Mobility/Falls and Aging

A resident in a facility where I was the Director of Nursing, claimed the reason he and his wife got married while in their late eighties, was the following,” It was a marriage of convenience. Rather than using a cane or a walker, we can lean on each other.”

Mobility is the capacity one has for movement. In infancy, it is a major mode of learning and interacting with the environment. Throughout life, it remains a significant means of contact, sensation, exploration, pleasure, and control. In old age one moves more slowly and purposefully, sometimes with more caution.

Movement is integral to the attainment of all levels of need, as conceived by Maslow’s Needs identified by elders, which include pride, maintaining dignity, social contacts, and activity. All of these are facilitated by mobility. Thus in terms of Maslow’s hierarchy of needs and the needs identified by elders, maintaining mobility is an exceedingly important issue.

Aging produces changes in muscles and joints, particularly of the back and legs. Strength and flexibility decrease markedly, and endurance to a somewhat lesser extent. Some normal gait changes in late life include a narrower standing base, wider swaying when walking, and the appearance of a “waddle.” Steps taken are shorter and with a decreased stepping motion. These changes are less pronounced in those who remain active and at a desirable weight.

When mobility declines, falling becomes a liability. Falling is one of the most serious and frequent problems associated with the aging process. The National Institute on Aging (NIA) estimates that each year one-third of all persons age 65 and older who live at home fall, and about half of those individuals fall repeatedly. Falls and the consequently broken hip cause 40% of nursing home admissions annually according to NIA. Fall-related mortality increases with advanced age and more than doubles with each decade of life.

There are many conditions that make the elderly susceptible to falls that lead to accidents, such as:

  • urinary frequency and urgency leading to unsafe maneuvering at toileting;
  • improper footwear or podiatric difficulties;
  • improper clothing such as long night clothes or robes;
  • improper use of a wheelchair, especially during transfer;
  • mental confusion and faulty judgment.

Here are several suggestions/actions to increase safety:

  1. Family, or the caretaker, should review all medications, especially tranquilizers, as to need, dosage, and side effects.
  2. Review with the individual the safe use of a wheelchair (i.e., lock brakes before getting up, lift foot supports before rising, etc.).
  3. It was found that anxiety and slow walking pace were correlates of the fear of falling.
  4. Check for poorly designed or unstable furniture.
  5. Avoid creating highly waxed and glossy floors.
  6. Avoid general clutter and obstructions.
  7. Limit alcohol intake.
  8. Rise slowly from bed or chair to avoid a sudden drop in blood pressure.

With all of the potential problems that can occur as one ages, especially regarding a decline in mobility and falling, it is recommended that a thorough assessment of an elderly individual who has fallen be conducted. The assessment should include:

  • performing a physical examination;
  • paying attention to environmental safety;
  • using walking aids and comfortable shoes; and
  • designing an exercise program to decrease impaired physical mobility.
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