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Age-related mobility disability is a self-reported inability to walk due to impairments, limited mobility, dexterity or stamina. [1] It has been found mostly in older adults with decreased strength in lower extremities. [2]
According to the National Research Council, the population of older adults is expected to increase in the United States by 2030 due to the aging population of the baby boomer generation; this in turn will increase the population of mobility disabled individuals in the community. [3] This raises the importance of being able to predict disability due to inability to walk at an early stage, which will eventually decrease health care costs. Aging cause a decrease in physical strength and in lower extremities, which ultimately leads to decrease in functional mobility, [2] in turn leading to disability which is shown to be common in women due to differences in distribution of resources and opportunities. [4] The early detection of mobility disabilities will help clinicians and patients in determining the early management of the conditions which could be associated with the future disability. Mobility disabilities are not restricted to older and hospitalized individuals; such disabilities have been reported in young and non-hospitalized individuals as well due to decreased functional mobility. [5] The increase in the rate of disability causes loss of functional independence [6] and increases the risk of future chronic diseases. [7]
Mobility is defined as the ability to move around, and mobility disability occurs when a person has problems with activities such as walking, standing up, or balancing. [8] The use of a mobility aid device such as a mobility scooter, wheelchair, crutches or a walker can help with community ambulation. [9] Another term that is coined to define mobility disabilities based on performance is "performance based mobility disability". [10] It is the inability to increase your walking speed more than 0.4 m/s. [11] An individual who is unable to walk at >0.4 m/s is considered severely disabled and would require a mobility device to walk in community.
There are a number of factors that could be associated with mobility disability, but according to the Centers for Disease Control and Prevention, "stroke is found to be the leading cause of mobility disability, in turn reducing functional mobility in more than half of the stroke survivors above 65 years of age". [12]
There are several measurement scales designed to detect mobility disabilities. The measures that can detect mobility disabilities are classified into two categories, self-reported measures and performance measures. There is a need to differentiate between these measures based on their ability to detect mobility disabilities, such as differences in their reliability and validity. Self-reported measures are commonly used to detect mobility disabilities, [13] but recently developed performance measures have been shown to be effective in predicting future mobility disabilities in older adults. [14]
Several qualitative research studies use survey, questionnaires and self-reported scales to detect a decrease in functional mobility or to predict future mobility disability in older adults. [15] The advantages of these qualitative research scales are easier data acquisition and can be performed on the larger population. Although there is difference in perception of condition between subjects (gender difference), type of chronic conditions and age-related changes such as memory and reasoning, all of which can affect the information and scores of the individual, still self-reported measures have been used extensively in behavioral and correlation studies. [16] The commonly used self-reported measures to detect mobility disability are Stroke Impact scale, Rosow-Breslau scale, Barthel index, and Tinetti Falls Efficacy Scale. Based on reliability and validity of these scales, Stroke Impact scale has proven to have excellent test-retest reliability and construct validity, however, if it can predict future mobility disability in older adults is yet to be found. In contrast, Rosow-Breslau scale, Barthel Index and Tinetti Falls Efficacy Scale proved important to predict future mobility disability based on the activities involved in these questionnaire scales.
Mobility disabilities due to age-related musculoskeletal pain or increase in chronic conditions are easier to detect by performance measures. Some commonly used performance measures to detect mobility disabilities are the 400-meter walking test, 5-minute walk test , walking speed, short physical performance battery test. Among these measures, 400-meter walk test and short physical performance battery test has been proven to be strong predictors of mobility disability in older adults. In addition to prediction, there is moderate to excellent correlation between these two tests. [17] Based on reliability and validity of measurement scales to predict mobility disability, self-reported measures such as Barthel index, and performance measures such as 400 m walk test and short physical performance battery test are strongly associated with prediction of mobility disability in older adults.
Activities of daily living (ADLs) is a term used in healthcare to refer to an individual's daily self-care activities. Health professionals often use a person's ability or inability to perform ADLs as a measure of their functional status. The concept of ADLs was originally proposed in the 1950s by Sidney Katz and his team at the Benjamin Rose Hospital in Cleveland, Ohio. Since then, numerous researchers have expanded on the concept of ADLs. For instance, many indexes that assess ADLs now incorporate measures of mobility.
Geriatrics, or geriatric medicine, is a medical specialty focused on providing care for the unique health needs of the elderly. The term geriatrics originates from the Greek γέρων geron meaning "old man", and ιατρός iatros meaning "healer". It aims to promote health by preventing, diagnosing and treating disease in older adults. There is no defined age at which patients may be under the care of a geriatrician, or geriatric physician, a physician who specializes in the care of older people. Rather, this decision is guided by individual patient need and the caregiving structures available to them. This care may benefit those who are managing multiple chronic conditions or experiencing significant age-related complications that threaten quality of daily life. Geriatric care may be indicated if caregiving responsibilities become increasingly stressful or medically complex for family and caregivers to manage independently.
Sarcopenia is a type of muscle loss that occurs with aging and/or immobility. It is characterized by the degenerative loss of skeletal muscle mass, quality, and strength. The rate of muscle loss is dependent on exercise level, co-morbidities, nutrition and other factors. The muscle loss is related to changes in muscle synthesis signalling pathways. It is distinct from cachexia, in which muscle is degraded through cytokine-mediated degradation, although the two conditions may co-exist. Sarcopenia is considered a component of frailty syndrome. Sarcopenia can lead to reduced quality of life, falls, fracture, and disability.
Fall prevention includes any action taken to help reduce the number of accidental falls suffered by susceptible individuals, such as the elderly (idiopathic) and people with neurological or orthopedic indications.
Gerontological nursing is the specialty of nursing pertaining to older adults. Gerontological nurses work in collaboration with older adults, their families, and communities to support healthy aging, maximum functioning, and quality of life. The term gerontological nursing, which replaced the term geriatric nursing in the 1970s, is seen as being more consistent with the specialty's broader focus on health and wellness, in addition to illness.
Frailty is a common and clinically significant grouping of symptoms that occurs in aging and older adults. These symptoms can include decreased physical abilities such as walking, excessive fatigue, and weight and muscle loss leading to declined physical status. In addition, frailty encompasses a decline in both overall physical function and physiologic reserve of organ systems resulting in worse health outcomes for this population. This syndrome is associated with increased risk of heart disease, falls, hospitalization, and death. In addition, it has been shown that adults living with frailty face more anxiety and depression symptoms than those who do not. The presence of frailty varies based on the assessment technique, however it is estimated that 4-16% of the population over 65 years old is living with frailty.
Balance in biomechanics, is an ability to maintain the line of gravity of a body within the base of support with minimal postural sway. Sway is the horizontal movement of the centre of gravity even when a person is standing still. A certain amount of sway is essential and inevitable due to small perturbations within the body or from external triggers. An increase in sway is not necessarily an indicator of dysfunctional balance so much as it is an indicator of decreased sensorimotor control.
Ageing is the process of becoming older. The term refers mainly to humans, many other animals, and fungi, whereas for example, bacteria, perennial plants and some simple animals are potentially biologically immortal. In a broader sense, ageing can refer to single cells within an organism which have ceased dividing, or to the population of a species.
The Barthel scale is an ordinal scale used to measure performance in activities of daily living (ADL). Each performance item is rated on this scale with a given number of points assigned to each level or ranking. It uses ten variables describing ADL and mobility. A higher number is associated with a greater likelihood of being able to live at home with a degree of independence following discharge from a hospital. The amount of time and physical assistance required to perform each item are used in determining the assigned value of each item. External factors within the environment affect the score of each item. If adaptations outside the standard home environment are met during assessment, the participant's score will be lower if these conditions are not available. If adaptations to the environment are made, they should be described in detail and attached to the Barthel index.
The correlation between old age and driving has been a notable topic for many years. In 2018, there were over 45 million licensed drivers in the United States over the age of 65—a 60% increase from 2000. Driving is said to help older adults stay mobile and independent, but as their age increases the risk of potentially injuring themselves or others significantly increases as well. In 2019, drivers 65 years and older accounted for 8,760 motor vehicle traffic deaths, and 205,691 non-fatal accidents. Due to their physical frailty, older drivers are more likely to be injured in an accident and more likely to die of that injury. When frailty is accounted for and older drivers are compared to younger persons driving the same amount the over-representation disappears. According to the Insurance Institute for Highway Safety, a senior citizen is more likely than a younger driver to be at fault in an accident in which they are involved. The most common violations include: failure to obey traffic signals, unsafe turns and passing, and failure to yield.
Geriatric trauma refers to a traumatic injury that occurs to an elderly person. People around the world are living longer than ever. In developed and underdeveloped countries, the pace of population aging is increasing. By 2050, the world's population aged 60 years and older is expected to total 2 billion, up from 900 million in 2015. While this trend presents opportunities for productivity and additional experiences, it also comes with its own set of challenges for health systems. More so than ever, elderly populations are presenting to the Emergency Department following traumatic injury. In addition, given advances in the management of chronic illnesses, more elderly adults are living active lifestyles and are at risk of traumatic injury. In the United States, this population accounts for 14% of all traumatic injuries, of which a majority are just mainly from falls.
The Berg Balance Scale is a widely used clinical test of a person's static and dynamic balance abilities, named after Katherine Berg, one of the developers. For functional balance tests, the BBS is generally considered to be the gold standard.
The Timed Up and Go test (TUG) is a simple test used to assess a person's mobility and requires both static and dynamic balance.
Self-rated health refers to both a single question such as "in general, would you say that your health is excellent, very good, good, fair, or poor?" and a survey questionnaire in which participants assess different dimensions of their own health. This survey technique is commonly used in health research for its ease of use and its power in measuring health.
The Disability Rating Scale (DRS) was developed as a way to track a traumatic brain injury (TBI) patient from 'Coma to Community'. The scale was used to rate the effects of injury and decide how long recovery might take. The rating gives insight into the cognitive impairment of the individual with the TBI.
Anne B. Newman is an American scientist who researches epidemiology and gerontology. She received her Bachelor's, Master's and M.D. degrees from the University of Pittsburgh. Newman's primary focus of study is on atherosclerosis, longevity and what specific factors allow for people to thrive while aging. She focuses on geriatrics, gerontology and epidemiology. She was the first scholar to be awarded the Katherine M. Detre Endowed Chair of Population Health Science at the University of Pittsburgh. She has been listed on the annual ISI Web of Knowledge most highly cited scientists for 2015, as published by Thomson Reuters. Newman is a member of the Delta Omega Honor Society in Public Health and the American Epidemiology Society. Newman's highest qualifications are in geriatric medicine and her certification is through the American Board of Internal Medicine. Newman lives in Point Breeze Pennsylvania with her husband, Frank Kirkwood. She is a mother of three.
The Parallel Walk Test is a quick and simple quantitative measuring tool for balance during walking and could be a useful tool in clinical settings for assessing balance before and after treatments and to discriminate high fall risk potential.
Limits of Stability (LoS) are a concept in balance and stability, defined as the points at which the center of gravity (CoG) approaches the limits of the base of support (BoS) and requires a corrective strategy to bring the center of mass (CoM) back within the BoS. In simpler terms, LoS represents the maximum distance an individual can intentionally sway in any direction without losing balance or needing to take a step. The typical range of stable swaying is approximately 12.5° in the front-back (antero-posterior) direction and 16° in the side-to-side (medio-lateral) direction. This stable swaying area is often referred to as the 'Cone of Stability', which varies depending on the specific task being performed.
Dynapenia is the loss of muscular strength not caused by neurological or muscular disease that typically is associated with older adults.
The Thai frailty index is the index commonly used to measure frailty in Thailand. It consists of 30 variables, including hypertension; diabetes; stroke; chronic obstructive pulmonary disease; chronic kidney disease, cognitive impairment; falls; dental problems; hearing problems; underweight; urinary or fecal incontinence; poor quality of life; depressed mood; fatigue; sleep problems, needing help for bathing; dressing, eating; walking; toileting; drug management; and doing housework. The index ranges from 0 to 30, 30 being the highest level of frailty. The index can be used to predict all-cause mortality.
