title: What do older people understand by mobility-related difficulties?
abstract: Despite the centrality of the difficulty concept in the study of disability, there has been little research on its significance from the point of view of people with functional limitations. The main objective of this study was to describe what older people understand when asked about difficulty in undertaking mobility activities. As a secondary objective, we considered whether there are any differences depending on the type of activities, according to the International Classification of Functioning (ICF) mobility domains.
  
  
  METHODS
  Seventeen community-dwelling men and women aged 70 years old or over were interviewed by means of a questionnaire containing 55 items covering the ICF mobility domains. The participants responded to the items while thinking aloud, saying what led them to give a specific answer about their level of difficulty. Inductive content analysis was conducted and categories, subthemes and themes were identified.
  
  
  RESULTS
  Causes of difficulty (pathologies, impairments, symptoms) and accommodations (task modifications and use of aids) were the two themes identified; and their importance (and that of the subthemes included) varied across the types of activity. All the participants said that they had no difficulty in at least one task, despite mentioning changes in the way they performed them.
  
  
  CONCLUSIONS
  Older people's opinions were consistent with theoretical models of disability and with the standard practice of measuring functional limitations by asking about the degree of difficulty; however, the design of these measures needs to be improved in order to detect perceptions of no difficulty in the presence of task modification.
authors.affiliation: Department of Nursing, University of Alicante, Alicante, Spain. Electronic address: juan.ramos@ua.es.
authors.forename: Juan Diego
authors.initials: JD
authors.lastname: Ramos-Pichardo
authors.affiliation: Department of Nursing, University of Alicante, Alicante, Spain. Electronic address: julio.cabrero@ua.es.
authors.forename: Julio
authors.initials: J
authors.lastname: Cabrero-García
authors.affiliation: Department of Health, Alcoy, Alicante, Spain. Electronic address: lgonzalez866e@gv.gva.es.
authors.forename: Lorena
authors.initials: L
authors.lastname: González-Llopis
authors.affiliation: Department of Nursing, University of Alicante, Alicante, Spain. Electronic address: mariajose.cabanero@ua.es.
authors.forename: María José
authors.initials: MJ
authors.lastname: Cabañero-Martínez
authors.affiliation: Department of Nursing, University of Bio Bio, Chillán, Chile. Electronic address: calmunoz@ubiobio.cl.
authors.forename: Carmen Luz
authors.initials: CL
authors.lastname: Muñoz-Mendoza
authors.affiliation: Department of Nursing, University of Alicante, Alicante, Spain. Electronic address: angela.sanjuan@ua.es.
authors.forename: Angela
authors.initials: A
authors.lastname: Sanjuan-Quiles
authors.affiliation: Department of Nursing, University of Alicante, Alicante, Spain. Electronic address: m.richart@ua.es.
authors.forename: Miguel
authors.initials: M
authors.lastname: Richart-Martínez
authors.affiliation: Department of Health Psychology, University of Alicante, Alicante, Spain. Electronic address: areig@ua.es.
authors.forename: Abilio
authors.initials: A
authors.lastname: Reig-Ferrer
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D059026:Diagnostic Self Evaluation; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: Difficulty; Functional limitation; Mobility; Older people; Qualitative study