{"doi":"10.1093/ptj/pzad182","title":"Community Mobility Among Older Adults Who Are Socioeconomically Disadvantaged: Addressing the Poverty Penalty","abstract":"Community mobility is an important marker of health, function, participation, and quality of life among older adults.1 Community mobility, or the ability, frequency, and amount of assistance needed to get around outside the home and participate in meaningful activities, commonly declines after acute hospitalizations and often remains restricted for up to 2 years following hospitalization.2 Persistently unresolved restrictions in community mobility among older adults raises questions as to whether community mobility is appropriately prioritized in posthospitalization care, and if contemporary restorative care interventions adequately meet the needs of older adults. Within this Point of View, we assert that a lack of urgency addressing community mobility disproportionately disadvantages older adults with low socioeconomic status. Socioeconomic status is a social condition, which contributes to health disparities and inequities within the population, making it an important social determinant of health.3 Socioeconomic disadvantage is associated with becoming homebound or requiring institutional care,4 and the rate of socioeconomic disadvantage will likely to grow over time with increasing income inequality in the United States.5 The divide in community mobility by socioeconomic status is multidimensional and compounded by contextual factors, thereby creating a poverty penalty among older adults. Poverty penalty is a phenomenon where people with low socioeconomic status tend to burden a higher cost to health when recovering from an acute hospitalization than people with high socioeconomic status.6 However, little work has examined the impact of the poverty penalty on community mobility among older adults recovering from acute hospitalizations. This is a major gap, given the growing number of older adults living in poverty (poverty among adults aged 65 and older 10.3% in 2021 vs 8.9% in 2020) in the United States.5,7 There are 3 key, and often interrelated, mechanisms through which socioeconomic disadvantage can impact community mobility. First, socioeconomically disadvantaged older adults living in economically deprived neighborhoods face greater challenges navigating the outdoor environment. Environmental justice work has found lower neighborhood socioeconomic status to be associated with more degraded pedestrian infrastructure.8 Among adults with a functional limitation, living in a neighborhood with cracked sidewalks, potholes, or broken curbs is associated with a fourfold increase in the risk for mobility disability compared to living in a neighborhood with streets in good condition.9 Furthermore, older adults who perceive the lack of sidewalks, or poorly maintained sidewalks, to be a problem in their neighborhoods have 15% to 65% higher odds of reporting low community participation levels.10 Thus, higher levels of strength, better balance performance, and more stable gait would be required of older adults living in economically disadvantaged areas compared to those living in more economically advantaged areas. Second, socioeconomically disadvantaged older adults have lower access to important assistive devices to promote mobility as compared to their higher-income peers. Assistive devices, such as walkers, canes, and wheelchairs, help increase safety and confidence walking outside.11,12 Current Medicare policy only allows reimbursement for mobility aids a beneficiary needs to access the rooms inside the home without consideration for community-level demands.13 There is currently no coverage for assistive devices that are only needed to walk outside the home for Medicare or Medicaid beneficiaries.13 For example, a patient recovering from a hospitalization may only need a cane to get around inside the home but may need a more supportive device such as a 4-wheeled walker or wheelchair to allow mobility around the community. Medicare will cover the cane in this scenario but not the walker or wheelchair. While a patient who is weal","journal":"Physical Therapy","year":2023,"id":355457,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9532,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":45775,"name":"Jack M. Guralnik","orcid":"0000-0001-5108-7263","position":1,"is_corresponding":false},{"id":361159,"name":"Jason R. Falvey","orcid":"0000-0002-9063-0617","position":2,"is_corresponding":false},{"id":391040,"name":"Erica Twardzik","orcid":"0000-0002-3514-2610","position":0,"is_corresponding":true}],"reference_count":28,"raw_metadata":null,"created_at":"2026-07-19T01:13:16.394812Z","pmid":"38157292","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}