Ivan Soemiady, Wasis Udaya

IMMOBILIZATION IN ELDERLY
Introduction

• Increased life expectancy

• Rising percentage of elderly

population in Indonesia

• Health problem associated with the

elderly, particularly immobilization
Definition
 Loss of anatomical movement due to
alteration of physiological function
 In daily practice it may commonly known as
more than three-day-bed rest or inability to
perform mobile activity on bed, transfer or
ambulation
Risk Factor

Imbalance

Muscle
Psychological
stiffness
MainRisk
Factor

Weakness Pain
 Pain Weakness Stiffness

• Bone • Malnutrition • Arthritis

(Osteoporosis) • Electrolite • Parkinson
• Arthritis imbalance • Drug
• Muscle • Anemia (Haloperidol)
(myalgia) • Miopathy
• Neurologic
dysfunction
 Imbalance Psychological

• Neurologic • Demensia
factor • Depression
• Orthostatic
hypotension
• Drugs
(Diuretic,
antidepressan)
Assessment of immobilized
elderly patient
• History, duration, premorbid
History condition, pain, consumed drugs,
taking social, psychological, and
environment factors

Physical • Cardiopulmonary
musculoskeletal,
status,
neurologic,
skin,
GEH,
examination Genitourinary

Functional • Barthel’s index of ADL

status
Assessment of immobilized
elderly patient

Mental • Geriatric Depression Scale

Status
Cognitive • Mini Mental State Examination
Status • Abreviated Mental Test

• Mobility on bed, wheel chair,

Mobility maintaining balance
COMPLICATION & MANAGEMENT
Thrombosis

Venous
Immobilization Thrombus
Congestion
Thrombosis

 Clinical signs and symptoms of DVT include

swelling, pain, change of skin color on the
affected extremity
 Physical examination : unilateral
edema,warm surface, pain during passive
plantarflexion of foot, and superficial venous
dilatation
 D-dimer test and ultrasonography (doppler)
Wells Clinical Prediction
Rule for DVT
Treatment

 Low Dose Heparin (LDH) dan Low Molecular

Weight Heparin (LMWH)
 Graduated compression stocking(GCS) by
using elastic stocking
 Exercising the extremitiesand joint
movement, either active or passive, as
tolerated by the patient
Pulmonary Embolism (PE)

Immobilized Pulmonary
patient Embolism

DVT
Warning signal of PE

 Unexplained shortness of breath (the most

common symptom of PE)
 Chest discomfort, usually worse with a deep
breath or coughing
 A general sense of anxiety or nervousness
 Lightheadedness or blacking out
Laboratory & Radiology examination : D-
Dimer& CT Scan
Treatment

 Trombolitic :
Alteplase or Streptokinase
Wells Clinical Prediction
Rule for PE
Muscle deconditioning

Malnutrition

Loss of Decrease
gravitational & testosterone
Exercise Stress level

Decondition
Prevention

 Early mobilization
 Isometric training
Muscle & Joint Contracture

Stiffness & Contracture

Shortening of muscle fiber &

Connective tissue

Immobilization with non

functional position
Osteoporosis

Acidic
environm
Loss of ent
caused
mechanic by
Osteoporosis
stress decrease
blood
flow
 Acute
Renal
Failure

Hypercalcemia

Bone
resorption in
osteoporosis
Decubitus Ulcer
Pressure

Reduced blood flow to the

tissue (Tissue Ischemic)

Decubitus Ulcer
Staging of Decubitus Ulcer
Prevention

 Periodic reposition
 Protective padding
 Keep the skin dry but yet lubricated
 Anti-decubitus matresses
Treatment

 Pay attention to the patient’s hydration

status and nutrition intake
 Systemic antibiotics are indicated in patients
with sepsis, cellulitis, and osteomyelitis
 Debridement
 Circular massage on the edge of decubitus
wound
 Wound closure, skin graft, and myocutaneus
flap
Postural Hypotension

Decrease of
antidiuretic
hormone (
diuresis)
Baroreceptor
dysfunction

Plasma
volume Psdtural
deplesion hypotension
Prevention

 Adequate hydration
 Physical exercise
 Evaluation of drugs that may cause
hypotension
Pneumonia

Diaphragma & intercostal

muscle dysfunction
(Sputum retention)

Pneumonia

Decrease
pulmonary recoil
Urinary Tract Infection

 Retency urine in immobilised patient = UTI

 UTI + Hypercalciuria : Renal Stone
Hypoalbuminemia

Prolonged Increase Nitrogen

Hypoproteinemia
Immobilization Excretion
 Constipation

Increase water
Immobilization absorption Skibala
from faeces
 RESUME

Immobilization is defined as loss of

anatomical movement due to alteration of
physiological function, which in daily practice
it may commonly known as more than three-
day-bed rest or inability to perform mobile
activity on bed, transfer or ambulation. High
incidence of immobilization in elderly and the
life-threatening complication call for an
agreement on management of
immobilization and its complication
THANK YOU