Abstract
Objective
To determine how often physicians document mobility limitations in visits with older
adults, and which patient, physician, and practice characteristics associate with
documented mobility limitations.
Design
We completed a cross-sectional analysis of National Ambulatory Medical Care Surveys,
years 2012-2016. Multivariate analyses were conducted to identify patient, physician,
and practice-level factors associated with mobility limitation documentation.
Setting
Ambulatory care visits.
Participants
We analyzed visits with adults 65 years and older. Final sample size represented 1.3
billion weighted visits.
Intervention
Not applicable.
Main Outcome Measure
We defined the presence/absence of a mobility limitation by whether any International
Classification of Diseases (ICD)-9 or ICD-10 code related to mobility limitations,
injury codes, or the patient's “reasons for visit” were documented in the visits.
Results
The overall prevalence of mobility limitation documentation was 2.4%. The most common
codes were falls-related. Patient-level factors more likely to be associated with
mobility limitation documentation were visits by individuals over 85 years of age,
relative to 65-69 years, (odds ratio 2.32, 95% confidence interval 1.76-3.07]; with
a comorbid diagnosis of arthritis (odds ratio 1.35, 1.18-2.01); and with a comorbid
diagnosis of cerebrovascular disease (odds ratio 1.60, 1.13-2.26). Patient-level factors
less likely to be associated with mobility limitation documentation were visits by
men (odds ratio 0.80, 0.64-0.99); individuals with a cancer diagnosis (odds ratio
0.76, 0.58-0.99); and by individuals seeking care for a chronic problem (relative
to a new problem [odds ratio 0.36, 0.29-0.44]). Physician-level factors associated
with an increased likelihood of mobility limitation documentation were visits to neurologists
(odds ratios 4.48, 2.41-8.32) and orthopedists (odds ratio 2.67, 1.49-4.79) compared
with primary care physicians. At the practice-level, mobility documentation varied
based on the percentage of practice revenue from Medicare.
Conclusions
Mobility limitations are under-documented and may be primarily captured when changes
in function are overt.
Keywords
List of abbreviations:
ICD (International Classification of Diseases), NAMCS (National Ambulatory Care Medical Survey), PCP (primary care physician)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 29, 2023
Accepted:
November 21,
2022
Received in revised form:
November 15,
2022
Received:
September 20,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
A portion of this work was presented as a poster at the UPMC Rehabilitation Institute Research Day in Pittsburgh, PA, on June 22, 2022.
Disclosures: This research was supported by Promotion of Doctoral Studies (PODS) I award from the Foundation for Physical Therapy Research and an Adopt-A-Doc Scholarship from the Geriatric Academy of the American Physical Therapy Association to Valerie Shuman. Jenifer S. Brach, PT, PhD, FAPTA was supported by a Midcareer Investigator Award from the National Institute on Aging (K24 AG057728). The authors report no conflicts of interest.
Identification
Copyright
© 2023 by the American Congress of Rehabilitation Medicine.
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- The Unrecognized Problem of Mobility Limitations Among Older AdultsArchives of Physical Medicine and Rehabilitation
- PreviewThe “Graying of America” has been used to describe the rapid growth of the older adult population in the US. The number of adults 65 and older is expected to double from 49 million in 2016 to 95 million in 2060, representing a growth from 15% to 25% of the US population.1 Many older adults view mobility as an important component of successful aging,2 and mobility limitations have a profound effect on the physical, psychological, and social functioning of older adults.3 Mobility limitations are associated with increased risk of mortality, institutionalization, and health care utilization.
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