Prolonged immobility cause many disesae in older population......

1. Geriatric Rehabilitation
Topic: Prolonged Immobility

2. Defination:
Immobilization: Physical restriction of
movement to body or a body segment
Deconditioning: Decreased functional
capacity of multiple organ system
Age-related changes in Mobility
Normal gait is dependent on integrity
and interaction of three components:
1. Locomotion
2. Balance
3. The ability to adapt to the
environment

3. Causes for prolonged immobility:
Physical
Enviromental
Psychological

4. Physical
Musculoskeletal disorder:
 Arthritis
 Osteoporosis
 Fracture (specially hip and femur)
 Podiatric problems
 Other ( paget’s disease)
Neurological disorders
 Stroke
 Parkinson’s disease
 Cerebellar dysfunction, neuropathies
Cardiovascular disease
 Congestive heart failure
 Coronary artery disease
 Peripheral vascular disease
Pulmonary disease
 Chronic obstructive lung disease
Murphree RW. Impairments in Skin Integrity. Nurs Clin North Am. 2017 Sep;52(3):405-417. doi:
10.1016/j.cnur.2017.04.008. PMID: 28779822.

5. Psychological
 Fear (from instability and fear of falling)
 Depression
Environmental
 Forced immobility (in hospital and nursing
homes)
 Inadequate aids for mobility
 Poor lightening

6. Complication of prolonged immobility
Musculoskeletal
skin
Cardiovasular Pulmonary
Genitourinary
Gastrointestinal
Metabolic Psychological

7. Skin:
 Pressure sore
 Trauma to fragile skin, including ecchymosis and skin
tears, occur when elders need more assistance getting
up and down
Jaul E, Barron J, Rosenzweig JP, Menczel J. An overview of co-morbidities and the development of
pressure ulcers among older adults. BMC Geriatr. 2018 Dec 11;18(1):305. doi: 10.1186/s12877-018-0997-
7. PMID: 30537947; PMCID: PMC6290523.

8. Musculoskeletal
 Muscle deconditioning and atrophy
 Contractures
 Bone loss(osteoporosis)
Cardiovascular
 Deconditioning
 Orthostatic hypotension
 Venous thrombosis
 Embolism
Pulmonary
 Decreased ventilation
 Atelectasis
 Aspiration pneumonia
Gastrointestinal
 Anorexia
 Constipation
 Fecal impaction
 Incontinence

9. Genitourinary
 Urinary infection
 Urinary retention
 Bladder calculi
 Incontinence
Metabolic
 Altered body composition (decreased plasma volume)
 Negative nitrogen balance
 Impaired glucose tolerance
 Altered drug pharmacokinetics
Psychological
 Sensory deprivation
 Delirium
 Depression
Chulakadabba K, Muangpaisan W, Siritipakorn P, Wongviriyawong T, Suraarunsumrit P, Chalermsri C,
Intalapaporn S, Chatthanawaree W, Srinonprasert V, Assantachai P. Characteristics and Real-Life
Outcomes of Dementia and Cognitive Impairment at a Geriatric Clinic. Dement Geriatr Cogn Disord.
2020;49(3):312-320. doi: 10.1159/000509731. Epub 2020 Oct 19. PMID: 33075794.

10. Management of these complication
For ulcer prevention
 Proper positioning, change position at least every
two hours
 Air mattress, keep skin dry and clean

11. For contracture prevention
 Stretching and range of motion exercise of each of
the joints
 Maintain proper body alignment , therapeutic splints
 Pain control
Liu B, Moore JE, Almaawiy U, Chan WH, Khan S, Ewusie J, Hamid JS, Straus SE; MOVE ON Collaboration.
Outcomes of Mobilisation of Vulnerable Elders in Ontario (MOVE ON): a multisite interrupted time series
evaluation of an implementation intervention to increase patient mobilisation. Age Ageing. 2018 Jan
1;47(1):112-119. doi: 10.1093/ageing/afx128. PMID: 28985310; PMCID: PMC5859974.

13. Assistive device

14. Method of airways clearence
 Oral, nasal, transtracheal suctioning
 Chest expansion exercise
 Postural drainage
 Mechanical vibration
 Percussion
 Pursed lip breathing
Nutritional support
 High protein , high calorie diet
 Supplemental vitamin c
 Vitamin B complex

15. Thank you