Loss of Mobility: Predictors, Challenges, and Solutions

The aging process often leads to a decline in mobility among older adults. According to Mescape, anything that influences the musculoskeletal, neurological or cardiorespiratory systems can impact mobility. Pain and obesity are two key predictors of mobility challenges that accompany aging, and chronic conditions can exacerbate mobility issues, as well as disabilities such as vision or hearing loss.

Mobility issues not only make it challenging for older adults to navigate without assistance through their homes and public spaces but, in severe cases, can make it difficult to perform other activities of daily living (ADLs) such as bathing and dressing. A loss of mobility doesn't mean a loss of independence.

Predictors of mobility loss

Musculoskeletal pain is a common complaint among older adults, and while the specific pathway is unclear, it’s suspected that severe pain in the lower body causes people to become less active. This decreased activity contributes to a decline in muscle strength and the development of mobility limitations.

That said, studies have shown that musculoskeletal pain contributes directly to mobility limitations even when other factors on the pathway, such as self-rated health, chronic conditions and symptoms of depression, are accounted for. This loss of mobility occurs directly through impairments and functional limitation. One example is a hip fracture, which causes persistent pain in many cases and poor muscle strength and power in the affected leg. Despite proper treatment of the fracture, a hip fracture often leads to muscle power asymmetry in the legs, and subsequently, mobility decline.

Obesity is another proven predictor of loss of mobility, although the specific impacts of obesity on mobility have only recently been studied in-depth. Obesity contributes to a loss of mobility through the increased mechanical load placed on the body, “which increases their energy expenditure, placing increased demands on aerobic capacity and muscle strength compared with normal-weight individuals doing similar physical tasks,” Medscape describes.

A 22-year follow-up study found that individuals, who were overweight in midlife but without impairment, were at double the risk of future mobility limitations compared to peers of the same weight. When being overweight was compounded by two or more impairments (poor hand grip strength, squatting test or self-reported difficulties with running), the risk of mobility limitations is six times that of a normal-weight peer without impairments.

Of course, other conditions contribute to mobility loss; Alzheimer’s disease or dementia, Parkinson’s disease, or multiple sclerosis all impact the central nervous system (CNS). Additionally, a decrease in bone mass or density, a decrease in flexibility of the joints, muscle atrophy, and other changes in the muscle tissue can also contribute to a loss of mobility.

Challenges of loss of mobility

A loss of mobility leads to a myriad of challenges and increased risk of injury in older adults. According to HealthInAging.org, mobility issues can increase the risk of falls, which can lead to serious injury such as hip fractures or even head injuries. Even if a fall does not lead to an injury, older adults then develop an increased fear of falling. This fear in turn leads to a decrease in activity, facilitating a vicious cycle of decreased activity contributing to a greater loss of mobility.

A loss of mobility makes it difficult for older adults to navigate certain areas of the home, such as bathrooms which often have tile flooring that becomes slippery when wet.  It can also become more difficult to walk freely throughout the home or navigate outdoor areas, such as a lawn or sidewalk, where the terrain is not level or unfamiliar. Driving can become more difficult as reaction time slows.

Preventing loss of mobility

A landmark clinical trial published by the University of Pittsburgh and seven other field centers in the Journal of the American Medical Association in May 2014 found that physical activity prevents loss of mobility among older adults. As a result of this longest-running randomized clinical trial evaluating physical activity in the elderly, the study recommends that something as simple as a 20-minute brisk walk around the neighborhood each day can significantly help older adults maintain their ability to walk.

“The study showed that prescribed daily physical activity would prevent older adults’ loss of mobility, defined in the study as the inability to walk 400 meters, or about a quarter of a mile. That is approximately equal to a trip from a parked car to a grocery store or a walk through a neighborhood,” according to the University of Pittsburgh’s published report.

For older adults who have already experienced a loss of mobility, remaining as physically active as possible will help to prevent further decline. Lifestyle modifications, changes to the home environment, and mobility aids are other solutions that help older adults with mobility loss maintain their independence. These solutions include:

  • the use of mobility aids, such as a walker, cane, or wheelchair
  • ensuring the home is clutter-free and free of clear hazards that increase the risk of trips and falls
  • one-level living modifications
  • ramps and other easy-access modifications
  • grab bars in bathrooms

There are many tools, aids, and modifications that can make life simpler for an older adult with mobility decline. Medical alert systems, for instance, can provide a safety net for older adults should they happen to fall when caregivers or other family members are not readily available to help. The degree of decline, the individual’s current living environment, family support, and other factors should be carefully considered when developing a plan for an older adult to continue to live independently, but safely, when a loss of mobility is present.

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