September 20, 2013

Paper suggests mobility is key to healthy aging
A clinical review from geriatricians urges primary care physicians to take a more aggressive role in ascertaining the mobility of their older patients.

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A clinical review from geriatricians at the University of Alabama at Birmingham suggests that mobility limitations are a litmus test for healthy aging and urges primary care physicians to take a more aggressive role in ascertaining the mobility of their older patients.

The study was published Sept. 18, 2013, in the Journal of the American Medical Association, as part of their continuing series, Care of an Aging Patient.

brown jama mobility sThe authors, Cynthia J. Brown, M.D., MSPH, and Kellie Flood, M.D., of the UAB Division of Gerontology, Geriatrics and Palliative Care, conducted a clinical review of academic papers published between 1985 and 2012 dealing with mobility issues in a general aging population.

“The review confirmed that increased physical activity and exercise are extremely important for healthy aging,” said Brown. “We’ve also identified mobility-limiting risk factors and created an approach to help medical professionals screen for and treat those risk factors.”

Brown said mobility limitations are often an early sign of impending functional decline in seniors. Recognizing an increase in those limitations at an early stage creates the opportunity for successful interventions aimed at warding off functional decline and keeping seniors living independently for as long as possible.

“Mobility limitations are the edge of that slippery slope that leads to loss of function,” said Brown. “A decline in mobility seems to quickly lead to an across-the-board decline, including the routine activities of daily living. Mobility is a sort of barometer for how well an older person ages.”

Recognizing an increase in those limitations at an early stage creates the opportunity for successful interventions aimed at warding off functional decline and keeping seniors living independently for as long as possible.
The approach that Brown and Flood recommend suggests that primary care physicians should ask all senior patients two questions: for health or physical reasons, do you have difficulty climbing up 10 steps or walking a quarter of a mile; and because of underlying health or physical reasons, have you modified the way you climb 10 steps or walk a quarter of a mile?

“Any modification of a task such as climbing 10 steps raises a red flag,” said Brown. “Asking the right questions can tell a clinician a great deal about the level of mobility in their older patients.”

Brown said that a positive answer to either of the two questions should lead the primary care provider to dig deeper and identify the physical, social or environmental components leading to the limitations, and they should take steps to address those limitations through physical therapy services and/or prescribing appropriate ambulatory devices. She also said primary care physicians are the front line of defense against other identified risk factors like obesity and smoking.

Brown, a physical therapist for 10 years before becoming a physician, suggests greater interaction between doctors and therapists.

“Mobility is one of the cornerstones of healthy aging,” she said. “With an increasing older population in the United States, it is incumbent on us to find ways to help older Americans continue to live well and independently. The major barriers – lack of physical activity, obesity and smoking – are all risk factors that can be successfully overcome with appropriate treatment and assistance.”
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