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Although mobility can be achieved by using various devices, the discussion here emphasizes walking. Immobility implies a limitation in independent, purposeful physical movement of the body or of one or more lower extremities. Immobility may result from physical decline, but it can also trigger a series of subsequent diseases and problems in older individuals that produce further pain, disability, and impaired quality of life. Optimizing mobility should be the goal of all members of the health-care team working with older adults. Small improvements in mobility can decrease the incidence and severity of complications, improve the patient’s well-being, and decrease the cost and burden of caregiving. This chapter outlines the common causes and complications of immobility and reviews the principles of management for some of the more common conditions associated with immobility in the older population.
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Immobility can be caused by a wide variety of factors. The causes of immobility can be divided into intrapersonal factors including psychological factors (eg, depression, fear of falling or getting hurt, motivation); physical changes (cardiovascular, neurological, and musculoskeletal disorders, and associated pain); interpersonal factors and the interactions older adults have with caregivers; environmental causes such as access to open, uncluttered areas for walking and policy that either facilitate or decrease opportunities to maintain mobility. Additional examples of the many factors that influence immobility are provided in Table 10-1.
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The prevalence of osteoarthritis is high in older adults, although symptoms of disease may not manifest ...