Clinical guidelines report immobility as a risk factor for osteoporosis and fracture in older adults with impaired physical function. Wheelchair use helps in increased mobility and independence for these patients. Several studies are conducted to identify if wheelchair-induced immobility might be linked to fracture risk and injurious falls. One such study conducted in Sweden compared the risk of fracture among older immobilized patients who use wheelchairs with ambulatory controls. The study results are published in the recent issue of JAMA Network Open.
Dr. Axelsson and team reported a lower risk of fracture, osteoporotic fracture, and hip fracture among patients in wheelchairs compared to controls. The risk of falls among wheelchair users was also lesser than half of the ambulatory controls. The experts noted that wheelchairs reduced fracture risk and provided protection against fall risk in frail elderly patients with disability. They concluded that wheelchair-induced immobility is not a risk factor for fracture.
A study involving 2711 residents by Spector et al. reported a two-fold increased risk for fractures in patients who used both a wheelchair and a cane or walker when compared to those who used only a wheelchair. Contrary to the present finding, the researchers also noted no significant difference between the risk for the wheelchair-only group and fully ambulatory or the cane- or walker-only groups.
The present findings underscore the need to consider prescribing wheelchairs for elderly patients during the decision-making process by clinicians to increase mobility and reduce the risk of fractures. However, further research evaluating patient satisfaction and increased risk of death among long-term wheelchair users is warranted.
References
- Axelsson KF, Litsne H, Lorentzon M. Comparison of Fractures Among Older Adults Who Are Ambulatory vs Those Who Use Wheelchairs in Sweden. JAMA Network Open. 2023 Feb 13;6(2):e2255645.
- Spector W, Shaffer T, Potter DE, Correa-de-Araujo R, Rhona Limcangco M. Risk factors associated with the occurrence of fractures in US nursing homes: resident and facility characteristics and prescription medications. J Am Geriatr Soc. 2007;55(3):327-333.