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Clinical investigations from the RACP

Immobility: evaluating it in elderly patients

John W Death

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Abstract

The effects of immobility as well as the causes should be sought when evaluating immobility in the elderly. There are often causes other than the most obvious explanation and finding these will help in appropriate management to improve the patient’s quality of life.

Key Points

  • Old age does not cause immobility, but immobilising conditions are common in old age.
  • The effects of immobility must be sought as diligently as the causes.
  • A neurological examination is difficult to perform and interpret in disabled elderly people, but it is absolutely essential.
  • When an elderly person, especially a woman, falls and cannot weight bear because of pain, she has a fracture until it is proven otherwise.
  • Postural hypotension is a common cause and complication of immobility. It is usually fixable. Always check lying and standing blood pressure in elderly patients.
  • The practice of looking for as many explanations for an elderly patient’s immobility as can be found, rather than the most obvious explanation, will serve the patient, the family or other carers and the physician well.

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