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Mobility in the Older Person

Anne-Maria Scanlon MISCP MCSP Senior Physiotherapist Age Related Health Care Adelaide & Meath Hospital, Dublin 24.

"If we could give every individual the right amount o f nourishment and exercise, not too little and not too much, we would have found the sa fest way to health."
Hippocrates (460 BC -377BC)

Physical activity is of benefit to people of all ages but is especially important in older adults. 17.6% of people aged between 65 and 69 live with a disability.This rises to 66.9% for those aged 85 years and older. (CSO, 2002)

As we get older, various physiological changes occur, irrespective of disease/pathology, which may impact on mobility.

These changes include:

  • A reduction in muscle mass as a result of a degeneration of muscle fibres.
  • A reduction in the blood flow to the muscle, both of which ultimately result in some reduction in power of the affected muscles, without necessarily affecting function
  • Poor sensation in the feet.
  • Poor vision.
  • Decreased physical endurance.

Type I muscle fibres are found mainly in the head, neck and trunk and allow an individual to maintain an upright posture. Type IIa muscle fibres are located in small muscles such as the biceps muscle in the arm.Type IIb are found in larger muscles which fatigue easily, such as the deltoid muscle in the shoulder and the gluteal muscles in the buttocks.

As we age, there is generally a greater loss of Type II (a and b) muscle fibres.There is a suggestion that as a result of reduced muscle power in the gluteal muscles, many older people find it more difficult to rise from a low seat. In a healthy older person the muscle fibre loss is subtle and many individuals experience only small challenges to their mobility. Reduced muscle strength and power is a major cause of functional dependence in the elderly, contributing also to the increase in the prevalence of many age-associated chronic diseases, such as pain, and osteoarthritis.

Debate centres on whether immobility in older age is an inevitable decline or simply a preventable disability in the older population. Research (Lyndon-Griffith (1996), Skelton (2001)) has shown that with regular exercise, deconditioned older adults can improve their functional ability (for example, the ability to move from one position to another with less assistance, to walk further with less assistance) and can as a result prolong independent living.

Social acceptance of physical frailty and provision of care and assistance to dependent persons has now turned to helping frail elderly adults to maintain or improve functional independence (Brill et al., 1998).

Benefits of exercise:

  • Improves muscle power.
  • Increases physical endurance.
  • Increases cardiovascular health.
  • Has a positive effect on cognition.
  • Has a positive effect on mood.
  • Improves quality of life.
  • Decreases the amount of physical assistance required for everyday tasks e.g. transfers, gait, activities of daily living.
  • Can help to improve confidence in mobility.

Some of the conditions associated with ageing that can be improved with exercise are: impaired gait and balance, arthritis, type II diabetes, coronary artery disease, hypertension, osteoporosis, obesity, depression, muscle weakness and decreased flexibility (Rogers & Evans, 1993, cited Lyndon-Griffith, 1996).

Self-Restricted Mobility

Self-Restricted Mobility refers to when an individual chooses to limit their level of activity. This may occur because of a fear of falling or increasing pain, as a result of depression, or from a belief that they are unable to carry out certain actions.

In some instances, self-restricted mobility can be a life preserving mechanism. For many people, self-imposed limitations on mobility escalate to a point where significant limitations to mobility result in reduced muscle strength.

An older person with reduced muscle power functions at an extremely low level and any slight setback can be devastating (Dean 1994). Acknowledgement of the rationale behind self-restricted mobility can result in appropriate intervention in a timely manner to limit the effects of this deconditioning.

Prolonged immobility results in:

  • Decreased muscle strength.
  • Increased joint stiffness.
  • Increased unsteadiness on the feet (usually as a direct result of a loss of muscle power).
  • Subsequent increase in the risk of falling.

Regaining mobility after an illness is therefore paramount to the well-being of the older individual. Due to age-related changes mentioned already, recovery might take longer than for a younger adult. However, with the right support, encouragement and perseverance, this recovery can be achieved.

Which Exercises are Good to Improve Mobility?

For an older person whose mobility may already be limited to some extent, many types of exercise seem daunting. Older people residing in nursing homes generally require exercise that will help to maintain a level of independence in mobility and activities of daily living.

Here are some simple exercises which are commonly advised.

Strengthening Exercises

Sit to Stand Exercise
Sit in a chair with armrests. Move your bottom forwards to the edge of the chair and stand up slowly. Stand as tall as possible before sitting down slowly. Repeat 5 - 10 times.

Many people do this exercise at a table where they can use their hands as support as they "climb" to their full height.

Stairs Climbing
Climbing onto and off the bottom step of the stairs with appropriate supervision and assistance can help improve power in the legs and cardiovascular system.

Arm Exercise
While sitting in a well-supported position on a chair, lift a walking stick/sweeping brush in both hands as high as possible overhead. Extreme caution should be taken for those who have suffered from a previous stroke.

Flexibility Exercises

Knee Rolling:
Sit on a bed with both knees bent up and with feet resting on the bed. Keep the knees together and gently roll them from one side to the other without letting the upper body follow through.This exercise is generally prescribed to help improve trunk pelvic flexibility and ease of movement in/out of bed and for turning.

Trunk Rotations:
Similarly, trunk turning aims to improve turning ability and posture by increasing flexibility of the trunk. Sitting in a well-supported position on a chair, fold the arms and turn as far as possible from the waist to look over your shoulder. Repeat to the other side.

Appropriate exercise should not cause increased levels of pain. Some muscle soreness and fatigue is expected at the commencement of a new exercise programme.

If in any doubt regarding exercise, it is advised to contact a Chartered Physiotherapist.

The Irish Society of Chartered Physiotherapists (ISCP) can help you locate a Chartered Physiotherapist in your locality. The offices can be reached on 01 402 2148 at Royal College of Surgeons Ireland, St. Stephen's Green, Dublin 2 or www.iscp.ie

References

CSO (2002) www.cso.ie

Lyndon-Griffith 1996 Exercise parameters for the elderly. (as part of Gerontology Manual) ed R Stone.

http://otpt.ups.ed u/Gerontological_Resou rces/Gerontological_ Manual

Skelton DA 2001 Effects of physical activity on postural stability. Age and Ageing 30- S4: 33 - 39, Brill et al 1998.

Dean E 1994 Cardiopulmonary Development. In Bonder BR, Wagner MB eds. Functional Performance in Older Adults. Philedelphia, PA: FA Davis Co.