immobility

Etiology: 1) musculoskeletal disorders a) arthritis b) sarcopenia c) osteoporosis, fractures (especially hip & femur) d) podiatric (foot) problems e) Paget's disease 2) neurologic disorders a) stroke b) Parkinson's disease c) cerebellar disorders d) neuropathies 3) cardiovascular disease a) severe congestive heart failure (CHF) b) coronary artery disease (frequent angina) c) peripheral vascular disease (frequent claudication) 4) pulmonary disease -> severe COPD 5) sensory impairment a) visual impairment b) fear of falling 6) environmental causes a) forced immobility (nursing home, hospital) b) inadequate aids for mobility 7) generalized weakness a) severe systemic illness (i.e. widespread malignancy) b) deconditioning (after prolonged bedrest) c) malnutrition 8) other a) pain b) depression c) adverse pharmaceutical effects (antipsychotic-induced rigidity) History: 1) nature & duration of disabilities causing immobility 2) medical conditions contributing to immobility 3) drugs that can affect mobility 4) motivation & other psychological factors 5) environment Physical examination: 1) skin 2) cardiopulmonary status 3) musculoskeletal assessment a) muscle tone & muscle strength b) joint range of motion c) foot deformities & lesions 4) neurological deficits a) focal weakness b) sensory & perceptual evaluation 5) levels of mobility a) bed mobility b) ability to transfer (bed to chair) c) wheelchair mobility d) standing balance e) gait Complications: 1) skin -> pressure ulcers 2) musculoskeletal a) muscular deconditioning & muscular atrophy b) contractures c) bone loss (osteoporosis) 3) cardiovascular a) deconditioning b) orthostatic hypotension c) venous thrombosis, embolism 4) pulmonary a) decreased ventilation b) atelectasis c) aspiration pneumonia 5) gastrointestinal a) anorexia b) constipation c) fecal impactation, fecal incontinence 6) genitourinary a) urinary tract infection b) urinary retention c) bladder calculi d) urinary incontinence 7) metabolic a) altered body composition -> decreased plasma volume b) negative nitrogen balance c) impaired glucose tolerance d) altered drug pharmacokinetics 8) psychological a) sensory deprivation b) dementia, delirium c) depression Management: 1) physical therapy 2) occupational therapy if appropriate 3) individualize specific goals 4) prevention & treatment of pressure ulcers

Related

immobilization prolonged sitting

References

Essentials of Clinical Geriatrics, 4th ed, Kane RL et al (eds) McGraw Hill, NY, 1999