1. Chapter Safe Mobility

2. Introduction
Mobility is the most important aspect of physiologic function
Maintenance for independence
Risks affecting mobility
Falls and fractures
Safety is the integral aspect of mobility

3. Age-Related Changes That Affect Mobility and Safety
Bones
Framework for musculoskeletal system
Age-related changes
Increased bone resorption, diminished calcium absorption, increased serum parathyroid hormone, impaired regulation of osteoblast activity, impaired bone formation secondary to reduced osteoblastic production, fewer functional marrow cells, and decreased estrogen in women and testosterone in men

4. Age-Related Changes That Affect Mobility and Safety—(cont.)
Muscles
Directly affects all activities of daily living (ADLs)
Age-related changes
Decreased size and number of muscle fibers, loss of motor neurons, replacement of muscle tissue by connective tissue, deterioration of muscle cell membranes, diminished protein synthesis
Sarcopenia: loss of muscle mass, strength, and endurance

5. Age-Related Changes That Affect Mobility and Safety—(cont.)
Joints and connective tissues
Harmed by continued use and begin to show wear and tear during early adulthood
Age-related changes
Diminished viscosity of synovial fluid, degeneration of collagen and elastin cells, fragmentation of fibrous structures in connective tissue, outgrowths of cartilaginous clusters, formation of scar tissue and areas of calcification in joint capsules and connective tissue, and degenerative changes in articular cartilage

6. Age-Related Changes That Affect Mobility and Safety—(cont.)
Nervous system
Age-related changes
Central and peripheral nervous system may be primary mechanism in diminished muscle function
Maintenance of balance
Altered visual abilities, slower righting reflex, impaired proprioception, diminished vibratory and positioning sensations in lower extremities
Body sway: measure of motion of the body while standing

7. Age-Related Changes That Affect Mobility and Safety—(cont.)
Osteopenia and osteoporosis
Loss of bone: age-related change
Bone density: amount of minerals in bone
Scored according to standard deviations
T-score: between 1 and 2.5 diagnosis is osteopenia
Lower T-score is diagnosis of osteoporosis
Osteoporosis: silent disease
Fragility fracture: little to no trauma

8. Question Is the following statement true or false?
Exercise programs to increase strength and endurance in the older adult population may help delay the onset of the age-related functional consequences of decreased strength and endurance

9. Answer
True
Age-related changes in skeletal muscles, which are controlled by motor neurons, directly affect all activities of daily living. The end result of these age-related changes is a decline in motor function and a loss of strength and endurance, even in healthy older adults. Exercise programs to increase strength and endurance may help delay the onset of the age-related consequences of disability and loss of function

10. Question Which statement about osteoporosis is true?
A. Primary osteoporosis occurs with pathologic problems
B. Secondary osteoporosis occurs as a result of age-related changes
C. Osteoporosis can cause serious negative functional consequences even in the absence of additional risk factors
D. Estrogen levels have a minimal impact on the development of osteoporosis

11. Answer
C. Osteoporosis can cause serious negative functional consequences even in the absence of additional risk factors
Osteoporosis is a gradual loss of bone mass that affects all adults to some degree and is strongly associated with low-trauma fractures in older adults. Osteoporosis is classified as primary when it is associated with age- related changes and as secondary when it is caused by medications or pathologic disturbances

12. Risk Factors That Affect Mobility and Safety
Risk factors that affect overall musculoskeletal function
Lacking physical activity and nutritional deficits
Vitamin D: essential for the absorption of calcium and bone health
Calcium: essential for good musculoskeletal function
Other dietary factors that increase risk
Low intake of high-quality proteins
Inadequate food sources of vitamin B12 and folic acid

13. Risk Factors That Affect Mobility and Safety—(cont.)
Risk factors for osteoporosis and fragility fractures
Inadequate calcium and vitamin D intake
Lack of weight-bearing activity
Hormonal changes with regard to estrogen in women
Small bones
Increased age
Tobacco use
Excessive alcohol consumption
Certain medications

14. Risk Factors That Affect Mobility and Safety—(cont.)
Risk factors for falls
History of falls
Use of walking aids
Pathologic conditions and functional and cognitive impairments
Medication effects
Environmental factors
Physical restraints

15. Question
Which statement related to risk factors for falls and the older adult is true?
A. Falls are most often the result of an isolated risk factor
B. The risk of falling increases in proportion to the number of risk factors
C. Risk factors for falls do not vary according to the environment
D. Functional abilities of the older adult are not considered a risk factor for falls

16. Answer
B. The risk of falling increases in proportion to the number of risk factors
Falls are the result of a combination of risk factors rather than one isolated risk factor, and the risk of falls increases in proportion to the number of risk factors

17. Pathologic Condition Affecting Musculoskeletal Function: Osteoarthritis
Osteoarthritis: degenerative inflammatory disease affecting joints and attached muscles, tendons, and ligaments
Characterized by pain, swelling, and limited movement of joints
Leading cause of disability
Risk factors
Trauma, genetics, obesity, and age-related changes
Focus: self-care health education interventions

18. Functional Consequences Affecting Musculoskeletal Wellness
Effects on musculoskeletal function
Diminished muscle strength, endurance, and coordination, increased difficulty performing ADLs
Susceptibility to falls and fractures
Osteoporotic fractures, increases with age, serious consequences
Fear of falling
Excessive anxiety about falling

19. Question
Which statement related to musculoskeletal function and the older adult population is true?
A. There is a greater decline in muscle strength in the upper extremities
B. Diminished muscle strength is attributed primarily to age-related loss of muscle mass
C. Older adults experience muscle fatigue after longer periods of exercise than do younger adults
D. Lifelong patterns of exercise and activity have little effect on muscle strength

20. Answer
B. Diminished muscle strength is attributed primarily to age-related loss of muscle mass
Beginning at about the age of 40 years, muscle strength declines gradually, resulting in an overall decrease of 30% to 50% by the age of 80 years, with a greater decline in muscle strength in the lower extremities than in the upper extremities

21. Nursing Assessment of Musculoskeletal Function
Assessment of overall musculoskeletal performance
Assessing musculoskeletal performance
Identifying risks for osteoporosis
Identifying risks for falls and injury
Falls Risk Assessment Tools

22. Nursing Diagnoses
Wellness nursing diagnosis: Readiness for Enhanced Self- Health Management
Related to osteoporosis: Health-Seeking Behaviors, Ineffective Health Maintenance
Related to fall risks: Impaired Physical Mobility, Risk for Falls
Additional diagnoses that address fear of falling: Fear

23. Planning for Wellness Outcomes
Balance, endurance, mobility, activity tolerance
Risk control, risk detection
Safety behavior: fall prevention, home physical environment
Coping, fear control, comfort level

24. Nursing Interventions for Musculoskeletal Wellness
Promoting healthy musculoskeletal function
Teaching about osteoporosis
Preventing falls and fall-related injuries
Addressing intrinsic risk factors
Addressing extrinsic risk factors
Using monitoring devices in institutional settings
Providing assistance in independent settings
Addressing fear of falling
Promoting caregiver wellness

25. Nursing Interventions for Musculoskeletal Wellness—(cont.)
Implementing fall prevention programs
Eliminating risks
Using monitoring devices
Addressing contributing factors
Preventing fall-related injuries and death
Hip protectors
Environmental interventions
Addressing fear of falling

26. Question
Which statement related to adequate calcium supplementation and the older adult is true?
A. Calcium supplements are rarely necessary
B. Calcium supplementation lowers the rate of fractures in older adults
C. Calcium supplements have few detrimental effects when taken by older adults
D. Absorption of calcium supplements is optimal at mg per dose

27. Answer
B. Calcium supplementation lowers the rate of fractures in older adults
A recent report from the U.S. Surgeon General recommended a pyramidal treatment approach to osteoporosis that includes physical activity, fall prevention, and supplementation with calcium and vitamin D as the foundation for fracture prevention. Absorption of calcium supplements is optimal at not more than 600 mg per dose

28. Evaluating Effectiveness of Nursing Interventions
Evaluation based on person’s ability to achieve and maintain highest possible level of independence and safe mobility
Incorporation of preventive measures in daily life to ensure safety and prevent osteoporosis
Expressed feelings of safety and improved quality of life
Evaluation of risk factors