I had the privilege to speak at the Oceanic Seating Symposium in Melbourne this time last year, exploring the inequalities of assistive technology funding due to age. This is a topic which is close to my heart, having commenced my OT career in Residential Aged Care and seeing a vast array of barriers for equipment to support independent mobility in this population.
It can be easy to get caught up in statistics when it comes to ageing:
- The number of older people is projected to double over the next 30 years, to 1.5 billion in 20501
- Globally the population aged 65 years or over increased from 6% in 1990 to 9% in 2019 with this proportion is projected to rise to 16% in 2050 (1 in 6) 1
- There are projections in New Zealand that by the 2050s, 1 in 4 will be over 65 years2
- In Australia in 2019, 49.6% people aged 65 years and over had a disability, representing almost half of all people with a disability3. This percentage was over 60% in New Zealand in 20132.
To create awareness and promote change, the World Health Organisation (WHO) has declared 2021-2030 to be the ‘Decade of Health Ageing’. I would encourage you to look up their report4 which discusses the goals and considerations for this decade. (If you are interested you can find the report here.) There are four key areas4 which the WHO identified were:
- Changing how we think, feel and act towards age and ageing
- Developing communities in ways that foster the abilities of older people
- Delivering integrated care and primary health services that are responsive to the needs of older people
- Providing older people who need it with access to long-term care
As allied health professionals, we can play a role in all these areas, however I would like to expand on point three for today. If you were to stop and reflect on your practice, would the assessment, goal setting and recommendations for wheeled-mobility prescription for a client over 75 years look different if that client were 10, 20 or 30 years younger? If so, how? Is the change due to assumptions of roles, occupations and the value of independent mobility, or perhaps based on subjective or objective measures? I can imagine ‘funding’ may come to mind, and if so, our previous blog could be worth looking at.
There is ample literature which recognises the importance of individual mobility solutions to improve function5-6, as well as reduce the risk of upper extremity injuries and pain6. The necessity to ensure a wheeled solution maximises biomechanics and push efficiency is therefore even more important as we acknowledge potential aged-related changes7.
Individual customisations for a manual wheelchair at a minimum include seat width and depth, front and rear seat-to-floor-height, centre-of-gravity, weight and potential power assist considerations. For a power wheelchair, it could be multiple power seat functions considering functional goals and the increased pressure injury risk for this population8, meaningful naming of profiles, tremor dampening, memory functions and adjustments to programming.
Whether a manual or power base is identified as the most appropriate, there is the necessity to consider a seating system alongside the base. The incorporation of cushion, backrest and other seating and functional supports and accessories are critical components to maximise function, independence and reduce pressure injury risk7.
Where is the dignity for a user to be placed in a wheelchair, or any chair for that matter, unable to move for long periods of the day when there is potential for some level of independence with an individualised prescription and set up? Whether this is to be used across all environments, or get themselves to the bathroom, using bilateral upper limbs or just one foot, this not only benefits the user but all of their supports when assessed and wholistically conducted6,9. Further to this, independent mobility contributes to maintaining quality of life for the elderly. 8 How important then is it for a holistic assessment and prescription of mobility aids not only for children, adolescents and adults, but also older adults. This includes the involvement of all relevant stakeholders and the provision of training to support the implementation of the new device.
We cannot limit our user’s potential for independence with their mobility based solely on their age. I encourage you to continue to look at each individual user and facilitate their access to custom assistive technology to promote functional outcomes.
Watch this video: "Global Campaign to Compat Ageism - #AWorld4AllAges (youtube.com)"
References
- United Nations. (2019). World Population Ageing 2019. Department of Economic and Social Affairs. World Population Ageing 2019: Highlights (un.org)
- Stats NZ. (2022, July 27). One million people aged 65+ by 2028. https://www.stats.govt.nz/news/one-million-people-aged-65-by-2028/#:~:text=The%20proportion%20of%20the%20population,one%2Dquarter%20of%20the%20population.https://data.worldbank.org/indicator/SP.POP.65UP.TO?locations=NZ
- Australian Bureau of Statistics. (2018). Disability, Ageing and Carers, Australia: Summary of Findings. ABS. https://www.abs.gov.au/statistics/health/disability/disability-ageing-and-carers-australia-summary-findings/latest-release.
- World Health Organization. (2020). Decade of healthy ageing: Baseline report.
- Lange, M. L., & Minkel, J. (2018). Seating and wheeled mobility: A clinical resource guide. Slack Incorporated.
- RESNA Position Paper (2023): The Application of Ultralight Manual Wheelchairs
- World Health Organization. (2022a, October 1). Ageing and health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
- Requejo, P. S., Furumasu, J., & Mulroy, S. J. (2015). Evidence-Based strategies for preserving mobility for elderly and aging manual wheelchair users. Topics in Geriatric Rehabilitation, 31(1), 26–41. https://doi.org/10.1097/tgr.0000000000000042
- Rice, L., Kalron, A., Berkowitz, S. H., Backus, D., & Sosnoff, J. J. (2017). Fall prevalence in people with multiple sclerosis who use wheelchairs and scooters. Medicine, 96(35). https://doi.org/10.1097/md.0000000000007860
Author
Roseanna Tegel BHthSc/MOT
Clinical Services Specialist
Roseanna Tegel joined Permobil in May 2023 as a Clinical Services Specialist. She graduated from Western Sydney University in 2016 with a Bachelor of Health Science/Master of Occupational Therapy and received the Prize in Undergraduate Occupational Therapy for Overall Achievement and the Cerebral Palsy Alliance scholarship. Roseanna began working at residential aged care facilities where her understanding of the need for suitable, person-centred equipment commenced. From there, she transitioned to work in community disability and quickly developed an interest for complex seating and mobility outcomes to benefit both the end user and wider network. She then stepped into a Team Leader role due to her passion for learning and best practice; supporting the Occupational Therapists with their own clinical needs and outcomes, and progressed to also provide external supervision to Occupational Therapists. Roseanna is motivated to support clinicians with their confidence and clinical reasoning allowing them to provide the best outcome for each individual user. Outside of work, Roseanna enjoys time with her dog, playing the 'cello, horse riding and aerial sports.