How to Tell When It’s Time for Mobility Support

If you're at the stage of life where you've noticed changes in your aging parent's mobility, it's a confusing time. Sometimes, they seem capable and strong. But other times, you've had to rush to catch their arm as they lose their balance or stumble and nearly fall.

Complicating matters, your parent is adamant everything is just fine. "It's common for older adults to struggle to ask for help," says Marvell Adams Jr., the Baltimore-based CEO of Caregiver Action Network, the nation's leading non-profit organization dedicated to supporting the tens of millions of Americans who care for aging, chronically ill, or disabled loved ones. This often stems from a fear of losing independence, Adams explains.

Changes in mobility are often the result of older adults restricting their movement to avoid pain, says Diana Girnita, M.D., Ph.D., a board-certified rheumatologist and founder of Rheumatologist OnCall in Irvine, CA. "There is a loss of range of motion and everyday movements like standing up from a chair, climbing stairs, or gripping a coffee cup become difficult," Dr. Girnita says.

As mobility declines, the risk of a fall goes up. So, when is it time to intervene?

What Does Mobility Support Mean?

Technically speaking, mobility support refers to any assistance, device, or therapy that helps a person move around more safely and comfortably. Despite misconceptions about mobility support being a sign of decline, in truth, a wide range of products, from canes to power mobility chairs, can help your parent maintain a more active life—on their terms.

"A mobility aid used the right way doesn't weaken you," says Dr. Girnita. "It gives you the stability and confidence to keep moving, which keeps you strong. The goal is never to do the work for your body; it's to support your body so that it can keep doing the work for itself."

By improving balance and stability, mobility aids also help to decrease fall risk, says Elizabeth Jaramillo, M.D., a board-certified internist and geriatric medicine physician at the University of Texas Medical Branch (UTMB) in Galveston, TX, who specializes in adult and elderly care.

Whatever mobility aid you're considering for your parent, remember that these tools are designed to help people stay active and independent—and they're not reserved for a certain age. Nearly one in three adults over 65 already use a mobility aid, according to the National Health and Aging Trends Study.

Signs Your Parent May Need Mobility Support

Indications your parent may need mobility support can be both obvious and subtle. "Family members should pay attention to physical and behavioral changes," says Adams. "Physical signs include frequent falls or near-falls, difficulty standing from a chair, unexplained bruises, changes in walking patterns, increased fatigue, or weight loss."

Behavioral signs include things like missed medications, challenges with personal hygiene, unopened mail, and difficulty managing finances. Emotional indicators are just as significant. "These may include withdrawing from activities they once enjoyed, increased irritability, confusion, or other noticeable changes in mood," says Adams. "Often, the need for additional support becomes apparent when everyday tasks that were once routine begin to feel overwhelming."

These are a few signs to watch for.

They Have Fallen or Nearly Fallen

Per the Centers for Disease Control and Prevention (CDC), more than one in four older adults age 65+ report a fall each year. A serious fall can obviously change your parent's mobility, but it also affects their confidence. You may notice that they start moving more cautiously or freeze before taking a step. They may express anxiety about showers or stairs or decline to take part in activities because they "don't want to be a bother."

Plus, one fall doubles their chances of falling again, says the CDC. Falls are the biggest concern Dr. Girnita has for her older patients. "When a knee or a hip is painful and unstable, and the muscles supporting it are weak, balance suffers, and a single fall can mean a fractured hip and a permanent loss of independence," she says.

They Hold Onto Furniture or Walls

If your aging parent is afraid of falling, they may tend to hold onto the counter, furniture, or walls, says Dr. Jaramillo. Or they may arrange furniture to create convenient handholds. "Look out for a general sense of them being hesitant when walking," she adds.

Furniture isn't a suitable mobility aid, as it's simply not designed for that purpose and may require your parent to reach for different heights and/or maneuver themselves in awkward positions.

Their Walking Pattern Has Changed

Compare your parent's manner of movement now to what it was a few months ago. Certain changes in how they move may be a cause for concern and a sign that mobility support could be beneficial:

• Difficulty turning
• Dragging one foot
• Limping
• Pausing before stepping off a curb
• Shorter or shuffling steps
• Slower walking
• Struggling to walk and talk at the same time
• Walking with their feet farther apart

Pain Is Limiting Their Movement

Pain can be caused by any number of issues, but if it's movement-related, it often stems from the joints. Joint pain limits movement in several ways. First, the body instinctively tightens muscles around a painful joint (known as muscle guarding) to physically prevent the joint from moving fully and triggering more pain. Second, swelling from extra fluid inside an inflamed joint presses on nerves and tricks the brain into thinking the joint can't move any further.

Signs that pain is limiting your loved one's movement include grimacing, rubbing part of their body (such as their hip or knee), and frequently asking to sit down.

They Tire More Easily

Fatigue becomes more common with age, particularly if your parent is managing one or several health conditions. When a walk around the block that used to be a no-brainer becomes the impetus for an hour-long nap, or doing household chores now requires finding a place to sit instead of stand, it's clear that fatigue is altering their ability to live like they used to.

In these cases, walkers, rollators, or power mobility chairs can provide an assist, so that your parent can keep up with their regular routine.

They Struggle to Stand Up or Sit Down

Moving from sitting to standing (and vice versa) is one of the most common moments for a fall. Joint instability and muscle weakness make this shift from one position to the other challenging. To compensate for lack of strength and guard against a fall, you may notice your parent repeatedly rocking in a chair before standing (to build momentum), pushing heavily on furniture, or pulling on another person as they stand or sit. They may also have difficulty getting out of bed, out of a car, or off the toilet.

They Avoid Stairs, Curbs, or Uneven Surfaces

Reluctance to go up or down stairs or making excuses to stay on one level of the home is another sign your loved one has lost confidence in their mobility and is afraid of falling, says Dr. Jaramillo. Other avoidance red flags include:

• They hesitate before stepping off a curb.
• They avoid grass, gravel, or cracked sidewalks.
• They insist on holding someone's arm in parking lots.
• They avoid sloped surfaces.

They Are Going Out Less Often

Pay attention to your parent's everyday routine: How much of it involves leaving the house? "Sometimes patients will decrease or stop activities outside the home due to feeling off-balance," says Dr. Jaramillo. Apparent disinterest in going out may also stem from fatigue, a fear of falling, or concern about lack of access to restrooms.

A hesitation to leave home may manifest itself in several ways, such as declining family outings they once enjoyed, shopping online rather than visiting stores, and no longer attending religious services, clubs, or social events they used to go to regularly.

They Increasingly Depend on You for Physical Help

It's common for an aging parent with mobility issues to hold onto their loved one's arm more often when walking outside of the home, says Dr. Jaramillo. "They may also depend on you more often for help with simple tasks like sweeping, vacuuming, other household chores," she adds. Other signs that your parent is becoming increasingly dependent on you for physical help include:

• Asking you to pick up groceries or prescriptions that they once handled themselves.
• Needing frequent help carrying items because doing it themselves upsets their balance.
• Needing help getting out of chairs.
• Not leaving home unless you go with them.
• Taking baths or showers less often or refusing to bathe unless you are with them.

By restoring some of your parent's independence, appropriate mobility support also reduces caregiver strain.

Less Obvious Signs of Declining Mobility

Mobility issues aren't always obvious—sometimes, what you're looking for are small shifts in behavior. Some more subtle signs that your parent may need mobility support include:

• Laundry or household maintenance is piling up.
• It takes longer for them to answer the door or phone.
• The refrigerator is low on food because grocery shopping is difficult.
• They have stopped using certain rooms or an entire floor of the house.
• They schedule fewer appointments that require leaving home.
• They wear the same clothes several days in a row because dressing is harder.

Questions to Ask Yourself as a Caregiver

Even if you believe mobility support is probably a good idea, it's a hard threshold to cross, especially since once you initiate a conversation with your parent, it may become an emotional one.

Double-check your instincts by asking yourself these questions, all of which point to a mobility aid being beneficial for your parent at this point:

• Has my parent fallen or nearly fallen in the past year?
• Do they hold onto furniture or people while walking?
• Are they giving up activities because of walking distance?
• Does pain or fatigue frequently interrupt outings?
• Are they suddenly spending more time at home?
• Do they need more physical help from me than they did six months ago?
• Do I worry about leaving them alone?
• Am I providing support that a mobility device could offer more safely?
• Would the right mobility support help them be more independent?

If the answer to several of these questions is "yes," it makes sense to arrange a professional mobility assessment.

How to Talk to Your Parent About Mobility Support

Even if you have a great relationship with your parent, and your parent is generally quite open to ideas around aging in place, broaching the topic of using a mobility aid is delicate. It's easy to interpret the suggestion as a veiled comment on competence, rather than its intended purpose of offering support.

Start the conversation with an open-ended question, such as "How are you feeling these days about walking and moving around on your own? Is there anything that might make it easier for you?" Then, listen to your parent's response without interrupting, Dr. Jaramillo says. If your parent previously used a mobility aid and then stopped, a good way to open the conversation is to ask where it is and why they stopped using it.

Frame your inquiries in a way so your parent understands you are concerned, says Dr. Jaramillo, while stressing that the purpose of the conversation is to work together to find a way to preserve their independence and quality of life and allow them to continue doing the things they enjoy.

Be specific about changes you have noticed—it's more effective than making vague, general statements. For instance, try saying something like, "I noticed you had to grab the counter several times yesterday for balance. Would you be open to finding something that makes walking steadier?" instead of "It's not safe for you to walk anymore."

Leading the discussion with what your parent can no longer do may make them feel frustrated or scared. Instead, focus on what they want to keep doing by asking what activities have become harder recently (visiting friends, shopping, traveling, and attending family events may be things they feel they are missing out on).

And finally, make mobility decisions together. Yes, you are your parent's caregiver, but if they don't feel like getting a mobility aid was their choice, they won't use it. Be patient—accepting mobility support takes time.

Who Can Assess Your Parent's Mobility?

It's not uncommon that you and your parent reach something of an impasse: You think it's time for mobility support; they think they are not yet at that stage. To break the stalemate, the advice of a healthcare provider may be useful.

There are several professionals with expertise on this topic, says Adams. A primary care provider will review recent changes, falls, pain, medications, and medical conditions, plus rule out treatable causes of declining mobility. A physical therapist can evaluate your parent's gait, balance, strength, and fall risk, and can also recommend and fit an appropriate device and demonstrate how to use it effectively and safely. And finally, an occupational therapist can assess your parent's ability to bathe, dress, and cook for themselves, and can recommend adaptive equipment to help your parent continue living independently.

What Kind of Mobility Support Might Help?

A mobility aid should promote independence, not limit it, says Adams. For someone with mild balance issues, a cane may be enough assistance. If your loved one needs additional support, one of these may benefit them:

• Walker. A walker is an effective aid if your parent requires greater stability while standing or walking.
• Rollator. This four-wheeled walker reduces the strain of walking by providing continuous, wheeled support and offers a seat for breaks from standing.
• Wheelchair. If long-distance walking is no longer comfortable and your parent has good upper-body strength for self-propulsion, a wheelchair could be a good aid.
• Power chair. For seated mobility that still provides independent movement, a battery-powered chair is a good choice.
• Mobility scooter. When long-distance walking is a struggle, this four-wheel device can help your parent cover maximum ground.

How Mobility Support Protects Independence

As balance and energy issues creep in, older adults often stop going out, socializing with friends, and doing the things that keep them sharp and connected. "That isolation and drop in activity can worsen both physical and mental health," says Girnita.

If you're on the fence about whether it's time for them to consider using a mobility aid, know that being proactive is the best way to keep Mom or Dad safe. "Mobility aids can prevent falls and serious injuries like hip fractures and help the patient continue with activities of daily living," says Dr. Jaramillo. As a caregiver for an older parent, raising the subject of mobilit aids is daunting, and there is a real chance they may bristle at the suggestion at first. But you never know—your parent might also be secretly relieved to have you call out a few things they, too, have noticed about their balance.

Have patience, show support, and be understanding. One conversation is the first step in making a decision that can give your parent back the freedom and independence they've lost.