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Muscle strength decline and fall risk in older walking aid users: a scoping review of biomechanical and clinical evidence

Year: 2026
Type: article
Study design: Systematic Review
Abstract: Background Walking aids—particularly rollators and wheeled walkers—are among the most commonly prescribed mobility devices for older adults, intended to enhance stability and prevent falls. Paradoxically, walking aid use has been identified as a marker of elevated fall risk. Age-related muscle strength decline may alter the biomechanical strategies required for safe walking aid–assisted ambulation; however, walking aid use is multifactorial and also reflects cognitive, sensorimotor, and device-competence factors as well as underlying frailty. To date, no review has systematically mapped the intersection of muscle strength decline, walking aid use, and fall risk. This scoping review aimed to map the available biomechanical and clinical evidence linking muscle strength decline to fall risk in older walking aid users. Methods Following the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported per the PRISMA-ScR guidelines, systematic searches were conducted across PubMed/MEDLINE, Scopus, and Web of Science Core Collection (January 2000–March 2026). The Population–Concept–Context (PCC) framework guided eligibility: the population comprised older adults (≥ 60 years) using rollators or other walking aids; the concept encompassed muscle strength decline and fall risk/incidence; and the context included all care settings. Two independent reviewers performed title/abstract and full-text screening, supported by a calibration exercise, pilot screening, and structured consensus procedures. Inter-rater reliability was quantified using Cohen’s κ. Data were charted using a standardized 76-variable extraction form, with biomechanical variables predefined a priori. Critical appraisal used JBI checklists matched to study design and AMSTAR 2 for reviews. Results From 328 identified records across three databases, 262 unique records remained after deduplication. Following title/abstract screening ( n = 262) and full-text assessment ( n = 159), 93 studies were included. Included studies enrolled older-adult populations consistent with the ≥ 60-year eligibility threshold; reported mean ages ranged from approximately 59 to 83 years, and individual study age ranges spanned approximately 60 to 98 years. Pooled participant totals could not be precisely aggregated owing to heterogeneous reporting (see Limitations). The majority were cohort studies ( n = 26; 28.0%) and cross-sectional studies ( n = 12; 12.9%), with 12 randomized controlled trials (12.9%). Six thematic domains were identified: Clinical/Predictive evidence (77.4% of studies), Assessment Tools (73.1%), Exercise/Intervention (57.0%), Technology/Device (47.3%), Biomechanical (26.9%), and Sarcopenia/Dynapenia (4.3%). Only 15 studies (16.1%) focused primarily on walking aid users; the remaining 78 (83.9%) addressed walking aid use as a covariate. Evidence mapping revealed no randomized controlled trials addressing strength- or sarcopenia-specific interventions in walking aid user populations. Conclusions Limited and fragmented evidence exists at the intersection of muscle strength decline and fall risk in older walking aid users. While walking aid use is consistently associated with elevated fall risk, this association is multifactorial, and dedicated, population-specific evidence—particularly regarding muscle strength interventions—remains scarce. Findings should be interpreted alongside contemporary multifactorial fall-prevention frameworks. Future research should prioritize population-specific trials evaluating strength-based fall prevention in walking aid users.
DOI: 10.1186/s11556-026-00436-8
Language: English
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W7208738488
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