How are older adults really faring when it comes to aging and mobility loss? Journey Health & Lifestyle polled leading geriatricians across the U.S. to learn about the most pressing issues they see in their practices. Several themes quickly emerged: Among them, the fact that most older adults seek mobility support only after they’ve had a fall. The biggest reason: Fear of losing their independence. Staying quiet about mobility struggles is the default for most seniors, in hopes no one will question their ability to continue caring for themselves.
“Changes to mobility are very difficult for most people to accept,” says Gerda Maissel, M.D., founder of My MD Advisor, a company that advocates for seniors’ medical rights in Hudson Valley, NY. “Our society tends to disregard older people rather than revere them. So when a change to our mobility comes up, we have many reasons not to want to think about it.”
But the ramifications of hiding or avoiding issues around mobility loss are huge. Nine out of 10 geriatricians said “most” or “at least half the time” anxiety over a potential fall leads seniors to restrict their mobility more than their actual physical limitations. “Fear of falling can become a limitation of its own,” says Edmundo Rodriguez-Frias, M.D., a Maryville, IL, clinician who is triple-board-certified in internal medicine, geriatrics, and gastroenterology. “I frequently see older adults who are physically capable of walking farther or doing more than they believe they can, but after a fall, they begin limiting their activity. That avoidance can lead to deconditioning, which then makes the original fear more justified.”
Mobility aids and physical therapy are the most underutilized tools when it comes to helping seniors maintain their mobility, geriatricians say. A mistaken belief that doing less will keep them safer leads to less activity, which becomes a downward spiral in physical and psychological health. “Depression, social isolation, and loss of confidence can markedly reduce activity even when the physical impairment is modest,” says Ron Schwartz, M.D., an assistant clinical professor of geriatrics at the University of Connecticut School of Medicine and medical director of Masonicare Health Center in Wallingford, CT.
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Here’s what else we learned.
Mobility Decline Begins Slowly
Difficulty rising from a chair, taking slower or smaller steps, and avoiding certain activities are the three biggest telltale signs an older adult’s mobility is beginning to decline, according to our experts. One in two geriatricians say seeing an older adult struggling to get out of a chair is a red flag that their mobility needs support. “Older adults often downplay the significance of their physical changes,” says Dr. Schwartz. “The biggest misconception older adults have is that loss of mobility is an inevitable part of aging and that nothing can be done about it.”
In Journey’s survey, 70% of geriatricians said that social activities are the first aspect of daily life typically affected by an older adult’s mobility issues, with many skipping events or dates with friends because of uncertainty over how they will physically navigate the situation. “Behavioral changes can appear before obvious physical disability. Someone may avoid a restaurant with stairs or turn down outings that require considerable walking,” Dr. Rodriguez-Frias says. “Those decisions can be an early clue that mobility is becoming more difficult.”
Psychological Fears Become Physical Limitations
Ninety percent of geriatricians said anxiety over falling restricts mobility in older adults more than actual physical limitations at least half the time; 60% said this is almost always the case. “Mobility decline is often a vicious cycle compounded by the fear of falling, which can be as disabling as an actual fall,” says Dr. Schwartz.
The fallout from this fear—restricting any nonessential movement—is clear: 80% of clinicians say inactivity is the leading culprit in preventable mobility decline in their patients (followed by medication side effects). Less daily movement contributes to fragile bones and weaker muscles, which then leads to more pain and instability when someone does start to walk. “I’ve seen patients who stopped stretching, walking, and doing hobbies because the movement was painful,” says Julia Loewenthal, M.D., an assistant professor of medicine at Harvard University and geriatrician with Lutanen Health in Boston, MA. “In the end, that made their symptoms worse. Movement is often part of the treatment.”
Regaining confidence in mobility starts with getting medical support. “The most important thing is to get a medical evaluation and referral to a physical therapist,” says Elizabeth Landsverk, M.D., a geriatrician in San Francisco and medical advisor to A Place for Mom, a senior living services company. “Use a walker if it’s recommended, and work on the physical therapy exercises to build up muscle strength.” Most importantly, she says, “Don’t give up.”
Inactivity Is a Major—and Preventable—Problem
Limited movement is of particular concern to geriatricians when seniors require hospital stays. Safety protocol often means older adults remain bedridden during their stay. “Hospitalization is the strongest predictor of new disability,” says Stephanie Rogers, M.D., the associate chief of the geriatrics clinical program and professor of medicine in the UCSF Division of Geriatrics in California. “Over half of new disability in older adults is because of a hospitalization because so much of the time in the hospital is spent in bed,” says Dr. Rogers, who has taken to social media to spread the word about healthy aging habits. “Deconditioning happens within days, and one-third of older adults who are admitted to the hospital leave with a new disability.”
At the same time, eight in 10 geriatricians cite physical therapy or mobility aids as the most underutilized tools for preserving mobility in seniors. “Many older adults operate under the ‘wear and tear’ myth that leads to inactivity,” says Zeeshan Khan, M.D., the chief of geriatric medicine at Hackensack Meridian Jersey Shore University Medical Center and associate professor of family medicine at Hackensack Meridian School of Medicine in New Jersey. “Moving less and resting more does more harm than good. When older adults are inactive it accelerates the age-related loss of muscle mass and strength.”
Support Arrives Only After a Fall
It shouldn’t take a fall to convince older adults to seek support for a mobility aid—but it does, according to every geriatrician we surveyed. The most common reason seniors resist using a mobility aid, 90% of clinicians say, is worrying that they will appear old or frail.
“For older people who fall or have fallen, they tend to believe cultural myths proliferated by our society and ageism—including that falling is inevitable… and using a walker or cane shows weakness,” says Marilyn R. Gugliucci, Ph.D., professor of geriatrics and director for geriatrics education and research at the University of New England in Portland, ME.
“People are very reluctant to believe that a wheelchair allows them to still do activities, such as attending a concert or visiting someone,” adds Dr. Maissel. “People struggle to think of a wheelchair as simply a tool to maintain their ability to get around and function, albeit in a different way.”
What Seniors Fear Most: Loss of Independence
Nine in 10 physicians identified the emotional loss of independence as their patients’ greatest concern. The doctors consistently described mobility as connected to staying at home, making decisions, socializing, and remaining part of the wider world.
Because of this, “many older adults continue to try to do all the activities, like changing curtains, without taking in consideration changes with balance,” says Manisha Parulekar, M.D., co-director of Center for Memory Loss and Brain Health at Hackensack University Medical Center and associate professor of geriatrics at Hackensack Meridian School of Medicine in Nutley, NJ. The fight to maintain activities they’ve done their whole adult life is both good and bad, Dr. Parulekar adds, depending on whether someone has support to do so safely. “As I tell my patients, any movement is better than no movement and exercising in a safe environment helps to improve all health outcomes and maintain independence.”
Moreover, cultivating a can-do mentality is valuable in and of itself, says Dr. Loewenthal. “The psychological relationship someone has with their body matters as much as the physical one,” she believes. “Patients who approach aging with a sense of agency tend to do better than those who accept it as an inevitable decline.”
Address Small Changes Early
If there is a single takeaway from Journey’s survey, it’s that a large gap persists between what older adults believe about mobility and aging versus what medical experts say is the most effective course of action to preserve movement as we age. “Older adults undervalue the effect of intervention in improving mobility, so they do not seek help or shield valuable information from their healthcare provider as they believe it is normal aging or it is not fixable,” says Wessam Labib, M.D., the division head and medical director of geriatrics medicine at Loma Linda University Health in California.
Journey’s poll found great consistency in the advice from geriatricians, including:
- Don’t assume mobility loss is inevitable.
- Mention changes to a healthcare provider.
- Keep moving safely.
- Use mobility equipment and physical therapy before a serious problem occurs.
- Treat mobility support as a way to preserve activity, not evidence of failure.
Finally, don’t wait for the proverbial other shoe to drop before taking action to shore up your mobility and take control of your health future. “Mobility decline is rarely caused by one dramatic event,” says Dr. Rodriguez-Frias. “More often, it happens through a series of small concessions, like stopping daily walks or avoiding crowded places. Each decision may seem minor, but together they can shrink a person’s world. The best time to address mobility is when those small changes first begin, not after independence has already been lost.”
Editor’s note: Journey Health & Lifestyle surveyed 10 geriatricians across the U.S. about aging and mobility. Doctors were asked to select the best answer, although some selected more than one response they felt applied. Findings are directional and are not representative of all geriatricians.
