Mobility and risk of falls are major concerns for older adults. For hospital staff, mobility is a major factor in decisions about discharging older adults to their homes. But how reliable is older adults’ self-reported ability to perform common mobility tasks? A recent study in two emergency departments compared older adults’ estimates of their mobility with their actual ability to perform a common mobility task.
The 272 participants in this study were 65 years old or better, and were neither nursing home residents nor critically ill. Individuals with cognitive impairment were also excluded. Each study participant was asked whether they could get out of bed, walk 10 feet, turn around, and get back into bed without assistance. If they said that they were not able to do this without assistance, they were asked whether they could perform this task with a cane, walker, or assistance from another person. When asked to estimate their ability to complete the task, 59 percent reported being able to do the task with no assistance, 17 percent said they could complete it with a cane or walker, 8 percent said they could do it with assistance, and 17 percent estimated that they would be unable to complete the task even with assistance.
After being asked about their ability to complete this task, participants were asked to perform the task described. If needed, they were provided a mobility device or physical assistance from another person. Of the total participants, only 172 agreed to attempt the task itself. Of those who agreed to attempt the task, a surprising number of participants’ estimates of their ability turned out to be incorrect. Overall, 77 percent of the participants accurately estimated their ability to complete the task, and only 3 percent underestimated their ability. Of those who reported being able to do the task without assistance, 12 percent did require assistance or were unable to complete the task even with assistance. Even more strikingly, of those who reported being able to complete the task with a cane or walker, 48 percent required assistance or were unable to complete the task even with assistance. Of those who reported needing assistance to complete the task, 24 percent were unable to complete the task even with personal assistance. As for the 55 participants unwilling to attempt the task, the researchers speculated that it was likely that the refusal to attempt the mobility would “suggest that many of these individuals would have had greater difficulty doing the task than they said they would.”
The authors suggest two potential explanations for the participants’ overestimation of their ability. First, their reason for entering the hospital may have impacted their mobility more than the patient expected. Second, some participants may have overestimated their ability out of a desire to be released from the hospital and go home.
These findings are particularly concerning since the authors note that “direct observation of physical function of older patients is not routinely performed by emergency providers.” As a result of this study’s findings on the unreliability of patients’ reported ability to perform such a common mobility task, the authors recommend that hospitals consider direct observation of older adults’ mobility before discharge. These findings also have relevance beyond a hospital setting, since many older adults may exaggerate self-reports of their mobility out of a desire to maintain their present living situation, whether that is a desire not to transition from a community dwelling to senior living setting, or a desire not to be placed in a higher level of care within a senior living setting. In order to accurately assess mobility and to minimize risks associated with limited mobility, this study suggests that direct observation of physical activity is preferable to relying on self-reports.
Roedersheimer KM, Pereira GF, Jones CW, et al. Self-reported versus performance-based assessments of a simple mobility task among older adults in the emergency department. Annals of Emergency Medicine. (2015). DOI: http://dx.doi.org/10.1016/j.annemergmed.2015.07.007