The most frequently reported limitation across the aging spectrum is walking, according to the 2011 Profile of Older Americans report from the Administration on Aging, a federal agency that is part of the U.S. Department of Health and Human Services. In 2010, 37 percent of older persons — aged 65 or older — reported some type of disability, and many needed some type of assistance as a result.
According to the report, the rate of limitations in walking among persons 85 and older is much higher (nearly 50 percent reported difficulty) than those for persons 65-74 (about 20 percent).
Physical Changes & Risks
There are multiple clinical problems that can influence and change mobility as people age, such as degenerative joint disease, osteoporosis, changes in the spine that alter balance and normal changes in sensation and sensory issues.
“All of the normal changes of aging can come together as well as disease-related changes,” says Barbara Resnick, RN, Ph.D., AGSF, and chair of the American Geriatrics Society Board of Directors.
People with dementia, as they progress, lose the ability to remember how to walk, for example. Musculoskeletal system injuries, such as a torn rotator cuff , can impact mobility — one common trigger of rotator cuff injuries in the elderly is pushing off with the arms. People with arthritis of the knee, other painful conditions in the legs or weak quadriceps in the thighs often compensate by pushing off with their arms when they rise from a chair, which can injure the shoulder muscles.
Diabetes-related changes in the muscles can influence function as well. Patients with diabetes can develop contracture of digits and limbs as a result of soft tissue thickening in these areas, which can lead to atrophy. Diabetes can also promote atherosclerosis, or hardening or the arteries, which impairs the circulation to many tissues of the body. When the muscles of the limbs are affected, the decreased blood flow can result in cramping and painful walking.
Then, there is the ever-present risk of falling, which can occur when one’s center of balance is off , or be a result of sensory changes, vision issues, peripheral neuropathy and normal decreases in sensation in feet and hands.
“The biggest problem with balance is deconditioning, weakening and lack of use of muscles,” says Resnick. “The muscles we need to hold ourselves up are not always what people use or work hard to maintain and strengthen with aging. It’s not just disease; it’s what we don’t do.”
The Emotion of Aging
Th e variety of physical changes happening to older adults that may impact mobility can lead to a roller coaster of emotions. People commonly think that depression is a normal part of aging, but it’s not, says Pam Toto, Ph.D., OTR/L, BCG, FAOTA, an assistant professor of occupational therapy at the University of Pittsburgh.
“Losing mobility is tied to sometimes losing independence and also losing autonomy,” Toto says. “That’s an added dimension, so it’s not just now I need a walker; it’s maybe I can’t continue to live in my home with a walker.
“Oftentimes it’s the results of the disability, the impact on people’s daily activities, that presents the challenge. There is a difference between feeling lost, feeling sad because I can’t do something that I want to do or needing to change my habits or routines and also being depressed. Depression is a medical condition, and it’s one of the most under-diagnosed medical conditions among older adults. As humans, we sort of logically justify it.”
Clinicians and providers should become familiar with the signs of depression and suggest screening to clients who show signs, or to their caregivers/families. Clinicians and providers can also educate consumers about services and new strategies, routines or habits that allow them to still do things, but maybe in a different manner, to improve quality of life and perhaps prevent or lessen depression.
Reasons for Reluctance
Mobility and accessibility equipment can help to make seniors more independent and keep them safer, but many seniors resist accepting help.
“Generally because these are extremely resilient people, they’re proud, determined and they want to do it themselves,” says Resnick.
Perception is a big reason that some seniors resist using mobility aids, according to Toto.
“Some people think that using those devices gives the perception of looking old,” she explained.
And some seniors may genuinely think they don’t need any aids, especially at home.
“They might think they need a walker, for instance, in a large-space environment, but in their own home, it’s bulky, it’s unwieldy and they’d rather hold on to the furniture or walls,” says Toto.
Toto also says seniors are sometimes suspicious that doctors and therapists are going to limit them and their independence.
Resnick recommends a “try before you buy” approach to persuade a reluctant senior to use a mobility device. She will often allow someone to borrow the device and says she will usually hear back, “Wow, that really helped.”
“Some of the things I do is to let people try these things, to play with them a bit because if they don’t find the assistive device to be helpful and of value, then maybe they shouldn’t use it,” she says.
Obviously, teaching seniors how to use devices appropriately and correctly, so that they are helpful versus a hindrance, can go a long way toward acceptance. But for some seniors, the “hindrance” might be a relatively minor detail, such as the device’s size or weight.
For seniors who insist their walkers are too big to lug around or say “I can’t go here with my wheelchair the way I used to,” Resnick sometimes recommends smaller devices, such as lighter wheelchairs and smaller, collapsible walkers that may require financial resources outside of Medicare. She also recommends that seniors with larger financial resources look for ways to change the home environment to provide clearer pathways, such as breaking down walls, or redoing showers.