Federally Qualified Health Centers Minimize the Impact of Loss of Frequency and Independence of Movement in Older Adult Patients through Access to Transportation Services

Loss of mobility in older adults (65 and older) is associated with falling, loss of independence, and mortality. This paper, which to the author's knowledge is the first of its kind, summarizes findings of Federally Qualified Health Center (FQHC) case reports and how FQHCs minimize the impacts of mobility loss in older adult patients (who would not receive primary services without these transportation programs) by providing access to primary care services through transportation programs. This paper features the transportation programs of four FQHCs located in both urban and rural United States areas: LifeLong Medical Care (Oakland, CA); Hudson Headwaters Health Network (Queensbury, NY); North End Community Health Center (Boston, MA); Aaron E. Henry Community Health Services Center, Inc. (Clarksdale, MS). This paper is beneficial to primary care providers and public health officials in outlining how transportation may be used to minimize the effects of mobility loss in older adult patients. 1. Introduction Recent research defines mobility as “where people move or travel, (while) taking into account the frequency of movement and degree of independence during such movement” [1]. Mobility is critical to the physical and mental health, as well as independence, of older adults, 65 and older [2, 3]. Healthy People 2020 recognizes the impact of mobility loss through its inclusion of older adult objectives reducing the proportion of older adults who have moderate to severe functional limitations [4]. Loss of mobility is a predictor of physical disability and is associated with falling, institutionalization, and mortality [5, 6]. A majority (68%) of adults, 50 years of age and over, experience some mobility limitations [7]. This loss of mobility not only affects physical health directly, but also indirectly—older adults experiencing a loss of mobility may be less able to access primary care and other health services [7–9]. Loss of mobility and other forms of impeded access in older adults “can lead to underutilization of primary care and preventive care services, which in turn may result in unnecessary hospitalizations, increased morbidity, and higher costs to the healthcare system than necessary” [10]. As older adults age, they are at greater risk for functional impairments that may hinder their ability to drive to primary care appointments [8, 11]. Poor elderly, who are 50% more likely to experience a loss of mobility, have the added barrier of having more difficulty affording public transportation services in order to get to their primary care providers [7].