One factor influencing ADL performance is mobility. Direct observation can identify problems in gait and balance. Early detection of deficits in mobility can identify those clients at risk of injury. Whenever possible, rehabilitation can then assist in restoring functional losses and reduce the risk of falls. For those deficits that cannot be rehabilitated, assistive equipment such as a cane or walker can be provided.
Immobility and inactivity can lead to the older person becoming chair- or bed-bound. These older persons often go on to develop edema, contractures, incontinence, or pressure sores. These complications place them at increased risk of falls and nursing home placement. It is important to inquire about recent falls and the circumstances under which they occurred and to test gait performance in all older adults. One tool, is the Tinetti Balance and Gait Evaluation tool . Those at high risk can be identified so that preventive measures can be taken as part of care planning. Factors increasing risk include confusion, incontinence, impaired mobility, generalized weakness, use of sedating medications and alcohol, postural hypotension, and history of previous falls.
To note the character of the gait it is best for the geriatric care manager to observe the person ambulating. Is the gait slow and shuffling or too fast and without concern for the environment? Note the person’s balance. Did the person need to grab onto the furniture to prevent a fall? Can he or she walk up the flight of steps to get to the bedroom or even up the two steps from the living room to the kitchen? Would a stair lift provide improved safety? It is important to observe footwear. Is the stylish older woman still wearing a shoe with a raised heel? Is the stylish older man still wearing a slip-on shoe that does not provide proper support? Recommending proper footwear can be the first step in preventing falls. Asking the person for a tour of the home is an excellent way to observe how he or she gets around and to make observations regarding home safety.
What about ambulating outside? Does the person need adaptive equipment outside because of uneven surfaces even if he or she is fine when ambulating on a smooth floor inside? Is the person able to get up the outside stairs? Are there railings to keep the person safe? Does the person need a ramp? Is the person cognitively intact enough to use a scooter for longer distances traveled in the nursing home? Does the person need a prescription for a wheelchair because he or she is unable to walk the long distance to the doctor’s office?