Annals of Long Term Care

The number of nursing home residents in the United States is projected to reach three million by the year 2030. Currently, over 80% of residents spend time sitting in a wheelchair every day. Many of these residents are overlooked for therapeutic treatment because they are perceived as being too physically disabled and/or without rehabilitation potential. Furthermore, use of wheelchairs is associated with many types of adverse outcomes and injuries, including deconditioning, pressure ulcers, skin tears, bruises, edema, nerve impingement, falls, discomfort, contractures, loss of independence and autonomy, social isolation, and decreased quality of life. There is increasing concern that wheelchairs are being overused in nursing homes. This growing trend can be curtailed by the development and implementation of a program to assess mobility, encourage ambulation, and restrict unnecessary wheelchair use. (Annals of Long-Term Care: Clinical Care and Aging 2010;18[6]:34-38)

The reduction of physical function in advancing age often leads to loss of independence, increased need for institutionalization, and premature death. As people age, they experience changes in proprioception, balance, muscle strength, and sensory function, all of which can have a negative effect on mobility and navigation around environmental hazards and barriers.¹ With the increasing population of older adults age 65 and over, the number of nursing home (NH) residents in the United States is projected to reach three million by the year 2030.² Currently, most residents are admitted directly from a hospital or from another NH with three or more admitting diagnoses.³ The most common medical conditions are cardiovascular diseases, mental and cognitive disorders, and musculoskeletal problems, all of which may contribute to mobility challenges in this population.⁴

For example, the effects of a stroke often result in impairment of gait, balance, proprioception, and endurance. Individuals with dementia lose their ability to plan and execute purposeful activities and may put themselves at risk of physical injury.⁵ Osteoarthritis and fixed spinal deformities (eg, kyphosis) frequently present challenges in assessing residents for comfortable seating and positioning, and can present a misleading picture when NH staff perceive residents as more functionally impaired than they actually are.^4,6,7 This presents a problem, in that the loss of mobility can sometimes result in unnecessary dependence upon others.

Some NH regulations, while intended to protect the presumably vulnerable adult population, actually limit the personal freedom of the residents. For example, most facilities have specific mealtimes and food choices, and residents are allowed visitors only during certain hours. Smoking and drinking alcohol are monitored closely, if allowed at all. With regard to safe mobility, wheelchairs may be assigned as a means of providing protection from injuries, particularly falls. While the intention is primarily protective, it may contribute to preventable decline in function. For example, wheelchair use in NHs is very common, with up to 80% of residents spending time sitting in a wheelchair every day, and many of these residents are overlooked for therapeutic treatment because they are perceived as too physically and/or functionally impaired to benefit from rehabilitation programs.⁸

Unfortunately, use of wheelchairs is associated with many types of adverse events and injuries that are often overlooked or unrecognized.