Sections in this chapter:

Understanding the Problem
When To Get Professional Help
What You Can Do To Help
Possible Obstacles
Carrying Out And Adjusting Your Plan

The changes that occur with aging can lead to problems with mobility (ability to move around), such as unsteadiness while walking, difficulty getting in and out of a chair, or falls. Muscle weakness, joint problems, pain, disease, and neurological (brain and nervous system) difficulties which are common conditions in older people can all contribute to mobility problems. Sometimes several mild problems occur at one time and combine to seriously affect mobility.

The number one mobility problem that older people experience is falls. Falls may result in broken bones, bruises, and fear of falling. Older bones break more easily than younger bones and they heal less quickly and not as completely. If a hip is fractured, canes, walkers, or wheelchairs may be needed permanently. Falls are a major cause of injury and death and so prevention is important.

When an older person falls and there is no serious injury, he or she can often crawl to a solid chair, sofa, or table and use it as a support in getting up. If the person needs your help to get up, lift him or her with your arms by bending your legs not your back. (Bend at your knees and push up with your legs). Move the person to a table (if possible) or bring over a table or chair, which can be used as a support when getting up. If the person is heavy, you will have to push a little at a time. Ask him or her to help. Do not injure your back trying to lift. Call for help and wait for it to arrive.

It often takes time for older people to recover from a fall. This may mean a significant amount of 24 hours-a-day bed rest. Unfortunately, extended bed rest may worsen existing medical illnesses and lead to new ones such as circulatory problems, further loss of strength, pressure sores, or pneumonia.

When older people have falls even if the fall isn't serious they may become fearful of falling again. This can lead to inactivity which can cause additional health problems. One of the most important things you can do to help someone with mobility problems and fear of falling is to encourage physical activity. Even a little activity strengthens bones and muscles, improves steadiness when walking, and helps prevent fractures. If the older person is afraid of falling, suggest using a walker. In addition to helping the older person stay active, you can help prevent falls and fractures by doing a home safety check (see safety checklist at the end of this chapter) and correcting conditions that may lead to falls.

Tell the doctor or nurse about mobility problems and especially falls, since they may be caused by medical conditions. Medicines, alcohol, or worry can result in drowsiness or distraction, which can lead to falls. Certain medical conditions such as poor eyesight and diseases like arthritis can also affect mobility. The risk of falling can often be reduced if the medical condition is diagnosed and treated.

In case of an emergency

Call the doctor immediately if any of the following conditions exist:

When symptoms are not an emergency but should be reported

Problems that should be reported during regular office or clinic hours are:

Know the answers to the following questions before calling the doctor: (A useful acronym for remembering the important parts to a fall history is SPLAT: symptoms, previous falls, location, activity, and time.)

Here is an example of what you might say when calling; remember to use the SPLAT acronym as your guide:

"I am Susan Smith, daughter of John Smith. My father fell early this morning at 6:00 a.m. (TIME) while getting up from the toilet (ACTIVITY) in the bathroom (LOCATION). He fell on his left side on the grab bar but caught himself before he fell to the ground. He became dizzy (SYMPTOMS) and lost his balance when he stood up. I don't think he hurt himself, but he is very shaken up and continues to have dizziness with any quick movements. A similar thing happened when I was helping him out of bed earlier this week (PREVIOUS FALLS), but I was there to catch him before he lost his balance. Should I bring him to see you?"

back to top

Identify fall hazards in the home and eliminate them. Many older people fall because of unsafe conditions at home. Use the Safety Check List (adapted from the National Safety Council) reprinted at the end of this chapter to help make sure the older person's environment is as safe as possible.

Pay special attention to safety proofing the bathroom since this is where most falls occur. Put rubber appliqués or rubber mats on the tub bottom. Tubs and showers are easier to get into if side rails are added or if handrails are installed onto shower walls. Toilet seats can be raised and side rails attached to the toilet. These safety items can be purchased at medical equipment stores or through their catalogs. In addition, special toilets that have a higher seat than standard ones can be installed by a plumber.

Ask the nurse or therapist for help. Visiting nurses, occupational therapists, or physical therapists that come to the home can identify fall hazards and make recommendations to improve safety. They can help you conduct your own home safety check or do one for you.

Help the older person stay physically active. A regular program of exercise can strengthen muscles and improve flexibility. With increased strength and balance, an older person is better able to maneuver and avoid a potential fall. Some simple exercises that older people can do are included at the end of this chapter. Ask the doctor if these exercises would be beneficial. Check with local hospitals, senior centers, and community centers to see if they offer exercise or walking programs for older people.

Ask the doctor about walking aids. A large selection of canes and walkers is available that make mobility easier and safer. Older people who use a cane should be encouraged to carry it with them at all times. If they are even a little bit unsteady on their feet, they should use a cane or walker. Some of the newer designs of walkers even come with a built-in seat, which allows the person to sit and rest when tired. Although canes and walkers can be purchased at some drug stores, it is a good idea to check with a doctor or physical therapist to find out what type of cane or walker the older person needs. A physical therapist will make sure the cane or walker is adjusted to the right height and teach the older person how to use it.

Ask the doctor about medications. Throw out all outdated medications and, with the doctor's assistance, eliminate similarly acting medications.

Make sure vision and hearing are tested regularly and properly corrected. Seeing poorly or not hearing well can be a cause of mobility problems and can lead to falls.

Make sure proper footwear is worn. Sturdy, well-fitted, low-heeled shoes with wide, nonstop (rubber soles) should be worn. A walking shoe with good arch support and heel counter is recommended. Avoid slippers (unless they have non-slip soles), clogs, or sandals that can easily come off. Avoid long shoe laces, or pants that are too long which can cause tripping.

If the older person is afraid of falling, discuss these fears. People with a fear of falling will need to practice doing the things of which they are afraid. Otherwise, they will not get the exercise they need and this can lead to other medical conditions such as circulatory problems. Set small goals and gradually build up the activity level. Start by doing activities while someone is present to help and give support. Build confidence by giving praise and encouragement, then gradually encourage being active when alone.

Create opportunities for socializing. Look for community activities that will keep the older person mobile.

Don't help the older person too much. Resist the temptation to do everything for the older person because you are afraid "something might happen." Older people need to stay active and like to remain independent.

back to top

Think of other obstacles that could interfere with carrying out your plan

What additional roadblocks could get in the way of doing the things suggested in this chapter? For example, will the person cooperate? Will other people help? How will you explain your needs to other people? Do you have the time and energy to carry out the plan?

You need to develop plans for getting around these roadblocks. Use the six problem-solving steps in the chapter on "Using the Eldercare at Home book to solve caregiving problems."

back to top

Checking on results

Be realistic about expecting change. A large part of your plan will be prevention. Don't be discouraged if you do not see increased level of activity. If the older person is maintaining activity and no falls are occurring, your plan is working because you are preventing the problem from getting worse.

If your plan doesn't work

If mobility problems are getting worse, ask the doctor or nurse for help. Tell them what you have done and what the results have been.

back to top

A Few Words About Wheelchairs

If the older person cannot get around by foot anymore and must use a wheelchair, exercises are still very important to keep bones strong and joints flexible. The old saying still holds true: "If you don't use it, you lose it." Not all older people need to use wheelchairs full time. It may be a good idea to use a wheelchair for long distances in order to save time and to avoid fatigue. Depending on the needs of the person who will use the wheelchair, the physician or physical therapist will be able to make suggestions for the type of wheelchair to use, what features it should have, and how to use it safely.

Managing the person in a wheelchair. Some important points to consider:

A good fit.

Exercises for Persons 55 Years Old and Older

These exercises are to be started gradually. Work at your own pace and level of ability. Start with 5 or 10 repetitions; do fewer if necessary or more if you can. Slowly increase by adding 2 to 4 or more repetitions every 5 to 10 days. Progress until you can do approximately 15 to 25 repetitions of each exercise. Do these exercises at least three times weekly.

If you need help getting started or if you have any concerns about your health, show these exercises to your physician.

Adapted from Border B and Wagner M. Functional Performance in Older Adults. FA Davis, Philadelphia, PA:1994, pp. 60-61 and "What You Need To Know About Balance and Falls. A Physical Therapist's Perspective," American Physical Therapy Association, Alexandria, VA: 1998.

Safety Checklist

Bathroom