Mobility and Balance in Seniors
last authored: Jan 2010, David LaPierre
last reviewed:
Introduction
When people are ill, they don't move very much; as they improve, they begin moving better.
A patient should ideally be assessed in a similar situation as their home.
Tracking mobility and balance in frail seniors is perhaps a better assessment of recovery than more traditional factors such as temperature or CBC.
Clinical assessment can be fast and simple as a screen. Mobility is hierarchical - if a patient can ambulate, they an also turn in bed. Ask patients to get up and go, walking with their aid, and withstand a gentle nudge. If this is difficult, further testing should be carried out.
The HABAM (Hierarchy of Balance and Mobility) is a clinicial tool for assessing and following balance, transfers, and mobility.
Regular evaluation is important in order to ensure safety, identify potential targets for therapy, and monitor recovery.
Mobility
Patients should be assessed wihout assistance at first.
The most basic movement is turning from side-to-side in bed, especially to avoid bed sores on pressure points such as the sacrum, greater trochanter, and lateral malleolus. If this is not possible, patients should be turned every two hours.
Ability to rise from lying to sitting is next.
Ability to get out of bed and then sit down in a chair. Watch for signs such as increased use of arms to rise, scooting to the edge of the bed or chair while rising, and multiple attempts to rise.
Timed Up and Go Test
Equipment: arm chair, measuring tap,e, stop watch
- make mark on floor for patient
- start timing on the word 'go'
The timed-up-and-go assesses frailty and falls risk. The patient begins in a chair, and at the word 'go' stands up, walks three metres, turns, walks back, and sits down. Give a practice run, and average the next two runs. The patient should use their walking aid. Over 20 seconds suggests greater fall risk.
This test can be used to track improvement or decline.
Transfers
Transfers, or the shift from one position to another, are affected by mobility. Patient factors can require two or more people. Unsteady patients require supervision due to increased risk for falls.
Patients requiring transfer assistance and with nocturia will cause significant caregiver stress due to sleep distruption.
A one-person pivot shift occurs when the patient holds the caregiver's shoulders and pivots with knees and hips locked in extension.
Getting in and out of a bathtub is one of the most difficult and dangerious transfers for seniors. Family members and other caregivers should be trained in transfer techniques.
Balance
Balance is static - unsupported sitting or standing - or dynamic - reaching or bending, or ability to maintain balance after a gentle nudge.
The functional reach test measures how far a patient can reach while standing with feet together. The arm should begin at 90 degrees should flexion, with fist clenched. Have patient then reach along a metre stick. Provide assistance to prevent falls.
Give two practice attempts, then average the next two or three attempts.
A reach of less than 7 inches (18 cm) suggests a greater fall risk.
The Berg Balance is typically used by physiotherapists to measure static and dynamic balance across 14 items.
Ambulation
Ambulation should be assessed with use of usual aids, such as canes and walkers. Assess stability and distance covered.
Impaired ambulation affects ADLs, such as toileting, as well as IADLs and social functioning.
Gait
While observing gait, attend to
- height, length, symmetry of steps
- stance width
- ankle, knee, and hip movement
- arm swing
- deviation of path
- trunk sway
Particular patterns incude hemiplegic and parkonsonian gaits
Additional Resources
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