Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 4-04: Management of Common Geriatric Problems + Key Features Download Section PDF Listen +++ ++ Although common in older people, reduced mobility is never normal and is often treatable if its causes are identified Bedrest is an important cause of hospital-induced functional decline Among hospitalized medical patients over age 70, about 10% experience a decline in function, and those who experience critical illness are at particularly high risk + Clinical Findings Download Section PDF Listen +++ ++ Deconditioning of the cardiovascular system occurs within days and involves Fluid shifts Decreased cardiac output Decreased peak oxygen uptake Increased resting heart rate Postural hypotension More striking changes occur in skeletal muscle, with a resulting loss of strength and function Pressure injuries (formerly pressure ulcers), deep venous thrombosis, and pulmonary embolism are additional serious risks + Diagnosis Download Section PDF Listen +++ ++ Laboratory tests should be directed by the history and physical examination For a simple geriatric functional screening instrument, see eFigure 4–1 ++eFigure 4–1. Simple geriatric screen. PT, physical therapy; DIAPPERS, delirium, infection, atrophic urethritis or vaginitis, pharmaceuticals, psychological factors, excess urinary output, restricted mobility, stool impaction; PVR, postvoid residual; GDS, Geriatric Depression Screen; APS, Adult Protective Services; OT, occupational therapy; BMI, body mass index; MMSE, Mini-Mental State Exam. (Adapted, with permission, from Lachs M et al. A simple procedure for general screening for functional disability in elderly patients. Ann Intern Med. 1990 May 1;112(9): 699–706 and Moore AA et al. Screening for common problems in ambulatory elderly: clinical confirmation of a screening instrument. Am J Med. 1996 Apr;100(4):438–43.) Graphic Jump LocationView Full Size||Download Slide (.ppt) + Treatment Download Section PDF Listen +++ ++ Skin, particularly areas over pressure points, should be inspected at least daily If the patient is unable to shift position, staff should do so every 2 hours To minimize cardiovascular deconditioning, patients should be positioned as close to the upright position as possible, several times daily To reduce the risks of contracture and weakness, range of motion and strengthening exercises should be started immediately and continued as long as the patient is in bed Whenever possible, patients should assist with their own positioning, transferring, and self-care For patients at high risk for venous thromboembolism, antithrombotic measures should be used Avoiding restraints and discontinuing intravenous lines and urinary catheters increase opportunities for early mobility Graduated ambulation should begin as soon as possible Advice from a physical therapist is often helpful both before and after discharge Prior to discharge, physical therapists can recommend appropriate exercises and assistive devices After discharge, they can recommend safety modifications and maintenance exercises