patients about task modification rather than difficulty alone may be a more sensitive way to detect early or mild functional problems.
authors.affiliation: Department of Medicine, Division of Geriatrics, UCSF/Mt. Zion Center on Aging, University of California San Francisco, USA.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Pine
authors.forename: Barry
authors.initials: B
authors.lastname: Gurland
authors.forename: Mary-Margaret
authors.initials: MM
authors.lastname: Chren
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002183:Canes; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D008297:Male; D012306:Risk; D016138:Walking