Preserving Mobility in Elderly Population; Custom WC’s

Hannah Speckhart
Therapy Director
Southern Hills Skilled Nursing & Rehab

Preserving mobility throughout the elderly population is of growing concern as the baby boom generation becomes more reliant on adaptive devices as they age. Adaptive devices throughout functional mobility can include multiple options: canes (straight, quad, pyramid), walker (standard, front wheeled, rollator), and wheelchairs (manual, power). These devices allow people to maintain a level of independence and improve safety throughout mobility in the home and community environment.

More aging and disabled elderly adults and utilizing wheelchairs as a means of mobility. According to the National Health Interview Survery on Disability, “an estimated 1.5 million people in the United States use a manual wheelchair (MWC). Most use a MWC with the proportion of those using increasing sharply with age (864,000 in those 65 years and older). This population consists of many who have been using a manual wheelchair as a result of sudden onset of disability or gradual onset such as those persons with progressive diseases and elderly individuals who require a wheelchair for mobility.” A less explored option for qualifying elderly residents are custom seating assessments; ie. Custom wheelchair frame as well as custom cushioning. Custom wheelchairs are utilized by those in the community but can most commonly be found in long term care settings. The options in regards to features for custom wheelchairs are endless. If a resident can propel themselves with successful use of upper and lower extremities, a standard manual wheelchair would be most appropriate. There is also a subset of modifications that can be made to standard manuals to provide a slight tilt/recline feature in order to preserve skin integrity and decrease risk of breakdown while also maintaining independence to propel self with extremities (ie. Ki Mobility Liberty model). Another manual wheelchair meant for lower functioning individuals is a tilt-n-space wheelchair; it is able to achieve a 45 degree tilt in order to adjust a person’s weight bearing through buttocks to decrease risk of pressure ulcers. “It has been estimated that five million people in the United States have chronic pressure ulcers, there are 1.1-1.8 million people developing new ulcers each year, the financial cost and the emotional burden is heavy.” Pressure ulcers become increasingly common with the aging process because “aging skin loses elasticity, firmness, thickness, moisture, sensitivity and vascularity; and may reduce the tolerance to pressure and shearing forces resulting in greater risk for pressure ulcer development.” Wheelchairs that offer the technology can help to combat this dilemma as well as decrease the risk of development.

The Ki-Mobility Liberty model and Tilt-n-Space wheelchairs are the most common types recommended for those qualifying residents at Southern Hills. The therapy department works closely with multiple wheelchair vendors in order to complete assessments for submission to insurance companies for coverage since the cost of a custom wheelchair can be quite cumbersome. Standard manual wheelchairs with custom cushioning can start around $3-5,000. Most Medicaid insurance plans will cover the cost in full of a custom seating system, while other Medicare or commercial based plans will cover a portion.

Therapists are continuing to find creative ways to keep residents engaged and functioning at the highest level of independence in order to maintain quality of life with the most up to date adaptive devices and technology available.

Article Referenced: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562294/