Mobility

History

• What is the older adult’s baseline mobility? Level of activity?
• What does a typical day look like for the older adult in terms of mobility?
• What are their goals for mobility?
• Any recent falls or fear of falling? Are they unsteady when standing/walking?
• Does the older adult use a mobility aid or assistive device?

Functional Status

• Has functional status changed recently? Is caregiver assistance needed?
• Functional status can be classified as Independent, Needs Assistance or Dependent¹⁸

Activities of Daily Living (ADLs/ Basic ADLs)

• Feeding
• Bathing
• Grooming
• Dressing
• Toilet use, Continence
• Transfers (i.e. – bed to chair)
• Mobility

Instrumental Activities of Daily Living (IADLs)

• Telephone use
• Grocery shopping
• Food preparation
• Housekeeping, laundry
• Mode of transportation
• Medications
• Finances
• Computer use

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Selected Mobility Aids and Assistive Devices¹⁹

• Canes
  • Standard: For mild balance or one-sided weakness; not for weight bearing, caution re carpal tunnel
  • Offset: appropriate for weight bearing, caution to not use backward
  • Quadripod: best for hemiparesis
• Walkers
  • Standard: need to be lifted with each step
  • Front-wheeled: maintain normal gait pattern
  • Four-wheeled: not for weight bearing, less stable
• Devices
  • Sock donner, long shoehorn
  • Grabber to reach items from standing or sitting position
  • Alert button on bracelet or necklace to call for help if needed

Mobility assessment to support safe mobility and lower risk of falls^20,21

Intrinsic

• Chair stand: Able to stand from a chair without using arms?
• Gait speed: Timed Up & Go test ≥12 secs, 10 ft away
• Orthostatic hypotension (decrease in systolic blood pressure of ≥20 mmHg or diastolic of ≥10 mmHg, or lightheadedness/dizziness from lying/sitting to standing)²²
• Foot problems or difficulty trimming toenails²³
• Urinary incontinence
• Hearing or vision impairment
• Cognitive impairment, Depression

Extrinsic

• Psychoactive medications, Opioids²⁴
• Medications that can cause sedation or confusion, dizziness, hypotension, hypoglycemia
• Environment: clutter, shoes, pets, lights, stairs, shower, rugs

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Interprofessional Team Involvement: Consider physical therapy, occupational therapy, nursing, pharmacy, podiatry, audiology, optometry; also consider Tai Chi for balance.

Tools for Mobility

• Stopping Elderly Accidents, Deaths & Injuries: cdc.gov/steadi
• National Institute on Aging: nia.nih.gov/health/exercise-physical-activity