When Walking Fails: Mobility Problems of Adults with Chronic Conditions Suggests Policy Solutions

Study of the problems of health care access faced by people with impaired ambulation

Lisa I. Iezzoni, MD, MSc, of Beth Israel Deaconess Medical Center wrote, When Walking Fails: Mobility Problems of Adults with Chronic Conditions, a book about how mobility problems affect people's lives and how health care and other policies help or hinder their independence, published by University of California Press in 2003.

The project was part of the Robert Wood Johnson Foundation's (RWJF) Investigator Awards in Health Policy Research program.

Key Findings: Iezzoni reported the following key findings in her book and in several journal articles:

  • About 19 million adults who live outside nursing homes or other institutions say they have at least some difficulty walking or use a mobility aid.
    • Mobility difficulties are not exclusively conditions of old age.
  • People with mobility difficulties are more likely to have health insurance than those without such problems.
    • Medicare and health insurers often have coverage policies that prevent people with disabilities from obtaining assistive devices and regaining their independence.
  • The most common causes of mobility problems are arthritis and other joint problems, back problems, accidental falls, heart disease, motor vehicle accidents, and chronic lung disease.
    • People with mobility problems are more likely to be obese.
  • Many people who use wheelchairs or scooters do not view themselves as disabled.
    • Whether to start using a wheelchair or scooter is a critical decision for people who have progressive difficulty in walking.
  • Primary care physicians are generally poorly trained to recognize physical disabilities and to refer patients to appropriate rehabilitation specialists and assistive technology.
    • Physicians also carry misconceptions about the role a wheelchair might play in patients' lives.
  • People with mobility problems face barriers getting into and around health care settings.