Abstract
BACKGROUND: Lower extremity mobility difficulties often result from common medical conditions and can disrupt both physical and emotional well-being.
OBJECTIVES: To assess the national prevalence of mobility difficulties among noninstitutionalized adults and to examine associations with demographic characteristics and other physical and mental health problems.
DESIGN: Cross-sectional survey using the 1994–1995 National Health Interview Survey-Disability Supplement (NHIS-D). We constructed measures of minor, moderate, and major lower extremity mobility difficulties using questions about ability to walk, climb stairs, and stand, and use of mobility aids (e.g., canes, wheelchairs). Age and gender adjustment used direct standardization methods in Software for the Statistical Analysis of Correlated Data (SUDAAN).
PARTICIPANTS: Noninstitutionalized, civilian U.S. residents aged 18 years and older. National Health Interview Survey sampling weights with SUDAAN provided nationally representative population estimates.
RESULTS: An estimated 19 million people (10.1%) reported some mobility difficulty. The mean age of those with minor, moderate, or major difficulty ranged from 59 to 67 years. Of those reporting major difficulties, 32% said their problems began at aged 50 years or younger. Adjusted problem rates were higher among women (11.8%) than men (8.8%), and higher among African Americans (15.0%) than whites (10.0%). Persons with mobility difficulties were more likely to be poorly educated, living alone, impoverished, obese, and having problems conducting daily activities. Among persons with major mobility difficulties, 30.6% reported being frequently depressed or anxious, compared to 3.8% for persons without mobility difficulties.
CONCLUSIONS: Reports of mobility difficulties are common, including among middle-aged adults. Associations with poor performance of daily activities, depression, anxiety, and poverty highlight the need for comprehensive care for persons with mobility problems.
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References
Stewart MA, Buck CW. Physicians’ knowledge of and response to patients’ problems. Med Care. 1977;15:578–85.
Wartman SA, Morlock LL, Malitz FE, Palm E. Impact of divergent evaluations by physicians and patients of patients’ complaints. Public Health Rep. 1983;98:141–5.
Nelson E, Conger B, Douglass R, et al. Functional health status levels of primary care patients. JAMA. 1983;249:3331–8.
Calkins DR, Rubenstein LV, Cleary PD, et al. Failure of physicians to recognize functional disability in ambulatory patients. Ann Intern Med. 1991;114:451–4.
Calkins DR, Rubenstein LV, Cleary PD, et al. Functional disability screening of ambulatory patients: a randomized controlled trial in a hospital-based group practice. J Gen Intern Med. 1994;9:590–2.
Hoenig H. Educating primary care physicians in geriatric rehabilitation. Clin Ger Med. 1993;9:883–93.
Freedman VA, Martin LG. Understanding trends in functional limitations among older Americans. Am J Public Health. 1998;88:1457–62.
Harris T, Kovar MG, Suzman R, Kleinman JC, Feldman JJ. Longitudinal study of physical ability in the oldest old. Am J Public Health. 1989;79:698–702.
Kovar MG, Weeks JD, Forbes WF. Disability among older people: United States and Canada. Vital Health Stat 5. 1995;(8):1–82.
Manton KG, Corder L, Stallard E. Chronic disability trends in elderly United States populations: 1982–1994. Proc Nat Acad Sci. 1997;94:2593–8.
Guralnik JM, Fried LP, Simonsick EM, eds. The Women’s Health and Aging Survey: Health and Social Characteristics of Older Women will Disability. Bethesda, Md: National Institute on Aging, 1995. NIH publication 95-4009.
Branch LG, Jette AM. The Framingham disability study: I. Social disability among the aging. Am J Public Health. 1981;71:1202–10.
Jette AM, Branch LG. The Framingham disability study: II. Physical disability among the aging. Am J Public Health. 1981;71:1211–6.
Kelly-Hayes M, Jette AM, Wolf PA, D’Agostino RB, Odell PM. Functional limitations and disability among elders in the Framingham study. Am J Public Health. 1992;82:841–5.
Adams PF, Marano MA. Current estimates from the National Health Interview Survey, 1994. National Center for Health Statistics. Vital Health Stat 10 (193). 1995.
National Health Interview Survey on Disability Web site. Data collection survey instruments questionnaires for 1994 National Health Interview Survey Supplement Booklet: Disability Phase I and 1995 National Health Interview Survey Supplement Booklet: Disability Phase I. Available at: http://www.cdc.gov/nchs/about/major/nhis_dis/nhis_dis.htm. Accessed July 28, 1998.
Kerrigan DC, Schaufele M, Wen MN. Gait analysis. In: DeLisa JA, Gans BM, eds. Rehabilitation Medicine: Principles and Practice. 3rd ed. Philadelphia: Lippincott-Raven Publishers; 1998:167–87.
Alexander NB. Gait disorders in older adults. J Am Ger Soc. 1996;44:434–51.
Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriar Soc. 1986;34:119–26.
Tinetti ME, Ginter SF. Identifyingmobility dysfunctions in elderly patients. JAMA. 1988;259:1190–3.
Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the “get up & go” test. Arch Phys Med Rehabil. 1986;67:387–9.
Podsiadlo D, Richardson S. The timed “up & go”: a test of basic functional mobility for frail elderly persons. J Am Geriar Soc. 1991;39:142–8.
Nutt JG, Marsden CD, Thompson PD. Human walking and higher-level gait disorders, particularly in the elderly. Neurology. 1993;43:268–79.
Joyce BM, Kirby RL. Canes, crutches and walkers. Am Fam Physician. 1991;43:535–42.
Ragnarsson KT. Lower extremity orthotics, shoes, and gait aids. In: DeLisa JA, Gans BM, eds. Rehabilitation Medicine: Principles and Practice. 3rd ed. Philadelphia: Lippincott-Raven Publishers; 1998:651–67.
Karp G. Choosing a Wheelchair. A Guide for Optimal Independence. Sebastpol, Calif: O’Reilley & Associates; 1998.
Karp G. Life on Wheels. For the Active Wheelchair User. Sebastpol, Calif: O’Reilley & Associates; 1999.
Palmer ML, Toms JE. Manual for Functional Training. 3rd ed. Philadelphia: F.A. Davis Company; 1992:119–26.
Warren CG. Powered mobility and its implications. J Rehabil Res Dev Clin Suppl. 1990;0:74–85.
Oliver M. Understanding Disability: From Theory to Practice. New York: St. Martin’ Press; 1996.
Thomson RG. Extraordinary Bodies. Figuring Physical Disability in American Culture and Literature. New York: Columbia University Press; 1997.
Charlton JI. Nothing About Us Without Us: Disability Oppression and Empowerment. Berkeley, Calif: University of California Press; 1998.
Feasley JC, ed. Health Outcomes for Older People: Questions for the Coming Decade. Washington, DC: National Academy Press; 1996.
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701–7.
Oliver D, Britton M, Seed P, Martin FC, Hopper AH. Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies. BMJ. 1997;315:1049–53.
Tinetti ME, Williams CS. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med. 1997;337: 1279–84.
Rizzo JA, Friedkin R, Williams CS, Nabors J, Acampora D, Tinetti ME. Health care utilization and costs in a Medicare population by fall status. Med Care. 1998;36:1174–88.
Wagner EH, LaCroix AZ, Buchnes DM, Larson EB. Effects of physical activity on health status in older adults I: observational studies. Annu Rev Public Health. 1992;13:451–68.
Santiago MC, Coyle CP, Kinney WB. Aerobic exercise effect on individuals with physical difficulties. Arch Phys Med Rehabil. 1993;74:1192–8.
Davis G, Plyley MJ, Shephard RJ. Gains of cardiorespiratory fitness with arm crank training in spinally disabled men. Can J Sport Sci. 1991;16:64–72.
Compton DM, Eisenman PA, Henderson HL. Exercise and fitness for persons with disabilities. Sports Med. 1989;7:150–62.
Fentem PH. Exercise in prevention of disease. Br Med Bull. 1992;48:630–50.
Ensrud KE, Nevitt MC, Yunis C, et al. Correlates of impaired function in older women. J Am Geriatr Soc. 1994;42:481–9.
Wee CC, McCarthy EP, Davis RB, Phillips RS. Physician counseling about exercise. JAMA. 1999;282:1583–8.
Verbrugge LM, Lepkowski JM, Imanaka Y. Comorbidity and its impact on disability. Milbank Q. 1989;67:450–84.
Burns TJ, Batavia AI, Smith QW, DeJong G. Primary health care needs of persons with physical disabilities: with are the research and service priorities? Arch Phys Med Rehabil. 1990;71:138–43.
Stuifbergen AK, Becker H, Sands D. Barriers to health promotion for individuals with disabilities. Fam Community Health. 1990;13:11–22.
Stuifbergen AK, Becker HA, Ingalsbe K, Sands D. Perceptions of health among adults with disabilities. Health Values. 1990;14:18–26.
Gans BM, Mann NR, Becker BE. Delivery of primary care to the physically challenged. Arch Phys Med Rehabil. 1993;74:S15–9.
Iezzoni LI, McCarthy EP, Davis RB, Siebens H. Mobility impairments and use of screening and preventive services. Am J Pub Health. 2000;90:955–61.
U.S. Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Baltimore, Md: Williams & Wilkins; 1996.
DeJong G, Batavia AI, Griss R. America’s neglected health minority: working-age persons with disabilities. Milbank Q. 1989;67 Suppl 2 Pt2:311–51.
Bassuk SS, Glass TA, Berkman LF. Social disengagement and incident cognitive decline in community-dwelling elderly patients. Ann Intern Med. 1999;131:165–73.
Helbing C, Sangl JA, Silverman HA. Home health agency benefits. Health Care Financ Rev Annu Suppl. 1992;14:125–48.
Cassel CK, Besdine RW, Siegel LC. Restructuring Medicare for the next century: what will beneficiaries really need? Health Aff (Millwood). 1999;18:118–31.
LaPlante MP, Hendershot GE, Moss AJ. Assistive technology devices and home accessibility features: prevalence, payment, need, and trends. Adv Data. 1992;217:1–11.
Batavia AI. Of wheelchairs and managed care. Health Aff (Millwood). 1999;18:177–82.
Iezzoni LI. Boundaries. Health Aff (Millwood). 1999;18:171–6.
Wickizer TM. Controlling outpatient medical equipment costs through utilization management. Med Care. 1995;33:383–91.
American Medical Association, Department of Geriatric Health. Guidelines for the Use of Assistive Technology: Evaluation, Referral, Prescription. 2nd ed. Chicago: American Medical Association; 1996.
Rubenstein LV, McCoy JM, Cope DW, et al. Improving patient quality of life with feedback to physicians about functional status. J Gen Intern Med. 1995;10:607–14.
Espallargues M, Valderas JM, Alonso J. Provision of feedback on perceived health status to health care professionals. A systematic review of its impact. Med Care. 2000;38:175–86.
Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. JAMA. 1989;262:907–13.
Nelson E, Wasson J, Kirk J, et al. Assessment of function in routine clinical practice: description of the COOP Chart method and preliminary findings. J Chronic Dis. 1987;40(Suppl 1):55S-69S.
Wasson J, Keller A, Rubenstein L, Hays R, Nelson E, Johnson D. Benefits and obstacles of health status assessment in ambulatory settings. The clinician’s point of view. The Dartmouth Primary Care COOP Project. Med Care. 1992;30(5 Suppl):MS42–9.
Wald JS, Rind D, Safran C, Kowaloff H, Barker R, Slack WV. Patient entries in the electronic medical record: an interactive interview used in primary care. Proc Annu Symp Comput Appl Med Care. 1995:147–51.
Iezzoni LI. What should I say? Communication around disability. Ann Intern Med. 1998;129:661–5.
Peters L. Women’s health care. Approaches in delivery to physically disabled women. Nurse Pract. 1982;7:34–48.
President’s Advisory Commission Consumer Protection and Quality in the Health Care Industry. Consumer Bill of Rights and Responsibilities. Washington, DC: 1997.
Hoenig H, Nusbaum N, Brummel-Smith K. Geriatric rehabilitation: state of the art. J Am Geriatr Soc. 1997;45:1371–81.
Mathiowetz NA, Lair TJ. Getting better? Change or error in the measurement of functional limitations. J Econ Soc Measure. 1994;20:237–62.
Iezzoni LI, McCarthy EP, Davis RB, Siebens H. Mobility problems and perceptions of disability in self- and proxy-respondents. Med Care. 2000;38:1051–7.
Andresen EM, Fitch CA, McLendon M, Meyers AR. Reliability and validity of disability questions for US census 2000. Am J Pub Health. 2000;90:1297–9.
Todorov A, Kirchner C. Bias in proxies’ report of disability: data from the National Health Interview Survey on disability. Am J Pub Health. 2000;90:1248–53.
Epstein AM, Hall JA, Tognetti J, Son LH, Conant L Jr. Using proxies to evaluate quality of life. Can they provide valid information about patients’ health status and satisfaction with medical care? Med Care. 1989;27(3 Suppl):S91–8.
Branch LG, Meyers AR. Assessing physical function in the elderly. Clin Geriatr Med. 1987;3:29–51.
Magaziner J, Simonsick EM, Kashner TM, Hebel JR. Patient-proxy response comparability on measures of patient health and functional status. J Clin Epidemiol. 1988;41:1065–74.
Rothman ML, Hedrick SC, Bulcroft KA, Hickam DH, Rubenstein LZ. The validity of proxy-generated scores as measures of patient health status. Med Care. 1991;29:115–24.
Dorevitch MI, Cossar RM, Bailey FJ, et al. The accuracy of self and informant rating of physical functional capacity in the elderly. J Clin Epidemiol. 1992;45:791–8.
Spragers MA, Aaronson NK. The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease: a review. J Clin Epidemiol. 1992;45:743–60.
Sneeuw KC, Aaronson NK, Osoba D, et al. The use of significant others as proxy raters of the quality of life of patients with brain cancer. Med Care. 1997;35:490–506.
Olin GL, Hongji L, Merriman B. Health & Health Care of the Medicare Population: Data from the 1995 Medicare Current Beneficiary Survey. Rockville, Md: Westat; 1999:77.
Allaire SH, LaValley MP, Evans SR, et al. Evidence for decline in disability and improved health among persons aged 55 to 70 years: the Framingham Heart Study. Am J Public Health. 1999;89:1678–83.
Iezzoni LI. When walking fails. JAMA. 1996;276:1609–13.
Miles-Tapping C, MacDonald LJ. Lifestyle implications of power mobility. Phys Occup Therapy Ger. 1994;12:31–49.
Abresch RT, Seyden NK, Wineinger MA. Quality of life: issues for persons with neuromuscular disease. Phys Med Rehabil Clin N Am. 1998:233–48.
Mairs N. Waist-high in the World. Boston: Beacon Press; 1996:38–9.
Cleland M. Strong at the Broken Places. Atlanta: Cherokee Publishing Company; 1989.
Scherer MJ. Living in the State of Stuck. How Technology Impacts the Lives of People with Disabilities. Cambridge, Mass: Brookline Books; 1996.
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Dr. Iezzoni was supported by The Robert Wood Johnson Foundation Investigator Award in Health Policy Research.
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Iezzoni, L.I., McCarthy, E.P., Davis, R.B. et al. Mobility difficulties are not only a problem of old age. J GEN INTERN MED 16, 235–243 (2001). https://doi.org/10.1046/j.1525-1497.2001.016004235.x
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DOI: https://doi.org/10.1046/j.1525-1497.2001.016004235.x