1. Understanding the importance of mobility in older people
The ability to maintain mobility is seen as a key contributor for healthy ageing and quality of life and optimal mobility can be defined as the ability to safely and reliably move from one space to another. When an older person has reduced mobility it can decrease their independence and social participation, resulting in loneliness and isolation as well as result in limited access to goods and services, including health services.
Mobility challenges also contribute to additional health conditions such as cardiovascular disease, diabetes, and cancer1 as well as significantly increasing the risk of falls and fall- related injuries. Functional decline, including reduced mobility, is one of the main contributors to entering into residential aged care (as seen in this PDF).
2. How we can contribute to the Royal Commission’s recommendations
The recommendations from the Royal Commission highlight the important role that Allied Health Professionals (AHPs), including podiatrists, can make in enabling enhanced quality of life for older people; specifically around mobility. Take Recommendation 36 for example.
Recommendation 36: Care at home to include allied health
“The assessment process for eligibility for care at home identifies any allied health care that an older person needs to restore their physical and mental health to the highest level possible (and maintain it at that level for as long as possible) to maximise their independence and autonomy”
While the focus of the Royal Commission was on the current challenges associated with caring for older people who require additional support and assistance, it is important to highlight the role podiatrists can play. Particularly in optimising mobility and independence proactively; before older people become reliant on aged care services. This way we can delay functional decline and reduce the risk of early dependence on an aged care system that is clearly struggling (and likely to take significant time to improve).
The importance of ensuring improved quality of life for people as they age is gaining momentum. This call to action has been assisted by the World Health Organisation (WHO) who have declared a ‘Decade of Health Ageing’ from 2021 to 2030.
The overarching goal of this decade is to improve or maintain older people’s functional ability. It is functional ability that enables wellbeing and is closely linked to quality of life. This shines a light on the importance of ensuring all older people have an opportunity to age well.
Alongside this, one of the four goals of the Decade of Ageing is to:
“...deliver integrated care and primary health services that are responsive to the needs of older people”
3. Proactively identify ways to maintain and improve the mobility of all older people
As health professionals, we can help to maximise the health and wellbeing of older people through proactive and integrative approaches. These are person-centred and have a focus on functional mobility; helping to facilitate long-term independence and autonomy.
The challenge is that older people often perceive that mobility issues are just a part of ageing and nothing can be done to reduce the impact. It is imperative that we change this mindset.
How? Through ongoing conversations, such as strategies that older people can undertake to maintain or improve their overall mobility. These include referral pathway options for more tailored support if needed.
The most important thing we can do is to start the conversation with every older person on what mobility challenges they currently have in their daily lives.
It is equally important to determine what mobility-related activities or tasks they would like to be doing but are struggling with. By regularly reviewing the small challenges that older people face, it provides the opportunity to implement early interventions that can minimise the impact; and reduce the risk of mobility decline.
Other strategies include:
- Regularly undertaking office-based functional mobility assessments such as the Sit to Stand (STS) assessment or the Timed Up and Go Test to objectively identify early signs of decline
- Integrating an emphasis on self-management approaches such as:
- Encouraging regular incidental walking
- Suggesting different types of physical exercise that incorporate elements of resistance, flexibility, balance and aerobic fitness2
- Applying routine podiatric interventions which may minimise the impact of ageing through improving general mobility.
Take home messages
- Given podiatrists regularly see the older population we have an opportunity to assist older people to reduce their risk of functional decline and premature reliance on aged care services.
- It is important that we routinely ask all our older clients about their specific mobility concerns. We want to support them to understand that there are ways to assist them in improving or maintaining their mobility (rather than accepting it is just a part of ageing).
- Identify and instigate early intervention strategies to improve mobility in all older people. In doing this, podiatrists can be agents of change and contribute to this narrative; as advocated by both the Royal Commission in Aged Care and the WHO’s Decade of Healthy Ageing.
If you would like more information on this topic, please consider reviewing the following:
1 Lee, I. M., & Buchner, D. M. (2008). The importance of walking to public health. Medicine & Science in Sports & Exercise, 40(7), S512-S518.
2 Yu, R., Tong, C., & Woo, J. (2020). Effect of an integrated care model for pre-frail and frail older people living in community. Age and Ageing, 49(6), 1048-1055.