January 24, 2021

The Weak Leg Epidemic: Shedding Light on the Loss of Mobility in the Elderly

Written by: Iris Tabangcora, M.D.
Reviewed by: Mubashar Rehman, PHD

Background

The Center for Disease Control and Prevention (CDC) defines mobility as the ability to move around in the environment and maintain body positions. This also encompasses handling and moving objects as well as moving around using transportation. Preserving this function, particularly in the elderly population, is vital in maintaining the quality of life. 

In 2020, up to 61 million Americans lived with some form of disability, which translates to 2 in 5 adults aged 65 and above having activity limitations and interaction restrictions with their environment. Decreased elderly mobility accounts for the hugest chunk of this disability. Why should everyone be concerned with this latest finding? 

This ongoing epidemic of weak legs in the elderly is a public health concern as this leads to a triple peril of chronic pain, falls, and functional impairment.

Further studies also showed that loss of mobility in old age increases the risk of heart diseases, obesity, and diabetes. Unfortunately, barriers to healthcare access plague this vulnerable population group primarily because of costs and health disparities. This prevents the elderly from leading dynamic and independent lives. 

 

The Science of Mobility

Moving around is primarily a function of the musculoskeletal system. This involves the bones and muscles joined by connective tissues to fashion a machine designed for specific movements, i.e., the foot stepping up and down while walking or bringing two hands together for clapping.

This structural integrity is equipped with effective limb movements and provide overall support to soft tissues. Muscles contract all at once and can shift functions within milliseconds. That is why in a healthy state, mobility seems effortless despite all the mechanical effort going on inside the body. 

Physical activity improves muscle strength. The opposite happens when one leads a sedentary lifestyle, where cells shrink, therefore can no longer power a musculoskeletal engine. Moreover, there is a decline in the performance of these structures due to aging. Hence, any damage to these structures (age-related or otherwise) and reduction in physical activity both lead to decreased or loss of mobility in the elderly. 

Chemical energy from food intake is converted into mechanical work to produce force for movement. All of these processes occur inside the body silently as the elderly perform activities of daily living. To an extent, in a healthy state, the musculoskeletal system can function in the absence of oxygen. Generally, social problems like food insecurity can also contribute to loss of mobility in old age. 

 

Factors Affecting Decreased Mobility in Elderly

By this time, it is clear that decreased mobility in the elderly is the result of complex yet interrelated factors. There are several determinants of mobility, all of which are affected by an individuals’ gender, culture, and personal life. That is the reason why some elderly have decreased mobility while others do not. 

 

1. Cognitive Decline and Dysfunction

As people age, there is a decline in the quality and efficiency of cognitive functions like mental status (i.e., alertness), speed of processing of information, and executive functioning (e.g., judgment). These changes are different from a cognitive impairment that is a result of a disease process.

The decline in cognitive functions proves mobility as a challenge as the elderly may have difficulty navigating their environment and process instructions related to transportation. Generally, the elderly have slowed movements, decreased energy reserves (due to loss of fat), and a low tolerance for increased energy expenditure.

On the other hand, cognitive dysfunctions like Huntington’s and Alzheimer’s disease pose a risk for safe ambulation, eventually leading to loss of mobility in old age. It is also important to examine the medications they take as they can also affect cognitive functions. 

 

2. Psychosocial Determinants 

Depression in the elderly population is a common problem. That can seriously impair their self-esteem, interpersonal relationships, and coping behaviors. Consequently, these factors may affect mobility choices.

In a worse-case, it may lead to activity aversion. Unprocessed, traumatic experiences like previous falls may also cause irrational fear and lead to loss of mobility in old age. Because of slowing capabilities, the elderly are also prone to having low self-efficacy, i.e., growing, persistent disbelief that they can successfully carry out a particular task related to mobility. 

 

3. Financial Difficulties

Limited finances prove to be a major barrier to seeking healthcare. Often, the elderly population may find themselves in a situation full of debts that they don’t have the resources to seek healthcare when they feel any discomfort.

A lot of money is needed to purchase transportation aids and medications. Without this means, some may end up bound to their beds and will no longer enjoy the pleasure of moving around and having to interact socially.  

 

4. Physical and Environmental Factors

That may be the most common answer that comes to mind when discussing the loss of mobility in old age. In fact, among all factors, this is the most important. For instance, those with congenital and acquired (e.g. accident-related) loss of mobility will perpetually need mobility aids for transport.

Elderly living in confined spaces (e.g., detention centers, war-struck areas) will also face mobility limitations. The elderly who do regular strength exercises, in the absence of other pathologic factors, will have greater activity endurance and can better maintain posture, balance, and stability.

 

5. Gender, Culture, and Life History

These are unique factors influencing experiences and opportunities. Studies show that women are more prone to having decreased mobility compared to men. Some cultures consider the elderly members are weak or fragile and therefore should be sheltered and protected. That may also inhibit them from enjoying their usual activities. Other factors like occupation, personality, and hobbies can also influence mobility in older age. 

 

Conclusion

A complex interaction of several interrelated factors plays a role in decreased or loss of mobility in the elderly. It goes beyond just physical limitations, which is a short-sighted way of viewing this epidemic. The social factors mentioned above are just as significant. It is important to highlight every aspect to ensure active mobility in the elderly population.

To emphasize, regular physical activity and constant social support are the way to go to prevent the growing weak leg epidemic in the elderly population. Gone were the days when aging is made synonymous with physical deconditioning and social isolation. 

References:

  1. https://www.cdc.gov/ncbddd/disabilityandhealth/disability.html
  2. https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html
  3. https://academic.oup.com/gerontologist/article/50/4/443/743504?login=true
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1304541/

Article written by Iris Tabangcora, M.D.
Iris is a Philippine-based physician currently training in Emergency Medicine. She has been writing for various health websites for the last 10 years. Also a Nursing degree holder, she has spent her energy in educating nursing students on Research and Pharmacology. Her interests lie in medical education, research, and public health.

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