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Problems with mobility in older adults are common. In the United States, among noninstitutionalized persons 65 years and older, approximately 13% have difficulty in performing activities of daily living. Approximately 9% have difficulty with bathing, 8% have difficulty with walking, and 6% have difficulty with bed or chair transfers. The rate at which these problems occur increases progressively after the age of 65 years and climbs sharply after the age of 80 years, so that, for example, more than 34% of noninstitutionalized persons who are 85 years or older have mobility problems.

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Perhaps the most serious problem of mobility impairment is the tendency of older adults to fall and to be injured by falls. Death rates from falls per 100, 000 persons in 1999 were 9.1 for those between 65 and 74 years, 31.7 for those between 75 and 84 years, and 109.7 for those 85 years or older. For comparison, in those aged 75 years and older, the death rate from falls (67.9 per 100,000) is more than double that from motor vehicle accidents (29.8 per 100, 000). Falls and fall injuries are of substantial concern because of their frequency and because of their physical, psychological, and social consequences. Even a fall that does not result in injury can have a substantially adverse effect on an older person's self-confidence, mobility, and independence. Indeed, fear of falling, which can accompany decreased mobility, can lead to decreased physical activity outside and avoidance of social activities because of the possibility of embarrassment as well as injury in connection with a fall.

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Older females are substantially more prone to fall and to be injured in a fall than are older males. Three studies of rates of falls, involving more than 4500 adults ages 65 years or older, found those rates to range from 137 to 690 falls per 1000 persons per year, with older females falling from 1.3 to 2.2 times more often than older males. Three studies of rates of fall injuries requiring medical attention, involving more than 38, 000 adults, found that fall injuries leading to hospital admission or death occurred in males and females at rates per 1000 persons per year of 1.88 and 0.83, respectively, for those aged 20 to 29 years and increased steadily with age to 6.97 and 15.58, respectively, for those aged 70 to 79 years. Correspondingly, female-to-male ratios of these serious fall injury rates increased with age from 0.44 to 2.24.

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In 1996, there were 340,000 hip fractures requiring hospital admission. The direct medical and other costs for the injury have been estimated as being at least $16,300 in the first year following the injury. With current trends, approximately 500, 000 hip fractures are expected to occur in the year 2040, with an associated total annual cost of $240 billion. Most hip fractures occur in old adults, and more than 95% of those hip fractures result from a fall; the remainder fracture spontaneously ...

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