Topics in Geriatric Rehabilitation • Volume 28, Number 3, 190–194 • Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/TGR.0b013e3182581d72

Assistive Device Usage in Elderly People and Evaluation of Mobility Level Tülay Tarsuslu S¸ims¸ek, PT, PhD; Eylem Tütün Yümin, PT, MSc; Meral Sertel, PT, MSc; Asuman Öztürk, PT, MSc; Murat Yümin, MD This study examined assistive device usage and mobility level among elderly people. The inclusion criterion was age 65 years or older; all participants were volunteers. Participants were investigated in terms of their the sociodemographic characteristics and their levels of mobility device usage in everyday life, as assessed by the Rivermead Mobility Index and the Physical Mobility Scale. The study included 58 (35.6%) women (mean age ⫽ 73.18 ⫾ 6.62) and 105 (64.4%) men (mean age ⫽ 73.31 ⫾ 6.59). It was found that 31% of women and 19% of men used an assistive device in their everyday life; there was no significant difference in device usage according to gender (P ⬎ .05). The most common device among men and women was a walking stick. There were no significant differences between men and women in terms of Rivermead Mobility Index and Physical Mobility Scale scores; the mobility level of men was higher than women (P ⬍ .05). Assistive device usage is important for elderly people in maintaining indoor and outdoor mobility in everyday life. Our results should be taken into consideration in the rehabilitation of elderly people, especially elderly women. The use of mobility assistive devices reduces injury risk and becomes an important factor in increasing life quality in elderly people. Key words: assessment, assistive devices, elderly person, mobility

P

articipation in social activities with family and friends is important for elderly people within the scope of continuity of mobility. Active participation and social relationships are important parameters in quality of life but can be negatively affected among elderly people who cannot maintain their mobility and have ambulatory difficulties.1,2 Mobility limitations in elderly people are highly dynamic and characterized by frequent transitions between states of independence and disability. Mobility difficulties among Author Affiliations: School of Physical Therapy and Rehabilitation, Dokuz Eylül University (Dr S¸ims¸ek); School of Physical Therapy and Rehabilitation, Abant Izzet Baysal University (Messrs Yümin, Sertel, and Öztürk); and Family Medicine (Dr Yümin), Bolu, Turkey. The authors declared no financial or conflicts of interest with respect to the authorship andⲐor publication of this article. Correspondence: Tülay Tarsuslu S¸ims¸ek, PT, PhD, School of Physical Therapy and Rehabilitation, Dokuz Eylül University, 35340 Inciralti-Izmir, Turkey ([email protected]). 190

www.topicsingeriatricrehabilitation.com

elderly people, caused by fear of falling, may result in activity limitations in everyday life, life dissatisfaction, and lack of access to preventive care.3,4 Previous studies reported high rates of mobility difficulties in elderly people, especially in elderly women.5,6 Assistive device usage is very common in elderly people to resolve mobility difficulties and facilitate mobility in everyday life.7,8 Very often, elderly people use assistive devices for the sense of confidence they provide, although they do not have any disability or health problem. In addition to facilitate mobility, the use of assistive devices by elderly people develops selfconfidence and increases functional capacity and social participation.1,9,10 Elderly people with increased social participation may have reduced emotional problems and increased life satisfaction. Although the literature includes various studies on the use by elderly people of assistive devices in everyday life, there are few studies examining walking assistive devices among elderly people. The studies in the literature often examine the assistive devices used by elderly people to maintain their outdoor mobility (vehicles such as car, bus, bicycle, train, etc)2,9 or the assistive devices used to realize indoor and outdoor activities (bed, bath, and toilet activities, support from family and friends).3,11 The devices used to realize andⲐor facilitate mobility by elderly people in Turkey in order to increase or facilitate their walking and mobility skills from a different point of view.

MATERIALS AND METHODS The study included 163 elderly individuals 65 years and older. The inclusion criteria of the study were age 65 years or older, voluntary participation in the study, and the ability to understand the questions. The study included elderly people living in a nursing home in Bolu Province and nonresident visitors, present in the nursing home during visiting hours, who volunteered to participate in the study. Exclusion criteria were diagnosis of cognitive deficit and severely impaired visualⲐauditory acuity. All participants gave their informed consent for participation in the study. Data were collected through face-to-face interviews. Demographic data included age, height, weight, marital status, educational level, and chronic illness, in addition to the use of assistive devices. This study was evaluated and approved by Bolu Clinic Research Ethics Committee. July–September 2012

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

TGR200158.indd 190

12/07/12 10:49 PM

The mobility levels of individuals were evaluated through basic mobility Rivermead Mobility Index (RMI)12,13 and the Physical Mobility Scale (PMS).14 The Rivermead Mobility Index measures mobility state. It consists of 14 questions and 1 observation and includes a series of hierarchical activities, from turning in bed to running. One point is scored for each “yes” answer, and potential scores range between 0 and 15. A score of 15 points indicates that there is no problem in mobility, and scores of 14 and lower indicate the presence of mobility problem.12,13 The literature includes studies that showed the validity and reliability and emphasizes the usability of the RMI in the elderly population.12-14 The Physical Mobility Scale was developed by Australian physiotherapists and has been demonstrated to be valid and reliable. It evaluates specific mobility activities required for developing basic life functions.15 It has 7 parameters, each scored between 0 and 5 points. The lowest overall score is 0, and the highest potential score is 40. High scores indicate that there is no mobility limitation. In this study, the RMI and the PMS were evaluated and graded by the physiotherapist who observed elderly individuals and evaluated their performance.

DATA ANALYSIS The SPSS statistical package (Version 11.0 for Windows) was used to analyze the data. Mean and standard deviations were used in descriptive statistics. In statistical analysis, the t and ␹² tests were used to examine differences between sociodemographic attributes in men and women, the t test examined differences between mobility levels, and Pearson correlation was used to determine the relationship between evaluation parameters. In all tests, significance level was set at P ⬍ .05.

RESULTS The study included 58 (35.6%) women (mean age ⫽ 73.18 ⫾ 6.62 years) and 105 (64.4%) men (mean age ⫽ 73.31 ⫾ 6.59). Table 1 shows sociodemographic information of individuals, assistive device usage, the existence of chronic illness, and information about RMI and PMS scores. It was found that 31% of women and 19% of men used an assistive device in their everyday life; however, there was no significant gender difference in terms of assistive device usage (P ⬎ .05) (Table 1). The most frequently used device to maintain mobility was a walking stick. Educational and mobility levels differed significantly according to gender (P ⬍ .05) (Table 1). Similarly, significant differences were found between RMI and PMS scores of men and women (P ⬍ .05) (Table 1). Men were found to have greater mobility than women. The incidence of chronic disease was higher in women than in men; however, the difference was not significant. The most common chronic diseases were hypertension, Topics in Geriatric Rehabilitation

diabetes mellitus, rheumatic diseases, chronic lung diseases, and cardiac insufficiency (Table 1). The individuals had more than 1 chronic disease. A negative relationship was found between assistive device usage with age and RMI and PMS scores in men (P ⬍ .05). Similarly, a positive relationship was found between assistive device usage and RMI and between assistive device usage and PMS (P ⬍ .05) (Table 2). The correlation analyses in women indicated a positive relationship between assistive device usage and PMS, between assistive device usage and RMI, and between RMI and PMS (P ⬍ .05). However, no relationship was found between age and RMI or PMS scores and assistive device usage (P ⬎ 0.05) (Table 2). No relationship was found between the presence of chronic disease and assistive device usage and PMS or RMI scores (P ⬎ 0.05) (Table 2).

DISCUSSION Our study examined assistive device usage and mobility level among elderly individuals 65 years and older and determined that assistive device usage was greater in women (39%) than in men (19%). The most frequently used assistive device was a walking stick. In Turkey, a walking stick carries traditional importance in some regions and is frequently used because of increasing health problems. In addition, the incidence of chronic diseases was higher in women. The use of assistive devices among the elderly may negatively affect some functions in everyday life and obstruct the independence of individuals. Assistive device usage in everyday life may be due especially to rheumatic diseases affecting haunch, knee, and ankle; respiratory and circulatory diseases affecting physical functions; and diseases affecting balance and coordination.3,8 Previous studies found that greater dependence in everyday life, together with advanced age, living alone, the state of chronic disease, and increasing mobility problems, was related to assistive device usage.3,7,8,16 In our study, individuals stated that they used a walking stick to continue walking and to ensure safe mobility. Our study found that the mobility level of elderly women was significantly lower than that of men. Mobility level in women was related to assistive device usage, whereas that in men was related to age and assistive device usage. Mobility level and assistive device usage were not related to the existence of chronic diseases. The 2 evaluation methods (RMI and PMS) used in this study to determine mobility level are important tools for evaluating participation among elderly people. Previous studies reported that individuals who live in a nursing home or alone, who have low educational and socioeconomic levels, who have chronic disease(s), who have low mobility level, and who are dependent in everyday life activities need to use assistive devices.3,11,17-19 Low mobility www.topicsingeriatricrehabilitation.com

191

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

TGR200158.indd 191

12/07/12 10:49 PM

TABLE 1

The Sociodemographic Data of the Participants

Age, mean ⫾ SD, y

Women (n ⫽ 58)

Men (n ⫽ 105)

t Test, ␹² (P)

73.18 ⫾ 6.62

73.31 ⫾ 6.59

⫺0.115 (.908)

168.16 ⫾ 6.71

⫺8.811 (.000)

Height, mean ⫾ SD, cm

174 ⫾ 158.25

Weight, mean ⫾ SD, kg

98 ⫾ 70.96

73.33 ⫾ 11.42

Primary school

24 (41.4)

60 (57.1)

Secondary school

1 (1.7)

9 (8.6)

High school

3 (5.2)

8 (7.6)

College

3 (5.2)

5 (4.8)

…

2 (1.9)

27 (46.6)

31 (20)

Master’s degree Illiterate

9.942 (.019a)

Civil status, n (%) Married

20 (34.5)

59 (56.2)

3 (5.2)

7 (6.7)

Widowed

34 (58.6)

35 (33.3)

Divorced

1 (1.7)

4 (3.8)

Yes

43 (74.1)

68 (64.8)

No

15 (25.9)

37 (35.2)

Single

Chronic disorders, n (%)

1.512 (.219)

Use of assistive devices, n (%)

3.003 (.083)

Yes

18 (31)

20 (19)

No

40 (69)

85 (81)

What kind of assistive devices, n (%) Stick Crutch Walker or wheelchair

⫺1.279 (.203) 15.05 (.01a)

Educational level, n (%)

1.264 (.531) 14 (24.1) 3 (5.2) 1 (1.7)

17 (16.2) 1 (1) 1 (1)

RMI, mean ⫾ SD

13.84 ⫾ 2.01

14.59 ⫾ 0.78

⫺3.367 (.001a)

PMS, mean ⫾ SD

38.51 ⫾ 2.92

39.48 ⫾ 1.58

⫺2.745 (.007a)

Abbreviations: PMS, Physical Mobility Scale; RMI, Rivermead Mobility Index. a P ⬍ .05.

level among elderly people reduces functional ability and negatively affects leisure time and everyday life activities and also becomes an important factor affecting quality of life by reducing participation.1,8 The average ages of men and women included in our study were similar; however, the educational level of women was significantly lower than men and their mobility levels were lower than men. In parallel with these findings, rates of assistive device usage were higher among women than among men. Most women in our study were widows, and most of the men were married. Factors such as being female, living alone, and having a low educational level and factors affecting mobility (the existence and number of chronic diseases) 192

www.topicsingeriatricrehabilitation.com

may reduce functional capacity and therefore the level of independence in everyday life activities. All these factors result in the use of assistive devices to allow the individual to protect himself or herself, to maintain his or her mobility, to facilitate participation, and to minimize possible risk. The assistive devices used in everyday life for these reasons vary according to the functional state and needs of an individual. Studies conducted in Turkey showed that walking stick usage is common among elderly people with reasonable functional state.8,16 It was observed that the individuals included in our study frequently used a walking stick and that assistive devices such as a crutch, walker, and wheelchair were used by July–September 2012

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

TGR200158.indd 192

12/07/12 10:49 PM

TABLE 2

The Relationship Between Age, Use of Assistive Devices, Chronic Disease, and RMI and PMS Scores According to Gender in Elderly People Men

Women Age

Age r

1

Use of assistive devices

Chronic Disease PMS

RMI

r

⫺0.225

P

.090

r

0.163

PMS

⫺0.032

⫺0.200

⫺0.369

P Use of assistive devices

Chronic Disease

a

RMI b

⫺0.274a

.000

.744

.040

.005

1

0.002

0.456a

0.431a

.980

.000

.000

⫺0.075

⫺0.073

0.226

1

P

.222

.088

r

⫺0.155

0.351a

0.180

P

.246

.007

.176

r

⫺0.235

0.489

0.223

0.738

P

.075

.000

.092

.000

.445

a

.459 0.488a

1

.000 b

1

Abbreviations: PMS, Physical Mobility Scale; r, Pearson correlation coefficient; RMI, Rivearmead Mobility Index. a P ⬍ .01. b P ⬍ .05.

individuals with functional dependence and low mobility level. Determining the indication and aim of the assistive device usage among elderly people and informing the individuals accurately on the matter are important in terms of maintaining the mobility of the individual, minimizing injury risk, and ensuring social inclusion, which will result in improved life satisfaction and increased quality of life for the individual. No relationship was found between the existence of chronic disease and assistive device usage and mobility level in either men or women. The findings that individuals in our study are in the young elderly group (65-75 years) and that the presence of chronic diseases did not result in disability are important for the absence of the abovementioned relationship. Changes in the body systems with increasing age and disabilities and problems as a result of diseases may cause serious mobility difficulties, dependence in everyday life, and reduced life satisfaction.7,8,18 This study found that assistive device usage is related to mobility level in terms of sustaining mobility in everyday life among men and women; women with a low educational level were more likely to use assistive devices. Our results are regarded as being of great importance for medical personnel involved in elderly rehabilitation. Recommendation of personal evaluations made considering the sustainability of mobility in the elderly, especially in the women and of adaptive devices for each individual, is important in terms of individual independence, participation, and everyday quality of life. This topic needs more comprehensive future studies. Topics in Geriatric Rehabilitation

References 1. Mollenkopf H, Marcellini F, Ruoppila I, Flaschenträger P, Gagliardi C, Spazzafumo L. Outdoor mobility and social relationships of elderly people. Arch Gerontol Geriatr. 1997; 24(3):295-310. 2. Lord S, Despres C, Ramadier T. When mobility makes sense: a qualitative and longitudinal study of the daily mobility of the elderly. J Environ Psychol. 2011;31:52-61. 3. Roelands M, Oost PV, Buysse A, Depoorter A. Awareness among community-dwelling elderly of assistive devices for mobility and self-care and attitudes towards their use. Soc Sci Med. 2002;54:1441-1451. 4. Kim M-J, Yabushita N, Kim M-K, Nemoto M, Seino S, Tanaka K. Mobility performance tests for discriminating high risk of frailty in community-dwelling older women. Arch Gerontol Geriatr. 2010;51:192-198. 5. Sainio P, Koskinen S, Heliövaara M, et al. Self-reported and testbased mobility limitations in a representative sample of Finns aged 30+. Scand J Public Health. 2006;34(4):378-386. 6. Ostchega Y, Haris TB, Hirsch R, Parsons VL, Kington R. The prevalence of functional limitations and disability in older persons in the US: data from the National Health and Nutrition Examination Survey III. J Am Geraitr Soc. 2000;48(9):11321135. 7. Resnik L, Allen S, Isenstadt D, Wasserman M, Lezzoni L. Perspectives on use of mobility aids in a diverse population of seniors: implications for intervention. Disabil Health J. 2009;2: 77-85. 8. Çivi S, Tanrıkulu MZ. En epidemiological study to evaluate the level of dependence and physical disability with the prevalence of chronic diseases in the elderly. Turkish J Geriatr. 2000;3(3):85-90. 9. Burnett P, Licas S. Talking, walking, riding and driving: the mobilities of older adults. J Transport Geogr. 2010;18:596-602. 10. Lee C-T, Yeh C-J, Lee M-C, et al. Leisure activity, mobility limitations and stress as modifiable risk factors for depressive symptoms in the elderly: results of a national longitudinal study. Arch Gerontol Geriatr. 2012;54(2):e221-e229. doi:10.1016Ⲑj. archger.2011.06.014. www.topicsingeriatricrehabilitation.com

193

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

TGR200158.indd 193

12/07/12 10:49 PM

11. Nilsson CJ, Avlund K, Lund R. Mobility disability in midlife: a longitudinal study of the role of anticipated instrumental support and social class. Arch Gerontol Geriatr. 2010;51: 152-158. 12. Akın B, Emirog˘lu ON. Mobility related disability and associated factors in the elderly living at home. Turk J Geriatr. 2003;6:59-67. 13. Collen FM, Wade DT, Robb GF, Bradshaw CM. The Rivermead Mobility Index: a further development of the Rivermead Motor Assessment. Int Disabil Stud. 1991;13: 50-54. 14. Akın B, Emirog˘lu ON. The validity and reliability of Turkish version of Rivermead Mobility Index (RMI) in the elderly. Turk J Geriatr. 2007;10(3):124-130. 15. Nitz JC, Hourigan SR. Measuring mobility in frail older people: reliability and validity of the Physical Mobility Scale. Aust J Ageing. 2006;25:31-35.

194

www.topicsingeriatricrehabilitation.com

16. Arslan S¸, Gökçe-Kutsal Y. A multicenter epidemiological study to evaluate the prevalence of disability in the elderly. Turkish J Geriatr. 1999;2(3):103-114. 17. Yümin ET, S¸ims¸ek TT, Sertel M, Öztürk A, Yümin M. The effect of functional mobility and balance on health-related quality of life among elderly people living at home and those living in nursing home. Arch Gerontol Geriatr. 2011;52:e180-e184. 18. Öztürk A, S¸ims¸ek TT, Yümin ET, Sertel M, Yümin M. The relationship between physical, functional capacity and quality of life among elderly people with a chronic disease. Arch Gerontol Geriatr. 2011;53(3):278-283. 19. Sertel M, S¸ims¸ek TT, Yümin ET, Öztürk A, Yümin M. The relationship between the cognitive functions, daily activities, and mobility levels of elderly people living in a nursing home compared with those in a house environment. Top Geriatr Rehabil. 2011;27(1):87-92.

July–September 2012

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

TGR200158.indd 194

12/07/12 10:49 PM