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The Loss of Mobility Issue in Geriatric Patients

Loss of mobility is a prevalent age-related health topic that affects older adults and geriatric patients. Mobility is essential to maintaining an adequate quality of life, promotes independence, and is beneficial for health. However, many experience a decline in mobility with age, causing significant social, mental, and physical consequences. Immobility and its negative effects can be prevented through appropriate screening and interventions. Mobility is inherently linked to health status and quality of life, making it a critical age-related topic that should be engaged through public awareness and interdisciplinary interventions which would address critical categories of determinants for the condition.

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Problem and Population

The age-related problem identified in this report is mobility. The targeted population is older adults and geriatric patients who most commonly experience mobility issues with declining age. The number of older adults over 60 years of age is predicted to double by 2050 and compromise up to 20% of the global population (Manini, 2013). Mobility impairment is defined as the deficit or inability of a person to perform basic tasks or utilize extremities to walk, grasp, or move objects. There are various severities of immobility, ranging from decreased stamina to complete paralysis (Rantakokko, Mänty, & Rantanen, 2013). In the context of this paper, mobility will be referred to as the general degradation of movement due to age-related processes.

Mobility impairment is a dynamic process, which can transition based on the status of health and dependence on others. Immobility is a natural age-related concept due to impairment in the central nervous system and muscle decline. Mobility may be affected by inflammation, metabolic, hormonal, or genetic factors as well (Sorond et al., 2015). All age groups in the elderly and pre-elderly populations have experienced decreased mobility, most commonly due to the prevalence of arthritis, lower gross motor function, and obesity (Chen & Sloan, 2015).

There has been a significant association between the physical environment and activity levels of geriatric populations with their mobility based on standardized scales of measurement. As the demographical data shifts towards a higher elderly population with a more diverse sociocultural spread, lack of mobility and associated co-morbidities are significant. First, this impacts healthcare expenditures and resource utilization, both currently and in the future. Long-term care services, facilities, and personnel are required to care for seniors with immobility issues and disabilities. Finally, it directly impacts the quality of life of affected population groups (Chen & Sloan, 2015).

Implications

Cultural

Those who lose independent mobility are more likely to be socially isolated and lack participation in their community or even retirement homes. Social isolation due to this age-related issue is common, occurring as often as one in five adults. Males are more likely to experience isolation from family and caregivers. Social isolation leads to mental health issues and the destabilization of health (Wadley, 2018). Direct cultural factors impacted by limited mobility include lower educational levels, difficulty with acquiring information, and lack of awareness about critical sociocultural issues (Clares, Freitas, & Borges, 2014). Therefore, a person is unable to receive adequate information about vital socio-cultural aspects such as public health and safety.

Ethical

The loss of mobility creates a dependence of older adults on other people and caretakers. Over half of this population had difficulties and required help with daily activities, with 15% needing supporting care (Freedman & Spillman, 2014). However, ethical concerns come into play if the person cannot receive help from another caretaker consistently. This places an ethical responsibility on the health system or government to provide long-term resources for care.

Financial

Limitations in mobility, particularly extreme forms that lead to disability create significant indirect and extra costs of living and health services. These range from generally higher medical expenses to the need for assistive services and devices. These costs can accrue into thousands of dollars, often lacking compensation by insurance or government. Furthermore, immobility results in lower productivity for those continuing to work, leading to lower wages (Coleman, Sidovar, Roberts, & Kohn, 2013). Therefore, the elderly with mobility issues become a financially disparaged population within society.

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Legal

The elderly with mobility impairments may face several legal-related issues and challenges. There are existent policy barriers that cause a lack of awareness or enforcement of active legislation towards the protection of people with disabilities. Individuals may be denied participation or access to rehabilitation programs, services, and benefits. Basics of legally required reasonable accommodations are also overlooked (Centers for Disease Control and Prevention, 2018).

Interventions

Interventions for mobility improvement in older adults are traditionally multifactorial. They focus on improving underlying impairments through strengthening, endurance, and flexibility training while providing support services. One possible intervention to improve mobility in older adults is to improve motor skills through neurorehabilitation and task-oriented motor learning exercise. The intervention consists of several components including resistance exercise, stretching, aerobic conditioning, and progressive ambulation training. Furthermore, a more specialized task-oriented learning intervention focuses on defining movement goals. It combines exercises that seek to improve knowledge of muscle groups and various postures. Therefore, this intervention aids in correcting movement errors and adjusts motor development. Eventually, it helps to build a comprehensive, optimal movement plan that facilitates motor skill acquisition for adequate performance. Micro corrections of movement patterns greatly improve mobility in geriatric patients in terms of speed and energy cost of walking, improving both to a level close to that of healthy adults (Brach & VanSwearingen, 2014).

One of the greatest risks of mobility loss in elderly individuals is falling, causing injury or death. Loss of balance is an inherent part of declining functional mobility. Furthermore, older adults experience cognitive decline which impacts the emotional and social components of their life. A multicomponent intervention, combining physical exercise with cognitive training is potentially more effective at reversing mobility impairments. The physical activity consists of non-impact, multi-stage exercises, addressing balance, aerobics, and strength. Meanwhile, a cognitive approach focuses on memory, reasoning, and speed of processing training. Overall, this multicomponent intervention is effective at improving functional measurements such as mobility and frailty. Furthermore, the mental state of participants improves based on a geriatric depression scale, quality of life scale, and networking determinants (Tarazona-Santabalbina et al., 2016).

Available Resources

Physical exercise interventions require a compilation of community-wide resources for successful implementation. They can be effective there is social support within a community, including places of living, education, work, and worship. Community centers serve as a primary available resource for such interventions as they can offer facilities, equipment, and commonly professionals and volunteers to aid with the project. Public health resources are available as well since local governments and medical organizations are willing to sponsor and support effective but relatively inexpensive interventions with a highly developed evidence base to support positive outcomes. Hospitals, which experience the significant quality of care issues with geriatric mobility (due to falls) will welcome community interventions that decrease admission rates for seniors and improve the population’s overall health.

Physical activity interventions are best for communities as they can be actively advertised, efficiently delivered, and easily evaluated without significant input. Most resources, including physical, financial, and human capital are available within the communities themselves. These resources must remain in the community for the intervention to have prolonged effects past its completion. Seniors should be aware of the available facilities and professionals that can be easily accessed to continue the exercise routines.

Associated Costs

Physical activity interventions are generally cost-effective, particularly for older adults since the population size is limited. Intervention costs are mostly made up of salaries for researchers, health professionals, and trainers. These expenses can be significant, ranging from $12 to $30 an hour. Exercise equipment is required for both interventions as well. There are additional costs such as refreshments and hospitality for participants as well as telephone or online counseling for reminders and encouragement. Cost-effectiveness is calculated by totaling all expenses and dividing by the number of participants. Depending on the intervention, multi-week exercise programs can range from $900 to $1200. However, they are significantly cost-effective, as more than $28,000 can be saved per a major disability avoided in each participant (Groessl et al., 2009).

There is an evident curvilinear relationship between physical activity and health benefits, but cost-effectiveness is difficult to calculate without knowledge of concrete factors such as location, number of participants, and length of intervention. Research on the associated costs of such interventions is scattered and holds limited public health value. These expenses can only be determined based on estimations and previous studies since there is no reporting standard on such factors (Abu-Omar et al., 2017).

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Sustainability

Both interventions are highly sustainable as they offer specific programs as part of the intervention, and then provide seniors with the tools to continue their progress in home settings. The exercises, both physical and cognitive, do not require specialized equipment or fitness trainer oversight. Furthermore, it is sustainable for a long-term solution of the issue as the physical exercises often correct posture, technique, and efficiency in mobility which has significant and prolonged health benefits. The task-oriented motor exercises study conducted by Brach and VanSwearingen (2014) ran for 12 weeks, with the intervention group increasing gait speed by 0.13 m/s. This is clinically meaningful for older adults with gait dysfunction and serves as an improvement to a variety of mobility indicators.

Overall, exercise intervention programs often have positive and long-term outcomes since participants choose to maintain at least some components of the lifestyle or program. A general review of exercise interventions for people with disabilities found that in 86% of interventions, a significant health outcome was maintained, and 75% reported that physical gains were also kept (Lai et al., 2018). Therefore, technology and behavior change strategies are directly linked with sustainable intervention results.

Conclusion

Limited mobility is a critical age-related health factor that is impacting the rapidly increasing elderly population. Immobility causes physical co-morbidities, social isolation, and healthcare expenditures. It can have devastating implications for quality of life and financial or legal aspects. Declining mobility can commonly be prevented or improved with appropriate multi-component interventions that competently approach physical exercise and cognitive training. These do not require significant resources and can be sustained, resulting in improved outcomes that are better for the population.

References

Abu-Omar, K., Rütten, A., Burlacu, I., Schätzlein, V., Messing, S., & Suhrcke, M. (2017). The cost-effectiveness of physical activity interventions: A systematic review of reviews. Preventive Medicine Reports, 8, 72–78.

Centers for Disease Control and Prevention. (2018). Common barriers to participation experienced by people with disabilities.

Chen, Y., & Sloan, F. A. (2015). Explaining disability trends in the U.S. elderly and near-elderly population. Health Services Research, 50(5), 1528–1549.

Clares, J. W., Freitas, M. C., & Borges, C. L. (2014). Social and clinical factors causing mobility limitations in the elderly. Acta Paulista De Enfermagem, 27(3), 237-242. Web.

Coleman, C. I., Sidovar, M. F., Roberts, M. S., & Kohn, C. (2013). Impact of mobility impairment on indirect costs and health-related quality of life in multiple sclerosis. PLoS ONE, 8(1), e54756.

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Groessl, E. J., Kaplan, R. M., Blair, S. N., Rejeski, W. J., Katula, J. A., King, A. C., … Pahor, M. (2009). A cost analysis of a physical activity intervention for older adults. Journal of Physical Activity & Health, 6(6), 767–774.

Lai, B., Kim, Y, Wilroy, J., Bickel, C. S., Rimmer, J. H., & Motl, R.W. (2018). Sustainability of exercise intervention outcomes among people with disabilities: A secondary review. Disability and Rehabilitation, 6, 1-12. Web.

Manini, T. M. (2013). Mobility decline in old age. Exercise and Sport Sciences Reviews, 41(1), 2. Web.

Rantakokko, M., Mänty, M., & Rantanen, T. (2013). Mobility decline in old age. Exercise and Sport Sciences Reviews, 41(1), 19-25. Web.

Sorond, F. A., Cruz-Almeida, Y., Clark, D. J., Viswanathan, A., Scherzer, C. R., Jager, P. D.,… Lipsitz, L. A. (2015). Aging, the central nervous system, and mobility in older adults: Neural mechanisms of mobility impairment. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 70(12), 1526-1532. Web.

Tarazona-Santabalbina, F. J., Gómez-Cabrera, M. C., Pérez-Ros, P., Martínez-Arnau, F. M., Cabo, H., Tsaparas, K.,… Viña, J. (2016). A multicomponent exercise intervention that reverses frailty and improves cognition, emotion, and social networking in the community-dwelling frail elderly: A randomized clinical trial. Journal of the American Medical Directors Association, 17(5), 426-433. Web.

Wadley, J. (2018). Social isolation puts elderly at health risk.

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