Mobility Issues and Limitations in Aged Care

Why is Mobility Important?

Mobility is closely tied to our sense of independence, but also our social connectedness, activity and security (Health.Vic 2018). A person's wellbeing can be considerably compromised by a mobility restriction.

Mobility issues become more of a concern with age, and in many cases, the older adult must face a period of adjusting from complete independence to sudden reliance on another for even minor tasks, such as brushing their teeth or basic grooming.

A mobility impairment can range from limitations of stamina to total paralysis (Ferris State University 2019).

Often, a lack of functional mobility can contribute to additional health issues. For example, limited functional mobility in an older person could prevent them from maintaining continence (Health.Vic 2018).

Mobility Issues and Limitation Issues is directly tied to Aged Care Quality Standards: Standard 5: Organisation’s Service Environment.

The Effects of Facilitating Mobility and Self-Care

By encouraging and helping a patient to achieve or regain mobility, the risk of the following decreases:

• Depression;
• Delirium;
• Under-nutrition;
• The chance of falls and fall-related injuries; and
• Loss of confidence due to fear of falling.

(Better Health Channel 2015)

In a situation in which drastically reduced mobility results in bed rest, there is a heightened risk of additional health complications.

The Effects of Long-Term Bed Rest Due to Mobility Restriction

Cardiovascular

• Postural hypotension; and
• Reduced aerobic capacity.

Respiratory

• Reduction in arterial oxygen level; and
• Increased potential for atelectasis.

Musculoskeletal

• Reduced muscle mass;
• Reduced muscle strength;
• Muscle shortening;
• Joint contractures;
• Reduced bone density;
• Increased risk of falls/injury; and
• Pain.

Gastrointestinal

• Constipation; and
• Malnutrition.

Genitourinary

• Continence issues.

Skin

• Breakdown in skin integrity.

Psychological

• Confusion;
• Social isolation; and
• Depression.

(Health.Vic 2018)

Mobility and Aged Care

An older person living with reduced mobility may find it difficult to carry out simple tasks and participate in activities without assistance. Before committing to residential aged care, there are less drastic options available to assist them.

The first step is to ensure that their home environment allows them to live as independently as they would like to.

The following are recommended as basic aids to assist an older adult to live independently at home:

• Cleaning and laundry aids;
• Kitchen and laundry fixtures;
• Can and jar openers;
• Preparing and cooking utensils;
• Customised scissors;
• Handrails;
• Shower rails;
• Ramps;
• Easy-use taps;
• Trays and over-bed tables;
• Reaching and turning aids;
• Walking and standing aids;
• Dressing and grooming aids;
• Remote control devices;
• Sitting and sleeping support;
• Slip resistant mats and grip aids;
• Scooters and wheelchairs; and
• Intercoms and emergency call systems.

(Better Health Channel 2015)

What is ‘Functional Mobility’?

Functional mobility is the capacity to move from one position to another, enabling participation in everyday life.

Functional mobility includes:

• Bed mobility;
• Transfers;
• Walking;
• Wheelchair mobility;
• Accessing toilets;
• Getting in and out of a car; and
• Driving and taking public transport.

(Health.Vic 2018)

It is important to be aware that mobility restrictions and the use of gait aids can have a significant impact on a person’s ability to access their home and local area. This can result in difficulty maintaining and initiating social connections within their community (Health.Vic 2018).

Mobility Aids

Mobility aids are equipment that facilitates movement for someone who would otherwise be unable or limited in their attempt to move, participate in, or carry out a task. Mobility aids include:

• Wheelchairs;
• Walking frames;
• Ramps;
• Shower chairs;
• Splints;
• Braces; and
• Home oxygen services.

(Better Health Channel 2019)

Tips for Looking After Someone with a Mobility Impairment

There are small changes that can be made around the home to help the person living with a mobility restriction to move around the house. They include:

• Arranging the furniture to allow for plenty of room to walk around and keeping this space clear and uncluttered.
• Removing loose rugs and sealing carpet edges that may present trip hazards.

(Better Health Channel 2019)

Exercise

Exercise programs can be administered in both individual and group settings and may include strength, balance, functional retraining and aerobic exercises. Group classes can also provide an opportunity for social interaction and may help counteract the loneliness of isolation (Health.Vic 2018).

Types of Exercise

The exercise undertaken by older people with mobility limitations does not need to be strenuous. Research has shown that even minor increases of movement can make a difference in physical ability and prevent the likelihood of falls in people over the age of 65 (Aged Care Guide 2015.).

Recommend that, if they are able to, patients incorporate balance and strength training into daily routines – an example is taking the stairs more often and bending knees to pack the dishwasher. Exercises such as this are part of a program called Lifestyle-Integrated Functional Exercise (LiFE) (Aged Care Guide 2015).

Informed by rigorous study, this new approach to exercise has been shown to reduce falls by more than 30% through incorporating balance and strength training into everyday activities and daily routines (Aged Care Guide 2015).

Falls

Falls in elderly people are a major concern in terms of disability, institutionalisation, mortality and socioeconomic burden (RACP 2012).

In older adults, as high as 30% of falls have been shown to result in moderate to severe injuries, for example, lacerations, hip fractures and head trauma, resulting in an increased risk of premature death (RACP 2012).

The fear of falling may additionally lead to an avoidance of daily activities, social isolation, lowered quality of life and can precipitate an early move into aged care (RACP 2012).

Fall Facts and Stats

• One in three people over the age of 65 years suffer a fall each year.
• If someone has had a fall, they are more likely to have another.
• Each year more than 80,000 people over the age of 65 years are hospitalised as a result of a fall.
• Many falls can be prevented.

(Aged Care Guide 2015).

A fall prevention strategy is recommended to ensure the safety of the patient.

Intervention requires:

• A multifactorial approach using standard falls prevention interventions should be routine care for all residents of residential aged care facilities.
• In addition to a multifactorial approach using standard falls prevention interventions, a targeted and individualised falls prevention plan of care should be developed and implemented based on the findings of a falls screen or assessment.
• Provide vitamin D with calcium supplementation to residents with low blood levels of vitamin D.
• Residents are to have their medications reviewed by a pharmacist.

(Hughes 2018; Australian Commission on Safety and Quality in Healthcare 2009).

Conclusion

A mobility impairment can range from limitations of stamina to paralysis and has the potential to severely decrease the wellbeing of an individual through isolation, fear of falling, increased bed-rest and dependency on others for simple tasks. Limited mobility can be navigated through accessible home environments, support and exercise programs.

Additional Resources

• Aged Care Quality Standards: https://agedcare.health.gov.au/quality/aged-care-quality-standards

References

• Achieve Australia 2019, What is a Physical Disability, Achieve Australia, viewed 20 August 2019, https://achieveaustralia.org.au/disability-services/physical-disability/
• Aged Care Guide 2015, Get Creative with Exercise for Older People, Aged Care Guide, viewed 21 August 2019, https://www.agedcareguide.com.au/talking-aged-care/get-creative-with-exercise-for-residents
• Australian Commission on Safety and Quality in Healthcare 2009, Preventing Falls and Harm from Falls in Older People, Australian Commission on Safety and Quality in Healthcare, viewed 21 August 2019, https://safetyandquality.gov.au/sites/default/files/migrated/Guidelines-RACF.pdf
• Better Health Channel 2015, Disability and Aged Care, Better Health Channel, viewed 21 August 2019, https://www.betterhealth.vic.gov.au/health/servicesandsupport/disability-and-aged-care
• Better Health Channel 2019, Aids and Equipment at Home, Better Health Channel, viewed 21 August 2019, https://www.betterhealth.vic.gov.au/health/servicesandsupport/aids-and-equipment-at-home
• Ferris State University 2019, Mobility Disorders Defined, Ferris State University, viewed 21 August 2019, https://www.ferris.edu/HTMLS/colleges/university/disability/faculty-staff/classroom-issues/mobility/diagnosis.htm
• Health.Vic 2018, Mobility and Self-Care Support Independence, Health.Vic, viewed 20 August 2019, https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/older-people/falls-mobility/mobility/mobility-independence
• Health.Vic 2018, Understanding How Patients Move, Health.Vic, viewed 20 August 2019, https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/older-people/falls-mobility/mobility/mobility-understanding
• Hughes, Z 2018, 'Falls Prevention', Ausmed, 18 July, viewed 22 August 2019, https://www.ausmed.com/cpd/articles/preventing-falls
• RACP 2012, Falls Prevention in Older Adults, RACP, viewed 21 August 2019, https://www.racgp.org.au/download/Documents/AFP/2012/December/201212waldron.pdf