Immobility Syndrome

Immobility syndrome is the group of complications that follow prolonged bed rest or restricted movement in older adults. Effects develop across almost every organ system within days.

It occurs in acutely ill hospital patients, residents of care homes, and people with stroke, dementia, fractures or advanced disease.

Pathophysiology. Disuse causes rapid muscle and bone loss and joint stiffness. Venous stasis and a hypercoagulable state promote thrombosis. Pressure and shear damage skin. Loss of the upright posture reduces plasma volume, blunts baroreflexes and impairs ventilation and gut and bladder function.

Pressure injuries, contractures, rapid loss of strength, orthostatic hypotension, deep vein thrombosis and pulmonary embolism, atelectasis and pneumonia, constipation and faecal impaction, urinary retention, infection and incontinence, glucose intolerance, hypercalcaemia, delirium and depression.

Diagnosis is clinical. Examine the skin, joints, calves, chest, abdomen, bladder and mental state daily. Test calcium and renal function in prolonged immobility. Perform Doppler ultrasound or CT pulmonary angiography as suspected.

Differential diagnosis.

• Primary neuromuscular disease causing immobility.
• Pain, depression and apathy limiting activity.
• Cardiorespiratory limitation.

Prevention is the priority. Mobilise from the first day, sit out of bed for meals, avoid bed rest orders and unnecessary catheters and restraints.

Reposition at least every 2 hours when bed bound, use pressure relieving surfaces, and perform daily passive range-of-motion exercises.

Give pharmacological thromboprophylaxis to acutely ill immobile patients, such as enoxaparin 40 mg subcutaneously once daily (20 mg when eGFR is under 30 mL/min).

Maintain nutrition and hydration, manage bowel and bladder function, and provide early physiotherapy and occupational therapy.

Monitoring. Daily skin, bowel, bladder and mobility checks.