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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
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Deconditioning of the cardiovascular system occurs within days and involves
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
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Laboratory tests should be directed by the history and physical examination
For a simple geriatric functional screening instrument, see eFigure 4–1
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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