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Activities of daily living (ADLs) are fundamental skills that are necessary for independent self-care, such as eating, walking, using the toilet, dressing, bathing/showering, and mobility. ADLs are used to indicate an individual’s functional status and to determine qualifications for medical care, therapy, nursing care, and insurance eligibility. When loved ones need assistance with ADLs, this may require family caregivers to learn how to appropriately support and provide care in a manner that allows their loved one to maintain some independence living at home. This document will address challenges with mobility, define the actions of transferring and ambulating as they relate to mobility, and provide tools to support your caregiving responsibilities.
Mobility includes the concepts of ambulating and transferring. Ambulating is the ability to move from one place to another independently (Edemekong 2022). Transferring is defined as moving from one position to another such as moving from sitting to standing
Challenges with Mobility
Mobility is an ADL that has strong ties with other ADLs. A loss in mobility can impact the ability to bathe/shower and toilet. Because of this, this ADL may have a stronger connection with one’s sense of independence. Having difficulty with mobility whether due to an injury, fall, or other cause, can be challenging due to the following:
- Safety concerns: Limited mobility may indicate an increased risk for falls. The care recipient who is experiencing mobility challenges may want to do things on their own or rush to get from place to place. Caregivers must also be aware of their own limitations to avoid straining their back and joints when helping the care recipient to move (Family Caregivers Online, 2022).
- Loss of independence: The care recipient may not want to be a burden to their adult children, spouses, and/or loved ones, and they may wish to get up and complete their daily activities by themselves without being reliant on support.
Ambulating
Ambulating is the ability to move from one place to another. Oftentimes the care recipient may need assistance with ambulating if they have difficulty with balance, or have muscle weakness. This may be potentially caused by arthritis, Parkinson’s disease, or injury.
Tools to Assist with Ambulating
Finding the right tools can help contribute to both the safety and ease of ambulating while also helping the care recipient to remain independent longer. There are different assistive devices that can help with various levels of mobility.
For those who can ambulate independently with assistive devices:
- Canes provide balance and support taking the pressure off of one or both legs and can have different handles for varying grip preferences or to help for those with arthritis.
- Single-point canes are the most common type of cane, with a single point that touches the ground for care recipients with slight balance issues.
- Quad canes are heavier and more stable with four feet at their base; they are recommended for balance/stability issues, are freestanding, and help to reduce slippage.
- Forearm canes offer support to the care recipient’s forearms with an extension that takes the weight off hands and wrists, transferring to the upper arms.
- Rolling canes have wheels and require less energy to use; they are recommended for those with arthritis, arm weakness, hip or knee pain, or those who have suffered a stroke.
- Portable and folding canes are easier to transport.
- Walking sticks or hiking poles are popular walking tools used to improve balance (AARP, 2024).
- Walkers have a larger base of support and are for those who can ambulate but need more support/stability in both legs. They typically have a metal frame with attached legs and a varying number of wheels.
- Standard walker often called the pick-up walker has the most stability.
- 2-wheeled walker is for if the care recipient needs help bearing weight as they move.
- 3-wheeled walker is lighter and easier to move than a 4-wheeled walker and is good for tight spaces.
- Knee walker has a knee platform and helps if the care recipient has an injury on the foot or ankle.
- Rolling walkers, also known as rollators, typically include wheels on all legs depending on the model allow the user to push it forward without lifting allowing for endurance and can have features such as seats, backrests, and cupholders.
For those with limited mobility who can operate a vehicle:
- Scooters, often referred to as medical or handicap scooters, are typically electric and are made for those who cannot walk shorter distances or cannot operate a manual wheelchair.
- 3-wheeled scooters typically have a tighter turning radius than 4-wheeled scooters.
- 4-wheeled typically have similar features to the 3-wheeled but offer more stability.
- Portable and foldable scooters are easier to transport.
- Electric or “power” wheelchairs are for those who lack the strength to wheel themselves and can maneuver the chair with their hands and offer more comfort, stability, and support for longer periods of time.
For those with limited mobility requiring caregiver assistance:
- Gait belts in addition to a walker or a cane can offer an additional level of support and stability.
- Manual wheelchairs may become necessaryfor those who can no longer walk safely and may need assistance and require arm strength and skill from the user or another person pushing them to move the chair.
Transferring
Transferring is the ability to move from one position to another including the ability to get in and out of bed or getting in and out of a chair. Transferring takes place in different locations including the bed, chairs, toilet, car, or even a shower bench. As the first action taken before ambulating, it is essential to understand how transferring contributes to mobility, and to recognize that limitations with transferring can lead to mobility concerns.
Products for Transferring
Consider products and positioning aids to help the care recipient transfer both independently and with assistance.
- Grab rails, bed safety rails or bed transfer handles, transfer poles, and grab bars may be used to allow for self-transferring or assisted transferring.
- Positioners such as bed bolsters may be used to allow for postural support and the care recipient to be in a comfortable position while transferring.
- Transfer boards also referred to as slide or sliding boards are rigid, flat boards typically made of wood or plastic that may be used to allow those with limited balance to move from one surface to another.
- Gait belts may be used to aid in safe movement, transferring from a bed, chair table, etc. allowing the care recipient to move from one position to another with assistance.
For Education on the use of Assistive Devices
Consulting with your physician about durable medical equipment (DME) such as canes, wheelchairs, etc. which may be covered by insurance, rented, or purchased through medical equipment providers can be helpful to decrease the physical demands of you as a caregiver.
Additionally, consulting with a physical or occupational therapist may help you understand proper body mechanics, lifting techniques, for transferring, strengthening exercises, and for making the home more “mobility-friendly”.
For Additional Assistance
If additional assistance with mobility is needed due to needs greater than your physical capability, in-home care may be an option.
Conclusion
With knowledge of the right tools based on the care recipient’s level of independence for safety and accessibility that works best for both you and your care recipient, mobility can be a safer and easier process to navigate with more confidence in meeting them where they are at.
Sources
AARP. (2024). Caregiver tips: Improve balance with hiking poles. Retrieved from https://www.aarp.org/caregiving/tips-hacks/mobility/improve-balance-with-hiking-poles/
Edemekong, P.F., Bomgaars, D.L., Sukumaran, S., et al. Activities of Daily Living. [Updated May 2, 2022]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470404/
Family Caregivers Online, (2022). Caregiver tips – transferring. Retrieved from https://familycaregiversonline.net/caregiver-tips-transferring/
Texas Health and Human Services. (2023). Retrieved from https://www.hhs.texas.gov/sites/default/files/documents/maintaining-ind-assisting-adl.pdf
VA. (2023). TSGLI Activities of Daily Living Background. Retrieved from https://www.benefits.va.gov/INSURANCE/docs/TSGLI_ADL_Training_Slides_revised_with_PM_input.pdf