Mobility aid users aged 50+ face physical, social and psychological barriers to activity.
Older mobility aid users face physical, social and infrastructural obstacles moving around outdoors. Policy and practice can reinforce rather than support these barriers if we’re not careful.
Do you know someone 50 or older who uses a mobility aid? Chances are you do. Over a third of people in Wales are over 50 and report a mobility restricting disability or chronic illness. Not all of these people will need or use a mobility aid, but many will, yet some will refuse to use them because of social attitudes including ageism.. While there is research to understand the impact of mobility aid use in medical and health settings to reduce falls and make sure mobility aids fit the user, there has been very little investigation into the social and psychological implications of mobility aid use in out of doors settings, especially concerning older people.
Mobility aids like walking sticks, wheelchairs, crutches or even using a car for journeys that people used to walk becomes more prevalent as we age, be it on a temporary, intermittent or permanent basis. I carried out a study with 11 older people who use mobility aids along with 6 of their family members, friends or carers. I started by chatting to people at friendship groups to get a general sense of how people feel about using mobility aids. I then carried out interviews and walking interviews with some mobility aid users to understand how mobility aid use is assimilated into daily life. I also interviewed carers and loved ones to understand their observations of a loved one using a mobility aid, to establish whether mobility aid use impacts those around the mobility aid user. While conducting my study, most people I spoke to knew someone who used a mobility aid, even if it was a temporary experience. People would tell me stories of the time they, or their parent, or neighbour had broken their leg and needed to use a wheelchair or a walking stick. While supporting mobility, anyone who has experienced mobility aid use understands how mobility aid use changes the way daily routines and activities are experienced.
My research investigated the ways older people experience and describe these interruptions. Impacts were highlighted in areas of identity, relationships, and infrastructure (the ways people could navigate the physical environment). People felt unable to maintain their identity, to be the same person they used to be as they could not present themselves in the same way, or felt others saw them differently.
One challenge in this area of research, particularly because of the way we rebuff ideas of ageing and older people, is that we do not want to admit reductions in ability, to ourselves or others. However, using a combination of walking with people, asking them to tell me about their daily lives and what they used to do, it became clear that while mobility aids support mobility in some ways, using mobility aids can restrict movement in other ways. Changes to the way people have to move around, means trips take longer and use more effort. Additional planning for mobility aids affects relationships with family, friends and carers, and wider relationships with service providers. Places and the physical infrastructure become less accessible. While there are efforts to make places and infrastructure more accessible, this often comes at the cost of losing anonymity, independence or feeling less safe. People therefore have to change the way they feel about themselves because they have a physical symbol of age, and they have to ask for help.
Overall, the obstacles to carrying out normal daily routines were not described as huge ones, but constant streams of difficulties, such as:
- broken pavements
- paving which is difficult to walk on
- unwieldy ramps,
- having to ask for help to access places
- feeling subordinate to others
- feelings of being a burden to loved ones
- finding services to be inefficient or ineffective which makes seeking support time-consuming and stressful.
Some people described the thoughtless or derogatory remarks people made to them, highlighting the stigma that exists with mobility aid use. The combination of these obstacles made going out seem just like too much hassle, so people begin to avoid going out. The obstacles are also interlinked in complex ways. Places that are inaccessible can increase a person’s sense of reduced capacity which leads to loss of independence and changes to identity. Loss of independence leads to reliance on others which impacts on relationships. The feedback loop of mobility aid use in the diagram shows how each area of obstacle can affect the others.
Policy makers, planners and service providers need to provide a more coherent overall package to support older people who are mobility aid users. Without an approach that includes attention to social, emotional and psychological needs, mobility aid use leads to social exclusion and social isolation which are linked to decline in health and well-being. With improved health and well-being, older mobility aid users, will need less health and social care support, and be involved in more social, economic and community participation. There is an overall win-win for both mobility aid users and tax payers as improved health and well-being reduces total tax payer spend on socially excluded/isolated older people. Older mobility aid users gain better health, wellbeing and community participation, while society reduces overall spend and continues to receive the wisdom, creativity and general participation of less mobile older people.