Choosing Walking Shoes for the Elderly

Changes to Your Feet as You Age

Your feet will change in shape and size through the years, and your needs in footwear will change due to common conditions. These changes include:

  • Foot widening and lengthening: It is normal for your feet to become wider, longer, and flatter as the ligaments and tendons lose strength and elasticity. Injuries to them accumulate. It is normal to see your shoe size increase by a half size or more.
  • Foot swelling: You may experience foot and ankle swelling due to problems of circulation or the effects of medication and health conditions. You may need a larger pair of shoes for the days when you have more swelling. If you wear compression socks, you need to ensure your footwear can accommodate them without being too tight.
  • Thinning natural cushioning: You also lose the fat pad that cushions the bottom of your foot. You may notice discomfort and fatigue more and more as this natural padding is lost. Cushioned shoes or insoles can help.
  • Skin changes: Dry skin as you age can lead to calluses and you may get cracked skin on your heels.
  • Foot problems can worsen: Bunions, hammertoes, and other foot conditions continue to develop. You may experience the long-term effects of wearing shoes with pointed toes and elevated heels
  • Gait changes: Arthritis, neuropathy, and other conditions can change your gait, slowing your overall walking speed and sometimes resulting in a limp. This can result in placing pressure on different areas of the foot, leading to discomfort. Gait changes often develop after age 70 and are seen in the majority of people over age 80.
  • Bone density loss: Thinning bones are more at risk of fracture, including your foot bones.
  • Unable to touch your feet: You may lose flexibility as you age and have difficulty bending over or crossing your leg. If you can’t reach your feet easily, it becomes a challenge to put on your socks and shoes. You may need assistive devices such as a sock aid and to switch to a non-laced shoe. You may not be able to trim your toenails or wash and dry your feet.
  • Foot problems due to diabetes: More than one in five people have diabetes after age 65. This often results in loss of blood circulation and sensation in the feet. You will need to ensure your shoes fit well and do not rub and cause blisters, which can lead to infection.
  • Balance issues: As you age, your ability to balance and correct yourself if you slip or trip is reduced. You may be on medication that can make you dizzy as well. You will need shoes that have non-slip soles and enough structure for good support, including those with high collars.

If you are active and often enjoy walks for health and fitness, athletic walking or running shoes are the best choice. To ensure you are getting the right kind of shoes and they are fitted properly, visit a specialty running shoe store in your area. They don’t just serve young competitive runners. They have many long-time customers who look just like you and have similar needs.

While walking shoes may work, don’t be surprised if they recommend a running shoe instead. Running shoes lead the way in using lightweight cushioning and the latest technology. The right running shoes will flex in the forefoot and have a flat profile with a low heel-to-toe drop.

Look for athletic shoes that have a more rounded toe box and come in widths. New Balance is a brand that has long been known for both. They have a few walking styles with hook-and-loop closure if you prefer. Many models of Brooks also come in widths and they are known for their motion control shoes, the Beast for men and the Ariel for women.

Ask the salesperson to help you lace the shoes to get a good fit. You want to ensure they are not too tight over the forefoot but can be tightened at the ankle so your heel stays in the heel cup. There are tricks you can use.
Don’t skimp on getting good socks. Look for sweat-wicking socks that are anatomically-shaped that can reduce your risk of developing blisters. A running store is a good source for these.
Always shop for shoes later in the day when your feet may be a little more swollen. Wear the socks you plan to wear with the new shoes so you can ensure you get a correct fit.

Shoes for Everyday Walking for the Elderly

You may want to visit a specialty foot and ankle store to get recommendations for inserts, shoes, and shoe modifications. If you have significant foot pain or gait difficulties, discuss these with your doctor or podiatrist for a full assessment. Supportive and cushioning insoles can give you greater comfort or you may need a prescription orthotic.

For shoes you can wear when shopping, socializing, or around the house, there are brands and sources of designs that are useful for the elderly:
  • Propet is a brand that has a variety of shoe designs that include hook-and-loop tab closure rather than laces, extended widths, and other features you may need. They have a range of styles including athletic shoes, dress shoes, boots, sandals, and slippers. Many of their styles are rated as Medicare-approved diabetic shoes.
  • New Balance makes several models with hook-and-loop closure rather than laces. These include the 577, 813, which are Medicare-approved as diabetic shoes, and the 411 and 928, which come in extra wide. These shoes have leather construction and come in colors such as black, white, and tan.
  • Silvert’s sells adaptive clothing and footwear from a variety of manufacturers that can address needs such as very wide-fitting shoes, shoes with added depth to accommodate orthotics, shoes that are adjustable for foot swelling, and shoes with anti-slip soles.

Footwear to Avoid

These types of footwear may contribute to problems as you age. Wear them infrequently or with caution:

  • Pointy-toed boots or shoes: If you love your cowboy boots, it can be tough to give them up. But boots and pointy-toed women’s shoes constrict your toes and can rub and cause sores. Look for square-toed or round-toed versions that give your toes wiggle room.
  • Shoes with heels taller than 2 1/4 inch: An elevated heel raises your risk of turning your ankle and doing more damage if that happens. This is true for wider heels as well as skinny ones.
  • Slick-soled shoes: You need to reduce the chances of slipping and falling. Look for non-slip soles on all of your footwear.
  • Low-back or backless clogs, sandals, or flip-flops: You risk walking right out of these types of shoes on an incline and you can’t get a good walking motion while wearing them. Look for styles that have a comfortable, padded backstrap. Avoid any sandals that give you hot spots or blisters where the straps rub.
  • Flimsy shoes: You need more structure to cushion and support your foot as you age. Even the slippers you wear around the house should have a firm sole.
  • Rocker-soled shoes: This type of shoe is not recommended if you have any difficulties with balance or your gait is not steady.
  • Old, worn-out shoes: Shoes lose their support and cushioning as they age. You need to check your shoes and get new ones when you see wear on the sole, upper, or inside.

  How to Reduce the Chances of Falling Among Older Adults

Education and guidance are key to preventing fall-related hospitalization for those at risk

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“fall plan of care” can help spare older adults from fall-related hospitalizations, researchers report.

A team at the State University of New York at Binghamton reported that older adults who were enrolled in a Centers for Disease Control and Prevention (CDC) initiative experienced better outcomes. The initiative aims for fall prevention by raising awareness and discussing strategies with potential victims.

The research, published in the September issue of the Gerontologist, showed that those deemed at risk for falls who had a “fall plan of care” were 40 percent less likely to experience a fall-related hospitalization than those who were at risk but did not have such a plan.


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Although fall prevention guidelines have long been available to health care providers, they often fail to provide them to patients, researchers wrote. The CDC initiative relies significantly on intervention, with activities like strength and balance programs, medication management, occupational therapy and corrective eyewear.

The study noted the financial and human cost of falls.

Previous research has established that the average cost of a fall-related hospitalization is $30,000. In addition, after hospitalization there is an “increased burden on informal caregivers,” the study noted.

For every year an older adult ages, the chance of a major fall increases by 10 percent, the data showed.

Now let’s talk about your 324 other dementia risk factors

What’s Really Giving You Alzheimer’s

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It’s no surprise that old age is the biggest influence on whether you get Alzheimer’s, but you may raise an eyebrow over what can seem like an endless scroll of other potential risk factors for the deadly brain disease. After all, recent studies have tied an increased risk of dementia to breathing polluted air, drinking a daily diet soda, undergoing anesthesia, being “sleepy” in the afternoon, and, if you’re a woman, to either having lots of kids or not having enough of them, depending on which set of results you believe.

For those who feel like throwing their arms up in defeat, “it’s important to remember that risk factors are just that — factors, not fate,” says Gregory Jicha, M.D., a professor at the University of Kentucky’s Sanders-Brown Center on Aging. “We see folks all the time who have done everything right and still come down with dementia, and those who do everything wrong and never have an issue. It’s not something you can completely control.”

What’s more, experts note that many studies are quite limited in scope, with findings that may be interesting or useful to an Alzheimer’s researcher — as one piece of information in a complex array of genetic and environmental factors possibly causing changes in the brain — but that aren’t meant to influence behavior on an individual level. Findings that seem eerily specific  — say, how “sleepy” someone feels at 3 p.m., or how he or she responds to anesthesia — may in fact reflect larger, underlying conditions, such as how well someone sleeps in general, or how healthy he or she is before going into surgery.

That said, it is helpful to understand a smaller set of proven, significant and actionable risk factors, Jicha says. You may not be able to turn back the clock (or move to a less-polluted city, or change the number of children you had), but there is plenty you can do to protect your brain health. We asked experts to pinpoint the most important dementia risk factors — the ones you really need to focus on.


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Cardiovascular conditions

Anything that blocks or reduces blood flow in the body — a stroke, heart disease — also increases your risk for dementia. After all, your brain has a critical need for uninterrupted blood circulation, so it’s important to keep those vessels free and clear. Quit smoking, and work to get conditions that can harm your vascular health under tighter control. These can include high blood sugar, high cholesterol, obesity and, especially, high blood pressure. High blood pressure, or hypertension, is strongly associated with an increased risk of dementia — more so than any other single health condition. This may be in part because of its prevalence, says Jicha, who notes that between 70 and 80 percent of older adults have high blood pressure. “It’s also a silent risk factor that you can carry for years without realizing it,” he says. “That’s not the case for diabetes or obesity. It’s hard to run away from those conditions the way you can with high blood pressure.”

However, it’s best to talk to your doctor about your optimal blood pressure levels, says Joe Verghese, a professor at Albert Einstein College of Medicine and chief of geriatrics at the Montefiore Health System. “Blood pressure levels that require treatment in someone who is 60 are different than in someone who is 80,” he says. “The older you are, the more leeway you have in how high your blood pressure can safely be.”

Physical inactivity

“Your brain is not some isolated organ,” says James Hendrix, Ph.D., director of global science initiatives for the Alzheimer’s Association. “What’s healthy for the rest of your body is healthy for your brain.” That’s particularly true for physical activity, which not only improves your overall vascular health, but also may directly impact your brain’s ability to generate new nerve cells.

In animal studies, scientists have found that sustained moderate exercise (in humans that’s about 20 to 30 minutes) causes the body to produce a neurochemical called BDNF, or brain-derived neurotrophic factor. This chemical increases the rate at which new nerve cells are created by up to 500 percent. “In humans, we can see the BDNF increase, but we can’t crack open their brains to see whether they’ve given birth to new neurons,” says Jicha. “Still, we believe it may influence risk directly by compensating for the neurons lost in the disease process.”

A mental rut

Some recent studies have found that a high level of education may help keep dementia at bay. But experts say the association between extra years spent in school and a lower dementia risk likely has more to do with mental stimulation than whether your name ends with an M.A. or a Ph.D.

Verghese serves as clinical director for the Einstein Aging Study, which has found that both higher education and engaging in high levels of stimulating activities are protective against dementia. “But if you consider them both together, having education decades ago is less important than engaging in mentally stimulating activities right now,” he says. “In fact, in patients who already have dementia, engaging in mentally stimulating activities can help slow cognitive decline and prevent behavioral disturbances, even more so than some medications.” Keeping your brain active is a lifelong pursuit, but it’s especially important as you grow older, when retirement can mean fewer day-to-day mental challenges. Consider taking advantage of opportunities to go back to school (there are colleges in almost every state that offer free or reduced tuition for senior citizens.) Even the classroom-averse can take up puzzles or brain games, learn a new language or join a book club — anything to stretch your mind.

Social isolation

Losing a spouse can increase your risk for dementia. So can a lack of friends or other social connections. The common thread: isolation and loneliness. Among older adults outside of nursing homes or other institutions, nearly a third live alone. And without a job, nearby family or other regular opportunities to socialize, it’s easy to find yourself engaged in mostly solitary pursuits. “Not everyone wants to go to a senior center and engage in activity,” says Verghese. “But it’s clear that social stimulation is important for cognitive health.” Anything you can do to break free from isolation will do your brain good. This may include taking a class (see above), volunteering, joining a club or exercise group, attending religious services, going to lectures or book readings, or even becoming a regular at a local cafe.

Hearing loss

“Deafness is something we didn’t recognize as a risk factor even 10 or 15 years ago,” says Verghese. However, studies show that it has an effect on cognitive health, perhaps by cutting sensory input to the brain. Indeed, people who don’t get their vision checked or have untreated vision loss also have been shown to be at higher risk of cognitive decline. Hearing loss also has the effect of magnifying social isolation, making it difficult to participate in normal activities and leading to loneliness, stress or depression. The good news: “Good hearing aids are expensive, some people are embarrassed to wear them, but the fix is easy,” says Verghese.

Head injury

“When I was a kid, there was no such thing as a bike helmet,” says Jicha. There probably wasn’t when you were a kid, either, so growing up or in young adulthood, you may have had a head injury and thought nothing of it — this falls under that “non-modifiable” category of dementia risk factors, such as your age. Today, however, it’s vital to protect your noggin. As older adults continue to stay active long past retirement age, it’s important to realize that additional injuries can be catastrophic to the brain. Traumatic brain injury, or TBI, increases your risk of chronic encephalopathy (a condition affecting many retired professional athletes) as well as Alzheimer’s disease. “It’s not just ‘Did you have a significant injury when you were in Vietnam?,’” says Jicha, “but ‘How are you protecting your head today?’”

Sleep problems

The quality of your sleep can degrade as you get older, but if you’re regularly experiencing insomnia or you suspect you may have sleep apnea, a condition in which breathing is repeatedly interrupted during sleep, and that is most commonly marked by loud snoring, you should talk about it. “Studies have shown an association between apnea and disrupted sleep and a higher risk of Alzheimer’s, and the risk seems to really increase later in life,” says Hendrix. “Apnea seems to increase risk even independent of other issues, like obesity,” which is a factor in both sleep apnea and dementia. Part of the reason may be that apnea disrupts oxygen flow, says Hendrix, meaning parts of the brain may not be properly nourished. Sleep apnea has also been strongly linked to higher risk of stroke.

There’s also evidence that sleep is when our bodies are most able to get rid of amyloid proteins, which are made in the brain and may contribute to Alzheimer’s disease by disrupting communication in the brain and killing brain cells, says Jicha. “Everyone makes these proteins, but the reason we don’t all have Alzheimer’s is that we’re able to get rid of them more efficiently than they’re produced,” he says. “But that balance can tip as we age, and the role that sleep may play is intriguing.” The good news is that there are more and better treatments than ever for people with sleep apnea, including non-constricting supplemental oxygen masks, nasal-only masks and corrective surgeries. “It’s no longer CPAP or nothing,” says Jicha.

Poor diet

You may have heard that specific foods or supplements can either help ward off dementia (fish oil!) or put you on track for the disease (diet soda!). But experts say that the overall quality of your diet is much more important than any specific item in your pantry. “Are we saying you should never eat fast food? No,” says Hendrix. “But you shouldn’t make it a regular part of your diet.” So is there a best way to eat? Hendrix suggests abiding by the Mediterranean diet, which has been shown to reduce your risk of a number of serious health conditions, including dementia, most likely by improving vascular health but possibly also by impacting the buildup of amyloid proteins in the brain. So fill your plate with lots of produce like leafy greens, fish and foods high in unsaturated fats such as nuts and olive oil.