'When Walking Fails'

A Disabled Look at Navigating a City

NPR's Joe Shapiro and disability advocate Lisa Iezzoni.

NPR's Joe Shapiro, using a four-wheeled walker, called a Roll-A-Bout, and Lisa Iezzoni in downtown Washington, D.C. Vikki Valentine, NPR hide caption

itoggle caption Vikki Valentine, NPR
Iezzoni's book, When Walking Fails.

Iezzoni's book, When Walking Fails. University of California Press hide caption

itoggle caption University of California Press
Available Online

Lisa Iezzoni was in her first year at Harvard Medical School when she was diagnosed with multiple sclerosis. That was 27 years ago, when it was still thought that if you couldn't walk, you couldn't practice medicine. Iezzoni became a researcher instead. Now she teaches at Harvard, and has written a new book, When Walking Fails: Mobility Problems of Adults with Chronic Conditions.

NPR's Joseph Shapiro covers disability issues, and he joined the ranks of those who can't walk — at least temporarily — when he broke his ankle. On a recent visit to Washington, D.C., Iezzoni took him on a tour of sorts. He filed this report on how accessible the city is for those who have to wheel instead of walk.

Excerpts from Iezzoni's book, When Walking Fails, Mobility Problems of Adults with Chronic Conditions:

How Many People Have Mobility Problems?

One answer to this question comes from asking people. A nationwide survey in 1994 and 1995 interviewed people in their homes and apartments throughout the community, asking many questions about health and difficulties with daily activities. From this survey, we counted people who use mobility aids or who report difficulties walking three city blocks (about a quarter of a mile), climbing up 10 steps without resting, or standing for 20 minutes.

Roughly 19 million adults who live outside nursing homes or other institutions — just over 10 percent of persons 18 years of age and older — report at least some mobility difficulty or use of a mobility aid. Many problems probably cause only small irritations or inconveniences, but others suggest substantial impairments. Almost 6 million adults (3 percent) report either using a wheelchair or scooter or being completely unable to walk three blocks, climb 10 stairs, or stand 20 minutes. And 88 percent of them said their problems would last at least a year.

Rates of mobility problems rise with increasing age. On average, people reporting difficulties are in their early to mid-60s. But many problems had started years earlier. Almost 30 percent of those reporting major difficulties said their problems began under age 50 and 16 percent under age 40.

What Conditions Cause Mobility Problems?

The stereotypes do not fit the common causes of mobility problems. Arthritis is by far the most common cause, with back problems in second place. Together they account for almost 38 percent of mobility difficulties, estimated at almost 7.6 million people. The next leading cause, accidental falls, involves many fewer people (just over 6 percent, an estimated 1.2 million persons). The remaining common causes sort into either chronic progressive conditions or injuries. The common chronic diseases are those associated with aging: heart, lung and cerebrovascular (stroke) disease, osteoporosis and diabetes. Common causes therefore vary by age, with arthritis relatively more important for older people and back problems relatively more frequent among younger adults. All types of accidents are more common for younger people. Together, however, chronic conditions far surpass accidents in causing mobility difficulties, regardless of age group.

Oftentimes, disentangling a single reason for mobility problems is impossible. Multiple diagnoses account for walking problems among up to 75 percent of elderly people.

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