No matter how hard we try, we can't stop the aging process. Good genes and lifestyle choices can make getting older easier, but nobody can stop the clock from ticking. The list of possible ailments is long and varied, but the loss of mobility, along with independence, hits especially hard.
Physical challenges, such as arthritis and vision loss, often rob people of their mobility, but our mental states also can be a factor.
"A lot of it has to do with fear. People are fearful of falling, even if they have never fallen before," says Kristin Beadle, lead physical therapist at the John J. Gerlach Center for Senior Health. "That's actually the larger portion of people that are fearful of falling. They are intelligent people. They see the news and know what can happen after a fall."
The fear of falling can be the beginning of a downward spiral. For many people, getting up and moving around is the only exercise they get. Less movement means muscle loss and social isolation, which can lead to depression. Mind and body both suffer.
To get an idea of a person's risk of falling, Beadle suggests a balance assessment conducted by a physical therapist.
"Basically, you look at everything coming in because balance is basically sensory information in. You look at the mind, how it's being processed and whether there are any cognitive impairments," Beadle says. "Then we look at the motor output, including flexibility, strength and general mobility. So if anything's impaired in the entire loop, it can put balance and falling at risk."
If a person is found to have a significant risk of falling, a mobility device -- such as a cane, walker or scooter -- may be prescribed. Medical professionals will look for other options, such as physical therapy, to spare their patients the burden of relying on devices to get around, but sometimes it can't be avoided.
Once the need for a mobility device has been determined, the next step is to decide which one fits the needs of the patient. Simply showing up at a pharmacy and picking something out won't work. A screening by a physical therapist is necessary to sort through the endless options that are available. A cane may provide enough stability for someone with knee pain but not enough for someone with arthritis, who might be better served with a walker.
"I encourage people to see a therapist to see what kind of walker is most appropriate because there are a ton out there," Beadle says. "There are differences in the size of the wheels. There are differences in that some have two wheels; some have four. Some have wheels that all swivel; on some, just the front wheels swivel. There is the standard walker, which has no wheels.
"You don't just get a walker because you're unsteady. You need to know what kind of walker is best for you. If you have poor endurance and you're picking up a standard walker and moving and picking it up and moving, it's going to wear you out."
A new twist on the standard walker is the rolling walker, which has four wheels, bikelike brakes and a seat. If you're starting to feel fatigued, you can lock the brakes and sit down until your strength comes back. They cost between $100 and $150 and may be covered by insurance.
Sometimes getting around isn't the problem; it's just getting out of bed. Bed canes are replacing side rails as a better source of stability. They are attached to the bed frame or under the mattress and provide something sturdy to hold on to as you get out of bed.
Battery-powered scooters are advertised heavily on TV and can be covered by Medicare, which has made them very popular. They may be the ideal solution for some with mobility difficulties, but depending on a scooter may do more harm than good.
"If a person decides to get a scooter because it's free, you're also looking at decreasing their own physical mobility," says Roberta Newton, a professor of physical therapy at Temple University. "When (the scooters) first came out, a lot of older adults were using the scooters because they were cheap, and what we found out was they were decreasing their physical activity and becoming more sedentary. So they were relying on that device, and quality of life decreased."