Mobility Difficulties Are Not Only a Problem of Old Age

BACKGROUND: Lower extremity mobility difficulties often result from common medical conditions and can disrupt both physical and emotional well-being. OBJECTIVES: To assess the national prevalence of mobility difficulties among noninstitutionalized adults and to examine associations with demographic characteristics and other physical and mental health problems. DESIGN: Cross-sectional survey using the 1994–1995 National Health Interview Survey-Disability Supplement (NHIS-D). We constructed measures of minor, moderate, and major lower extremity mobility difficulties using questions about ability to walk, climb stairs, and stand, and use of mobility aids (e.g., canes, wheelchairs). Age and gender adjustment used direct standardization methods in Software for the Statistical Analysis of Correlated Data (SUDAAN). PARTICIPANTS: Noninstitutionalized, civilian U.S. residents aged 18 years and older. National Health Interview Survey sampling weights with SUDAAN provided nationally representative population estimates. RESULTS: An estimated 19 million people (10.1%) reported some mobility difficulty. The mean age of those with minor, moderate, or major difficulty ranged from 59 to 67 years. Of those reporting major difficulties, 32% said their problems began at aged 50 years or younger. Adjusted problem rates were higher among women (11.8%) than men (8.8%), and higher among African American (15.0%) than whites (10.0%). Persons with mobility difficulties were more likely to be poorly educated, living alone, impoverished, obese, and having problems conducting daily activities. Among persons with major mobility difficulties, 30.6% reported being frequently depressed or anxious, compared to 3.8% for persons without mobility difficulties. CONCLUSIONS: Reports of mobility difficulties are common, including among middle-aged adults. Associations with poor performance of daily activities, depression, anxiety, and poverty highlight the need for comprehensive care for persons with mobility problems

Facing others in pain : why context matters

Judging pain in another is challenging, largely because pain is a subjective phenomenon to which observers have no direct access. Despite this ambiguity, inferences often are made that can drive important clinical decisions, such as estimating another’s pain intensity, with significant implications for patient treatment and outcomes. This chapter focuses upon the influence of the context upon observer cognitive, emotional, and behavioral responses toward others in pain. In doing so, we consider context in its broadest form: characteristics of the patient/person in pain, the observer, and the situation, as well as elements of the reported pain experience, itself. Despite the increased understanding of and appreciation for the role of context in observer judgments, knowledge of how context, judgment, and treatment outcomes interact remains sketchy and in need of translational research. Such research is needed if we are to build our current base of knowledge and translate that knowledge into improved approaches to the assessment and treatment of patients in pain