Role of Mobility Aids in Aging Gracefully: Insights for Seniors

Importance of Mobility devices for Aging Population

Aging gracefully encompasses a multitude of factors, including maintaining mobility and independence as one grows older. Scientific research has shed light on the pivotal role that mobility aids play in facilitating this journey for seniors.

Studies show that attitudes and beliefs strongly affect the decision to use mobility aids. Despite the growing diversity of the population, no prior studies have compared attitudes towards and beliefs about mobility aids by race and ethnicity.

A study published in the PubMed Central, aimed to explore whether and how attitudes towards and beliefs about mobility aid use vary by population. They conducted 12 focus groups with 61 community dwelling persons age 65+ years from three different ethnic groups: White, Black, and Hispanic. For all groups, perceived benefits of mobility devices in maintaining independence and control produced positive attitudes.

Although beliefs about and attitudes towards mobility aids and disability are thought to be important factors in the use and non-use of devices, no prior studies have compared attitudes and beliefs about mobility limitations and mobility aid use across racially and ethnically diverse persons age 60+ years old.

Research suggests that a perceived increase in safety afforded by a device may offer the strongest predictor of mobility aid use, whereas perceived social stigma reduces acceptance and contributes to mobility aid abandonment, and the desire to avoid stigma associated with device use may override desire to increase independent mobility. However, these factors have not been studied across racial and ethnic groups.

Understanding the Importance of Mobility Aids

Studies conducted by leading researchers in gerontology and rehabilitation sciences consistently highlight the significance of mobility aids in promoting independence and quality of life among seniors.

For instance, a meta-analysis published in the Journal of Aging and Physical Activity concluded that the use of mobility aids, such as wheelchairs and rollators, is associated with improved functional mobility and reduced risk of disability among older adults.

Mobility Aids and Stigma

A number of participants across all ethnic groups believed that mobility aids stigmatized their users. They felt ashamed of needing help and felt that people with mobility problems were not seen “as normal.”

For all participants, the perceived stigma of mobility aid use was due to fear of aging and physical decline. Some said they did not want to use a device because they feared being seen as “crippled,” “an old lady,” “very sick”, or even as “dying”. Some feared that, after accepting a device, further decline would be inevitable.

The research findings demonstrate the negative influence of social pressures and perceived stigma about device use. Combating these pressures might be done through community-based social marketing interventions or peer-to-peer interventions so that non-device users can experience positive role models in other elderly persons who use mobility aids and articulate their benefits.

Having patients select their own equipment based on their preferences for device appearance could improve acceptance of mobility aids. Attractive devices which can be viewed as fashion accessories may be more readily accepted. This may be true for manual wheelchairs which can also be sporty-looking with enhanced function for an active lifestyle. However, in offering such choices, providers must consider patients’ resources and equipment costs.

Several non-device users stated that they would rather be dead or “not be here” if they needed a device. For many, use of mobility aids is associated with feelings of sadness and depression.

However, while fear of stigma associated with device use was normative, it was not a universal sentiment. Some device users from each group expressed appreciation for mobility aids and denied self-consciousness or embarrassment about using an aid.

Negative Attitudes Toward Device Users

In addition to perceived stigmatization of mobility aid use by others, focus group participants themselves expressed negative attitudes toward persons who use mobility aids whom they perceived “didn’t really need them.”

They saw such persons as “posers,” possibly intent on “taking advantage of others” by trying to get preferential treatment, or get attention from family members or spouses. Some stated that they did not want to be viewed as one of those types of people.

Device Functionality As Key Factor For Use Adoption

Some device users said that they sometimes went without using their device because they were concerned that they were becoming or could become “dependent” on it, and therefore lose the ability (and choice) to ambulate without it.

Some reported that the special effort required to incorporate devices into daily life posed obstacles to use. Cane users in all groups spoke about inconvenience, particularly when going from place to place and needing to find somewhere to put the cane without it falling.

Device users also mentioned forgetting their equipment, either at home or at stores. Furthermore, some said that holding a cane limited them “to only one hand.” Some reported that standard walkers or crutches presented even greater challenges, making it difficult or impossible to perform ordinary tasks like carrying objects.

Because of the awkwardness of performing daily activities with “standard” canes and walkers, device users and non-users were particularly positive about devices that could assist them in doing more than one activity, facilitating function in areas of their lives beyond mobility. Thus, they preferred walkers with seats and baskets to standard walkers.

Mobility Aid Device As An Independence Device

In all racial and ethnic groups, interviewees’ desire for independence and control over their lives was a major theme that supported use of mobility aids. Persons wanted to choose when and where they go and to “do things on their own,” “get where they want to go without waiting,” and “not be a burden”.

Some non-device users stated that they felt that use of mobility aids would increase their autonomy and control in the event of a mobility impairment. Non-device users viewed mobility aids particularly positively as a tool for rehabilitation or recovery, “just for you to get back on your feet.”

Participants also recognized that their immediate physical safety would be enhanced through use of devices, which in turn would enhance confidence and sense of independence. Participants from all groups felt that mobility aids could prevent them from falling and “breaking bones.”

Enhancing Independence and Quality of Life

The World Health Organization (WHO) emphasizes that access to appropriate mobility aids is essential for older adults to maintain their independence and participate fully in social and community activities. Research published in the Journal of Gerontology: Medical Sciences underscores the positive impact of mobility aids on seniors’ ability to engage in daily tasks independently, contributing to enhanced well-being and overall quality of life.

Promoting Safety and Fall Prevention

Falls are a significant concern for seniors, often leading to injuries and loss of mobility. However, studies have demonstrated that using mobility aids can substantially reduce the risk of falls among older adults. A systematic review and meta-analysis published in the Journal of Aging and Health found that mobility aid users had a lower incidence of falls compared to those without aids, highlighting the role of these devices in promoting safety and fall prevention.

Device Appearance and Symbolism

The appearance and design of devices clearly resonated with Blacks and Hispanics, who suggested that using canes could be fashionable, and had a heightened preference for and acceptance of “good looking” canes.

Overall, participants preferred equipment with a sporty appearance over standard medical-appearing devices.

Attitudes towards devices related to the severity of mobility impairments requiring their use. For example, some were open to using a cane as it is recommended for those with only mild impairment, but less open to the possibility of using a walker or wheelchair, symbolizing more impairment.

Many were vocal in their distaste for standard walkers, which they saw as a symbol of frailty, most appropriate for those who were sick, recovering from surgery or illness or homebound.

Participants viewed manual wheelchairs most negatively of all the devices discussed, associating them with the greatest loss of function and therefore viewing them as a particularly strong symbol of decline, loss of independence, and power.

Participants also indicated that managing manual wheelchairs independently requires considerable effort for older and/or weaker people. Many considered manual wheelchair use indicative of complete dependence, believing that users would not self-propel. Lastly, participants noted that manual wheelchairs tend to look very medical, not stylish or sporty.

Participants viewed power wheelchairs as much more acceptable than manual wheelchairs; some preferred power wheelchairs to using a walker because “they would have more independence.”

Mobility Aid Device or Assistance From A Carer

Several participants in White and Black senior groups expressed preferences for mobility aids over personal assistance because such assistance, they felt, would put them in a dependent position and diminish their sense of autonomy and control.

Having others help them made them feel that they were being “treated like a baby,” didn’t “feel right,” made them feel “terrible,” and disturbed their “own way of moving.”

Role of Therapists, Doctors and Physicians

The majority of participants in all racial and ethnic groups indicated that a doctor’s recommendation to use a device would strongly motivate their decision to adopt one.

Physicians’ advice to use a device might offer an important justification that shields device users from the negative opinions of others. “If it comes from the doctor’s mouth,” than the need must be “real.”

The study has important clinical implications. Health care providers should be aware that elderly patients may not always report mobility problems and may not use a device even when recommended.

Although physicians should be aware that some patients will resist their doctor’s recommendation to use a mobility device, our findings suggest that physicians can strongly influence the decision to start using an aid and could play an expanded role by discussing and observing mobility, recommending mobility aids or referring patients to other clinicians (e.g., physical therapists) to prescribe appropriate equipment and train patients in use. This may be particularly important for minority seniors for whom a doctor’s orders may offer some sense of protection from discrimination.

Referral to allied health professionals who can ensure proper fit and technique of device use may alleviate concerns of poor fit and function expressed by minority participants.

Framing mobility-aids as a means to enhance patients’ independence and autonomy may enhance patients’ acceptance of mobility-aids. Because elderly individuals value autonomy and choice, clinicians should emphasize situational, rather than mandatory and permanent device use.

They might suggest that mobility aids would be especially valuable to enhance safety and comfort in crowded places, on dark nights out, or during slippery weather, emphasizing the device’s multiple functions within the person’s needs, living environment and lifestyle, and engaging patients in problem-solving.

Customized Solutions for Individual Needs

Personalized assessments and recommendations are essential when selecting mobility aids for seniors. Research published in the Journal of Rehabilitation Research and Development emphasizes the importance of considering factors such as individual capabilities, environmental challenges, and user preferences to ensure optimal outcomes. Tailoring mobility aid solutions to meet specific needs enhances usability, comfort, and overall effectiveness.

Mobility Study for Aging People: Conclusions

Their conclusion was that social pressures and perceived stigma deter mobility aid use, particularly in minority populations. Greater physician involvement, positive peer models and affordable, safe, visually appealing devices would promote greater acceptance of mobility aids.

It is important to develop interventions that will encourage and facilitate use of mobility devices to enhance quality of life and social participation among diverse community dwelling elders with mobility impairment.

Study results suggest the following measures to promote mobility aid acceptance among diverse groups of elders: expanding the awareness and role of physicians in assessing the need for mobility aid use and making referrals for prescriptions; exposure to peer role models (emphasizing autonomy and independence for non-Hispanics, and ability to participate in family and community events for Hispanics); providing consumers with choice of equipment style and design; and production of safe, lower cost mobility aids that are affordable or reimbursed by third party payers.

Addressing stigma and misconceptions surrounding mobility aids is crucial to promoting their acceptance and utilization among seniors. A qualitative study published in the Journal of Aging and Society explored older adults’ perceptions of mobility aids and highlighted the importance of education, peer support, and positive messaging in overcoming barriers to their use.

Links: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768139/