GERIATRIC SYNDROMES: IMMOBILITY

Mobility or displacement capacity is very important to have autonomy and it's a essential component of people's lives.

In the elderly, mobility depends on the interaction between: 

• Personal factors: abilty, motor skills, cognitive or sensorial-perceptual capacity, health level and self-confidence level.
• Environmental and external personal factors: physical,architectural and family's or caregiver's attitudes.

IMMOBILITY is defined as a decreased ability to perform activities of daily living due to a deterioration of motor function.

In the elderly, a immobilized patient has more risk of medical complications than other patients.

There are two types of immobility:

• The relative immobility: the geriatric person has a sendentary lifestyle but is be able to move with more/less independance
• The Absolute immobility: the geriatric person has a very restricted mobility and this situation causes a chronic bed rest.

The relative immobility's risk is the chronic bed rest while the absolute immobility's risk is the institutionalization, morbimortality and caregiver's syndrome.

CAUSES

The immbolity has a lot of causes, but the most frequents are:

• Musculoskeletal diseases such as osteoarthritis, osteoporosis, fractures (hip or lower extremities), rheumatic diseases, etc.
• Neurological diseases such as stroke, parkinson, dementias, neuropathic diseases, etc.
• Cardio-respiratory diseases such as chronic obstructive pulmonary disease (COPD), severe heart failure, schemic heart disease, peripheral vascular disease (arterial or venous), etc.
• Neurosensory Diseases such as visual and auditory deficit, benign positional vertigo, etc.
• Psychological causes such as depression.
• Endocrine-metabolic causes such us diabetes mellitus, hypothyroidism, hydroelectrolytic disorders,etc.
• Generalized weakness: neoplasm, malnutrition,anemias, etc.
• Iatrogenic causes such as drugs or hospitalization.
• Environmental causes such as architectural barriers, physical obstacles or absence of support elements (cane, crutches, wheelchair...).
• Social Factors such as loneliness or absence of social support.

To understand the importance of immobility is necessary to say that 50% of the geriatric patients who are chronic bed rest, they die in 6 months

COMPLICATIONS

• Organic complications: muscular atrophy, contractures, pressure ulcers, ankylosis, deep venous thrombosis, pulmonary thromboembolism, constipation, urinary incontinence, sensory deprivation...
• Psychological complications: depression, delirium, fear of falling, psychomotor regression...
• Social complications: social isolation, institutionalization or inability to self-care.

To value the mobility there are some scales, for example: TINETTI'S SCALE and TIMED UP AND GO TEST

PREVENTION 

I think that is very important to prevent the immobility, because as we have seen previously, it causes a lot of health problems. For this reason, geriatric people who have a relative mobility should do regular exercise because in this way the person increases his muscle strength, bone density, coordination, balance, joint flexibility and his heart will be more healthy. In addition, to do exercise decreases anxiety and depression, and promotes the socialization.

The regular exercise decreases the mortality risk and helps people look and feel better. But the most important is that physical activity can extend years of active independent life, reduce disbility and improve the quelity of life for geriatric people.

Some exercises which are recommended for older people are: 

• LYING DOWN: 

1. Strech your arms and legs; take a deep breath.
2. Grab each leg with both hands below the knee and pull toward your chest slowly.
3. With your arms at your sides, bend at the elbow and curl your arms as if making a muscle.
4. Fold your hands on your stomach; raise your arms over your head toward the headboard.
5. Clap your hands directly above your head.
6. Lift each leg off the bed, but try not to bend your knee. Use an arm to help.

• SITTING

1. Shrug your shoulders forward, then move them in a circle, raising them high enough to reach your ears.
2. Touch your elbows together in front of you.
3. Twist your whole upper body from side to side with your hands on your hips.
4. Ben forward and let your arms dangle; try to touch the floor with your hands.
5. While still sitting, move each of your knees up and down as if you are walking; each time your right foot hits the ground, count it as one. Lift your knee high.

• STANDIG UP

1. Using your arms, push off from the bed and stand up; if you get dizzy, sit down and try again.
2. Hold your arms out and turn them in big circles
3. With hands at your side, bend at the waist as far as you can to the right side, then to the left.
4. Keep your feet planted on the ground and twist your upper body at the waist form side to side with your arms swinging; when you twist to the right, count it as one.
5. While holding onto the edge of the bed or back of a chair, bend your knees slightly.

• WALKING PLACES

1. Walking is good exercise because it helps toning muscles,maintaining flexibility of joints and is good for the heart and circulatory system. Walking for 20 minutes a day, 3 times a week can be effective.
2. When walking, push off from your toes and land on your heel. Swing arms loosely at your sides. Begin with 10-minute walk and buil to 20 to 30 minutes.
3. Walking up stairs requires effort. Place one foot flat on a step, push off with other and shift your weight. Use a railing for balance if necessary.
4. Wear supportive shoes and use whatever aids are necessary.

COME ON, STAND UP!