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.
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.
TABLE 10-1.Factors That Influence Immobility |Favorite Table|Download (.pdf) TABLE 10-1. Factors That Influence Immobility
|Intrapersonal factors ||Interpersonal factors ||Environmental factors ||Policy factors |
Fractures (especially hip and femur)
Other (eg, Paget disease)
|Interactions with caregivers that discourage mobility and use wheelchairs for convenience ||Lack of access to appropriate and safe aids for mobility ||Forced immobility in hospitals and nursing homes due to regulations such as not allowing the patient to get up until seen by a therapist |
Other (cerebellar dysfunction, neuropathies)
|Caregiving that decreases need for mobility by keeping everything easily accessible for the individual ||Lack of access to areas that are open and free of clutter for safe ambulation ||Falls policies that encourage sedentary responses to the fall |
Congestive heart failure (severe)
Coronary artery disease (frequent angina)
Peripheral vascular disease (frequent claudication)
|Caregiving that does not motivate or encourage mobility; walk with patients/residents and make mobility fun ||Lack of resources (eg, exercise equipment, grab bars, stair rails, rails in hallways) to help maintain mobility ||Lack of policies that encourage mobility such as walk-to-dine programs or removal of wheelchairs in the dining room |
Chronic obstructive lung disease (severe)
| || || |
Impairment of vision
Decreased kinesthetic sense
Decreased peripheral sensation
| || || |
|Acute and chronic pain |
|Fear of falling |
|Nutritional status |
The prevalence of osteoarthritis is high in older adults, although symptoms of disease may not manifest ...