Today’s blog post is a guest post from the MPH online program at Baylor University.
November 06, 2019
More than 49 million adults in the United States are now 65 and older, and this number is increasing rapidly, (PDF, 691 KB) External link according to the U.S. Census Bureau. That growth is fueled by lower fertility and increased longevity. As a result of this population growth, discussions of mobility and fall risks in older adults have been thrust to the forefront of public health.
While staying active is a key factor for wellness in older adults, not everyone is getting the help they need, and the consequences can be serious. Mobility impairment can cause older adults to lose more than just the ability to move freely. They may no longer be able to participate in activities they once enjoyed, engage socially, or retain independence. They are also at a higher risk for losing their life — the number of falls resulting in death among older adults in the United States is on the rise, External link according to the Centers for Disease Control and Prevention (CDC).
As the population of adults over the age of 65 continues to grow, understanding the link between exercise and mobility is paramount.
Falls and Other Effects of Mobility Loss
Maintaining mobility is important for both the physical and mental health of older adults. As people age and their ability to participate in activities they enjoy decreases, a number of health risks become more prominent.
Increased Fall Risk
In a 2014 study on body mass index and falls in adults External link co-authored by Kelly R. Ylitalo, assistant professor for Baylor University’s Robbins College of Health and Human Sciences, 27 percent of adults aged 45–79 in the United States reported at least one fall in the previous 12 months. Additionally, 11 percent reported an injurious fall, meaning it resulted in activity limitation or healthcare utilization.
The study also found that injurious falls appeared to increase with age for adults over the age of 70. However, mid-life women — aged 35 to 65 — reported the highest prevalence of injurious falls.27%of adults aged 45-79 reported at least one fall in the past 12 months, according to a 2014 study.11%reported an injurious fall, meaning it resulted in activity limitation or healthcare utilization.25,180people aged 75 or older died from a fall in 2016, compared with 8,613 in 2000, a 192% increase.
“Since mid-life women report the highest prevalence of injurious falls, our results highlight the importance of measuring falls earlier in the life course, as much of the existing evidence misses this critical time window,” the study on body mass index and falls in adults External link said.
Fall risk is not just a concern for injury and disability; it’s also affecting mortality rates among older adults. According to a 2019 report, the number of deaths caused by falls is increasing. In 2016, 25,180 people aged 75 or older died from a fall, compared with 8,613 in 2000. External link
When an individual becomes less mobile, he or she may start to avoid activities and social events, leading to the feeling of isolation. This can take a serious toll on one’s mental health.
Additionally, a person can experience isolation as mobility decreases, not just at the point of reaching disability. A 2013 study on social engagement among older adults External link found that both lower life-space mobility and disability were associated with lower levels of social engagement. The measure of social engagement included both activities outside the home, such as participation in organizations, and social interactions at home, such as talking on the phone or using the internet.
High Healthcare Costs
Not only does mobility loss affect people’s physical and mental health, but it also affects them financially.
According to the CDC’s resource on home and recreational safety, External link fall injuries are among the 20 most expensive medical conditions, with the average hospital cost for an injurious fall being more than $30,000. Additionally, as people age, the cost for treatment for fall-related incidents increases.
What Causes Loss of Mobility?
While many health risks can lead to mobility impairment, a study on mobility limitations in older adults External link cited the following as the most common factors:
- Low physical activity
- Strength or balance impairment
- Chronic disease, including diabetes and arthritis
One challenge of navigating these health risks in relation to mobility loss is that they can be cyclical. For example, low physical activity puts an individual at higher risk for obesity and type 2 diabetes. In turn, having a pre-existing condition such as obesity can lead an individual to engage in less physical activity due to impaired mobility.
“We know that physical activity has immense benefits for cardiovascular health and mobility, but about one-third of adults in the United States are inactive,” Ylitalo said. “So, this physical inactivity is a huge health problem, but it’s directly related to physical functioning and aging well throughout the life course.”
How Can Exercise Help Maintain Mobility?
When addressing the issues of increased fall risk and mobility loss, exercise and physical activity are critical for preventive care.
“The biggest myth we have to bust is that falling is expected with age,” said Ashlee Britting, a clinical specialist in geriatric physical therapy. “You should not just assume that weakness or debility is expected as you get older.”
Britting said the four areas of focus for maintaining mobility are:
Depending on a person’s health status, physical activity can be attainable in many ways, from regular walks to enrolling in exercise classes tailored for older adults. People who require specialized attention may also work one-on-one with a physical therapist.
Mobility Exercises for Older Adults
To help maintain mobility, older adults should focus on physical activities that help build strength, balance, flexibility, and endurance. The following exercises require no equipment and can easily be done at home or outdoors.
Purpose: To build strength
- Sit at the edge of a sturdy, armless chair with your knees bent and your feet shoulder-width apart and flat on the floor.
- Cross your hands over your chest and lean back, keeping your shoulders and back straight.
- Bring your upper body forward until you are in your original position.
- Extend your arms parallel to the floor and stand up from your seated position.
- Slowly sit back down.
- This can be repeated 10–15 times, with a rest in between each set.
Purpose: To improve balance
- Use a sturdy chair or supporting item to hold onto for stability.
- Keep your shoulders, back, and head straight.
- Stand on one leg and stretch the other leg forward for 10–15 seconds.
- Repeat this five times and switch to balancing on your other leg.
Back of Leg Stretch
Purpose: To maintain flexibility
- Find a sturdy bench or other surface of similar size.
- Sit sideways on the bench and stretch one leg out on the bench with your toes pointing up. Keep your other foot on the floor and make sure to keep your back straight.
- Hold the position for 10–30 seconds. If you don’t feel a stretch, lean forward from your hips.
- Repeat 3–5 times.
- Switch to the other leg and repeat 3–5 times.
Purpose: To build endurance
In addition to your normal walking routine, try these strategies to optimize your physical activity.
Reverse your route: After walking a distance, turn around and walk back to your starting point. Changing direction allows you to hit different hills and curves to change up your routine.
Time yourself: When doing a daily walking routine, use a timer each day and try to gradually reduce the time it takes for you to complete your route.
Explore different terrain: With consideration for your level of ability, try to find places to walk with different surfaces. This can include soft surfaces such as grass, accessible sidewalks and other paved walkways, and hiking trails.
Invest in the right shoes: As people age, the shape of their feet changes — tendons, muscles, and ligaments stretch to make the foot wider, and the natural padding of the foot can become thinner. Look for a walking or running shoe that fits the widest part of your foot, has a ridged sole, and leaves enough room for you to wiggle your toes while standing.
“Go4Life,” External link National Institute on Aging. National Institute on Health. Accessed September 30, 2019.
“Top 10 Elderly Balance Exercises to Improve Balance and Coordination,” External link Aging in Place. Accessed September 30, 2019.
“7 Ways to Upgrade Your Walking Workout,” External link Silver Sneakers. Accessed September 30, 2019.
“When Comfort Counts: Choosing a Walking Shoe,” External link AARP. Accessed October 1, 2019.
What Can Be Done to Age Healthily and Maintain Mobility?
In an ideal world, physical activity would be a normal part of every person’s routine throughout their lifetime. In practice, health professionals know this is not always the case. As people age, it is important to be self-aware and take action when signs of mobility impairment become noticeable.
Self-Assessment for Mobility
If an older adult is wondering whether they should talk to a clinician about mobility and fall-risk concerns, Britting recommends asking the following questions. If the answer is “yes” to any of these prompts, a clinician visit may be necessary.
- Have you had a fall or incidents of nearly falling?
- Do you feel dependent on your spouse or family member for assistance?
- Do you feel comfortable being home alone?
- Do you have difficulty standing up from a seated position?
- Have you noticed yourself avoiding certain activities?
It is also important for older adults to know how they can advocate for their health when talking with a clinician. According to a 2018 study from the National Center for Injury Prevention and Control, 48 percent of physicians and nurse practitioners routinely failed to recommend exercise when advising older patients about falls. External link
In addition to asking a clinician about physical activity recommendations, the CDC’s resource on home and recreational safety External link advises older adults to inquire about the following risk factors:
- Lower body weakness
- Vitamin D deficiency
- Side effects of medication, such as sedatives or antidepressants
- Vision problems
- Foot pain or poor footwear
- Inaccessible home environment
Resources for Further Reading
- National Council on Aging: Falls Prevention External link
- National Institute on Aging: Exercise and Physical Activity External link
- Centers for Disease Control and Prevention: Home and Recreational Safety External link
Please note that this resource is for informational purposes only. Individuals should consult their healthcare professionals before following any of the information provided.
Citation for this content: The MPH online program from Baylor University’s Robbins College of Health and Human Sciences.
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