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Seating and Wheeled Mobility for Older Adults Living in Nursing Homes: What Has Changed Clinically in the Past 20 Years?

Jones, Deborah A. PT, CEEAA, ATP; Rader, Joanne RN, MN, PMHNP

Topics in Geriatric Rehabilitation: January/March 2015 - Volume 31 - Issue 1 - p 10–18
doi: 10.1097/TGR.0000000000000050
Clinical Practices

There have been a number of changes in the clinical practice of seating and wheeled mobility (SWM) for older adults in nursing homes. Twenty years ago, physical restraints were being used indiscriminately with the intent to protect the person from falling. Currently, we know that physical restraints increased the risk of falls, discomfort, functional limitations, and fatalities. Some of those restrained were in ill-fitting wheelchairs. Through specific projects, collaborative efforts, awareness, education, and improved products, clinical practice has changed. The 5-step mat assessment and common postural problems in elders remain the same. Major barriers to improved seating and wheeled mobility still exist such as insufficient funding, inadequate education of practitioners, and poor maintenance of equipment. These barriers inhibit the availability of improved seating and wheeled mobility for older adults in nursing homes. Continued attention by practitioners, policy makers, and payers is necessary to increase access.

Providence Health and Services, Portland, Oregon (Ms Jones); and Rader Consulting, Portland, Oregon (Ms Rader).

Correspondence: Deborah A. Jones, PT, CEEAA, ATP, Providence Bridgeport Rehabilitation and Sports Therapy, 18040 SW Lower Boones Ferry Rd, Ste 200, Tigard, OR 97224 (

This work was supported by a grant # 029269 from the Robert Wood Johnson Foundation.

The authors thank the professionals who encouraged, read, and edited this article: Laura Cohen, Mary Lavelle, Mary Stewart and team, and Linda Elsaesser.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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