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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #14, #15, #16, #25, #45, #52, #53

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LEARNING OBJECTIVES

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Learning Objectives

  • Describe the prevalence and consequences of mobility disorders in older people.

  • Identify strategies to detect and evaluate mobility disorders.

  • Characterize approaches to the management of mobility disorders.

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Key Clinical Points

  1. Loss of mobility is a major cause of disability in older people but is rarely assessed in typical clinical practice.

  2. The assessment of mobility involves taking a history and performing a physical examination that identifies cardiopulmonary, musculoskeletal, and neurologic contributors.

  3. Mobility can be assessed by a number of simple performance tests including gait speed, the short physical performance battery, and the get up and go test.

  4. Interventions to promote mobility include addressing underlying impairments, therapeutic exercise, assistive devices, home adaptations, and caregiver training.

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INTRODUCTION

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Mobility problems are pervasive in older adults. Mobility limitations affect personal independence, need for human help, and quality of life. Limited mobility predicts future health, function, and survival. Like other geriatric syndromes, mobility disorders are often caused by diseases and impairments across many organ systems, so evaluation and management require multiple perspectives and disciplines. Health care providers should be able to assess and treat mobility problems. They should be able to measure and interpret clinical indicators of mobility such as gait speed, the short physical performance battery, and the performance-oriented mobility assessment. They should know the physiologic and biomechanical mechanisms underlying normal and abnormal mobility, the differential diagnosis of the causes of mobility disorders, and the approaches to management of mobility problems.

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DEFINITIONS AND METHODS OF CLASSIFICATION

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Defining Mobility

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Mobility is the ability to move one’s own body through space. Mobility requires force production and feedback control systems to navigate the mass of the body through a three-dimensional environment. Walking is the fundamental mobility task for human life. Mobility also includes a wide range of other important activities that require moving one’s body, from turning over in bed to climbing stairs. Mobility tasks have an inherent hierarchical order based on the biomechanical and physiologic demands made on the body. This orderedness is apparent in the developmental tasks of infancy and childhood, when mobility independence is first achieved. The simplest and first mobility task is turning over in bed, followed by sitting upright, transfers from lying to sitting and from sitting to standing, locomotion with an increased base of support (like crawling or using a walker), to independent two-legged walking, then more challenging tasks like ascending and descending stairs, running, climbing ladders, and sports.

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Mobility disability is best defined within a conceptual framework such as that of disablement (Table 116-1). Disability is caused by pathologic processes that lead to organ system impairments and functional limitations. Disability causes handicap by limiting life roles such as work ...

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