Although mobility can be achieved by using various devices, the discussion here emphasizes walking. Immobility refers to the state in which an individual has a limitation in independent, purposeful physical movement of the body or of one or more lower extremities. Immobility can 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), and environmental causes. Examples of these physical, psychological, and environmental factors include inappropriate caregiving, paralysis, lack of access to appropriate assistive devices, and environmental barriers such as lack of handrails on stairs or grab bars around a commode (Table 10–1).
Table 10–1. Common Causes of Immobility in Older Adults |Favorite Table|Download (.pdf)
Table 10–1. Common Causes of Immobility in Older Adults
Fractures (especially hip and femur)
Other (eg, Paget disease)
Other (cerebellar dysfunction, neuropathies)
Congestive heart failure (severe)
Coronary artery disease (frequent angina)
Peripheral vascular disease (frequent claudication)
Chronic obstructive lung disease (severe)
Impairment of vision
Decreased kinesthetic sense
Decreased peripheral sensation
Forced immobility (in hospitals and nursing homes)
Inadequate aids for mobility
Acute and chronic pain
Deconditioning (after prolonged bed rest from acute illness)
Severe systemic illness (eg, widespread malignancy)
Drug side effects (eg, antipsychotic-induced rigidity)
Fear of falling
Apathy and lack of motivation
The incidence of degenerative joint disease (DJD) is particularly high in older adults, although symptoms of disease may not manifest in all individuals who have radiographic changes (Lawrence et al., 2008). The pain and musculoskeletal changes associated with DJD can result in contractures and progressive immobility if not appropriately treated. In addition, podiatric problems associated with degenerative changes in the feet (eg, bunions and hammertoes) can likewise cause pain and contractures. These changes can result in painful ambulation and a subsequent decrease in the older individual's willingness and ability to ambulate. Patients who have had a stroke resulting in partial or complete hemiparesis/paralysis, spinal cord injury resulting in paraplegia or quadriplegia, fracture or musculoskeletal disorder limiting function, or prolonged bed rest after surgery or acute ...