The ageing of the population is one of the major societal and financial problems. The prevalence of disability increases dramatically by age. The loss of mobility can be devastating to the elderly. Mobility aids are a one-way street to maintain independent mobility. The performance of daily activities is restrained by a series of factors related to the assistive device limitations, or the ones emerged from environmental causes. A literature review reveals minimal tools for assessing mobility assistive devices able to capture users' satisfaction. The chapter presents an assessment methodology in order to investigate assistive mobility devices' limitations, dissatisfaction reasons, and identifies the most appropriate tools to study such limitations and conclude in valid outcomes. One of the valuable characteristics of the study presented in its generalizability since it is not disease oriented. A summary of the results from both the literature review and the real case study on a mixed group of end users are presented in the chapter.
TopIntroduction
Between 2015 and 2050, the proportion of the world's population over 60 years will nearly double from 12% to 22% (WHO, 2019). The ageing of the population is one of the major problems faced by the society causing significant problems (healthcare expenditure, social care, etc.) since the prevalence of disability increases dramatically by age. To this end, elderly people are often assumed to be frail or dependent and a burden to society. The healthcare systems around the globe should prepare to address the various concerns of older people. Healthy ageing is the target of most countries nowadays. The leading causes of disability globally among aged 60 years or over, according to WHO estimates for 2012 are: unipolar depressive disorders, hearing loss, back and neck pain, Alzheimer’s disease and other dementias, and osteoarthritis. Falls is also a major cause of disability among older persons globally (United Nations, 2015). The main geriatric syndromes include frailty, urinary incontinence, falls, delirium and pressure ulcers (WHO, 2019).
The loss of mobility, which is a widespread occurrence, can be devastating to the elderly and seniors. The Census Bureau of the USA reports that mobility problems are the most common disability among the elderly (United States Census Bureau, 2019). Mobility loss is also highly interconnected with depression. Mobility aids have been used to maintain independent mobility. Studies have argued that use of the devices may actually increase risk of falling by causing tripping or by disrupting balance control through other mechanisms (Walsh et al., 2009; Charron, Kirby & MacLeod, 1995; Roman de Mettelinge & Cambier, 2015). Although many studies have reported that mobility aids and/or environmental obstacles are associated with falls, the possible link between these two risk factors has not been studied.
The use of gait assistive devices, although can provide precious help for the elderly (Cetin, Muzembo, Pardessus, Puisieux & Thevenon, 2010) or the mobility-impaired, can also have limitations or adverse consequences. Studies show that 30% to 50% of people prescribed with a gait assistive device abandon their device soon after receiving it, mainly because they do not meet the needs of individuals. In one survey, almost half of the reported problems were associated with the difficulty or risk to use the prescribed device (Bateni & Maki, 2005). Another study reveals that 58.3% of knee osteoarthritis patients abandon the mobility aid due to adverse outcome and feeling of stigmatization (Akinbo, Sokunbi & Ogunbameru, 2008). According to (Lezzoni, Rao & Kinkel, 2009) the vast majority of persons with multiple sclerosis (MS) own more than one type of mobility aids. Persons with MS appear to “mix and match” different devices to suit their specific mobility needs. Canes and crutches are prescribed for people with moderate levels of mobility impairment, and walkers are prescribed for people with generalized weakness, poor lower-limb weight-bearing, debilitating conditions, or poor balance control, while wheeled walkers are favored for patients with Parkinson disease (Minor & Minor, 2013).
Some of the most commonly mentioned assistive device limitations or dissatisfaction reasons, as mentioned by users and health scientists, are: (i) handling the rollator gait assistive device (Brandt, Iwarsson & Ståhl, 2003; Hallén, Orrenius & Rose, 2006), (ii) the weight of the device (Brandt, Iwarsson & Ståhl, 2003; Hallén, Orrenius & Rose, 2006; Hill, Goldstein, Gartner & Brooks, 2008), (iii) the brake-use of rollator devices (Thomas et al., 2010), (iv) users are prone to falling because of the dependence on memory to activate the rollator’s parking mechanism, (v) the inability of the current rollator to effectively park when the braking mechanism is engaged (Siu et al., 2008), (vi) social stigmatizing (association with aging and physical decline) (Hallén, Orrenius & Rose, 2006) (Hill, Goldstein, Gartner & Brooks, 2008; Thomas et al., 2010; Resnik, Allen, Isenstadt, Wasserman & Iezzoni, 2009), and (vii) upper-extremity pathologies because of the extended use of walking aids (i.e. tendonitis, osteoarthritis, and carpal tunnel syndrome) (Bateni & Maki, 2005).