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Muwardi

Book Reading Geriatri

MOBILITY

Jennifer Brach, Caterina Rosano, Stephanie Studenski

ALBAFITH

PEMBIMBING :
dr.Bayu Basuki, SpPD.Mkes
DEFINISI
• Mobility is the ability to move one’s own body
through space. Mobility requires force production
and feedback control systems to navigate the mass
of the body through a three-dimensional
environment.
• Mobility Disability is pathologic processes that lead
to organ system impairments and functional
inability to carry out normal mobility activities,
caused by functional limitations in walking,
transferring, or climbing stairs, which are, in turn,
caused by problems with strength, endurance,
coordination, balance, and range of motion.
KLASIFIKASI

•Mobility can be assessed by self-report,

professional observation, or direct
measurement. Instruments to assess mobility
from all three perspectives have been
developed.
•Self-report  the easiest type of measure to
obtain when gathering data from large
populations, limited by  reliability,
accuracy, and nonresponse, lack ability to
discriminate small but important differences.
KLASIFIKASI
• Professional report  reflect the opinion of an
experienced assessor, can integrate over time, more
feasible when an individual is considered an unreliable
informant or is unable to cooperate with testing,
Limited  need for experienced assessor and training
and can be vulnerable to problems with interassessor
reliability.
• Performance  more independent of opinion, can
produce quantitative results, which discriminate small
but important or subclinical differences. Limited 
require direct observation, subject cooperation, and
standardization of instructions and procedures.
EPIDEMIOLOGI
• Mobility disability increases dramatically with age;
dependence in getting around inside increases from 5%
of persons aged 65 to 74 years to 30% of persons aged
85 years or more.
• Women tend to have higher rates of mobility disability
than men and
• Nonwhites higher > whites.
• Older persons who have a 0.1 m/s decline in gait speed
over 1 year have a double risk of dying during the
subsequent 5 years, whereas older persons who have a
0.1 m/s improvement in gait speed over 1 year have a
40% decreased risk of dying in the following 8 years.
EPIDEMIOLOGI
•Severe mobility disability, sometimes called
immobility  accelerates impairments in
multiple organ systems, including bone,
muscle, heart, circulation, lung, skin, blood,
bowel, kidney, nutrition, and metabolism.
•Increased risk of death, disability, and
institutionalization
 PATOFISIOLOGI
Three perspectives are described here:
• Epidemiologic risk factors 
• Demographic factors  age has the strongest effect, with
lower income, and lower educational level also playing a
role.
• Behavior-related  smoking, alcohol abstention, low
physical activity, high body mass index, and high waist
circumference.
• Psychological factors  negative attitudes toward aging, fear
of falling, and poor emotional vitality.
• Diseases  heart attack and stroke, baseline hypertension,
diabetes, angina, dyspnea, exertional leg pain and incident
cancer, and hip fracture.
 PATOFISIOLOGI
• Biomechanical Perspective: Direct Assessment of the
Body in Motion 
• Normal walking maximizes energy efficiency. When walking
changes owing to biomechanical alterations caused by
disease or aging, walking becomes more energy demanding.
• Normal walking also requires excellent control of balance
and timing. When problems develop with balance and
timing, the priority for safe walking may be to increase
stability and support at the expense of losses of energy
efficiency.
• Thus, difficulty increases from sitting to standing to walking,
to climbing stairs, walking a line, or running.
• A biomechanical approach to postural alterations and body-
segment movement abnormalities can be useful for
identifying causes of, and solutions to, mobility problems.
PATOFISIOLOGI
•Physiologic Perspective: Using Organ System
Impairment to Link Function and Disease 
• balance control (neurologic system),
• force production (cardiopulmonary and muscular
systems), and
• structural support (skeletal system—bone and
joints)
Gait Speed as an Integrator of
Multiple Approaches
•Walking is the foundation of mobility, is
influenced by biomechanical and physiologic
processes, and is a major driver of disability
•Normal usual walking speed in the older
adult should be at least 1 m/s.
•Energy expenditure can be measured in
metabolic equivalents (METs)
•Energy requirements in METS and the
expected activity level can be associated with
gait speed
EVALUASI (ASSESMENT)
EVALUASI (ASSESMENT)
Clinical Assessment of Mobility Performance
 Clinical Assessment of Mobility Performance

Clinical Assessment of Mobility Performance

• The Modified Gait Abnormality Rating Scale

• The Hierarchical Assessment of Balance and Mobility
• The Berg Balance Scale
• The Activity
• Measure for Post-Acute Care (AM-PAC)
• The Dynamic Gait Index
Differential Diagnosis Based on a Physiologic
Perspective
Differential Diagnosis Based on a Physiologic
Perspective
Differential Diagnosis Based on a Physiologic
Perspective
Psychosocial and Environmental Assessment
MANAGEMENT
Intervening Directly on Mobility
•Rehabilitative in nature and involve exercise,
adaptive equipment, and environmental
modifications
Treating Impairments
•Impairments can be linked to diseases &
pathologic processes  treatment, and some
impairments can be improved directly
regardless of pathologic cause
 MANAGEMENT
Care for the Immobile Person
•Interventions to reduce the consequences of
immobility include determining the level of
care need and living setting,
•training others to properly position and move
the patient,
•implementing a mobilization plan,
•use of pressure-reducing devices to prevent
pressure ulcer, and, sometimes,
•using equipment to aid in transfers
 KESIMPULAN
• Mobility limitations constrain many functions required
for independent living and are powerful indicators of
future problems.
• Mobility can be classified using simple screening.
• Evaluation starts with a triage function or simple
measures like gait speed.
• A comprehensive mobility evaluation is resource
intensive and requires a multidisciplinary team.
• Evaluation and management include a biomechanical
approach to function, a biomedical approach to the
physiologic components of mobility, and a
psychosocial and environmental approach to
modifying factors.
TERIMA KASIH