Making mobility-related disability better: a complex response to a complex problem
Geriatric Medicine Research Unit, Dalhousie University and Queen Elizabeth Health Sciences Centre, 5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1, Canada
Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada
BMC Medicine 2012, 10:121 doi:10.1186/1741-7015-10-121Published: 15 October 2012
Mobility disability in older adults can arise from single system problems, such as discrete musculoskeletal injury. In frail older adults, however, mobility disability is part of a complex web of problems. The approach to their rehabilitation must take that complexity into account, as is reported by Fairhall et al. First, their overall health state must be assessed, which is achieved by a comprehensive geriatric assessment. The assessment can show how a particular patient came to be disabled, so that an individualized care plan can be worked out. Whether this approach works in general can be evaluated by looking at group differences in mean mobility test scores. Knowing whether it has worked in the individual patient requires an individualized measure. This is because not every patient starts from the same point, and not every patient achieves success by aiming for the same goal. For one patient, walking unassisted for three metres would be a triumph; for another it would be a tragedy. Unless we understand the complexity of the needs of frail older adults, we will neither be able to treat them effectively nor evaluate our efforts sensibly.