Immobility Syndrome Research Articles

Physiotherapy Intervention in Elderly Immobility Syndrome: Narrative Review

With aging, several physiological changes occur in the elderly, including a decrease in muscle mass, bone density, and balance, which increase the risk of falls. As the elderly population continues to grow, the role of the physiotherapist becomes indispensable in promoting the autonomy and independence of these individuals. This study presents a narrative review on the physiotherapist's role in preventing immobility syndrome in the elderly. Immobility syndrome primarily affects the musculoskeletal system, leading to functional limitations that impact posture transfer and bed-to-chair mobility, hindering daily activities, altering gait patterns, and reducing the activity of certain systems. The implementation of early rehabilitation protocols within the first 48 hours of intervention can be applied to improve mobilization and prevent the onset of immobility syndrome. As the elderly population expands, the proactive involvement of physiotherapists in preventing and managing immobility-related issues becomes crucial. This not only enhances the quality of life for older individuals but also reduces the burden on healthcare systems. Overall, physiotherapy plays a vital role in mitigating the negative effects of immobility in the elderly, promoting their well-being, and maintaining their functional independence.

Rehabilitation in Older Adults Affected by Immobility Syndrome, Aided by Virtual Reality Technology: A Narrative Review.

Individual mobility deficit in older adults induces a variety of medical conditions, diminishing their functional capacity in pursuing activities of daily living. In immobility syndrome patients, such conditions are prone further deterioration through a drastically reduced scope of physical activity, owing mostly to poor self-motivation and the monotonous character of conventional rehabilitation regimens. As evidenced by published research, virtual reality technology solutions in rehabilitation management actually add significantly to patients' self-motivation, while promoting their active involvement in therapy through visual, auditory, and kinaesthetic stimuli. Effective rehabilitation training aided by virtual reality solutions helps patients acquire specific physical and cognitive skills to be subsequently emulated in the real-world environment. The extra added advantage lies in facilitating such training within patients' own home environments, combined with online monitoring of their progress, when not personally supervised by a physiotherapist, which also boosts the overall cost effectiveness of the therapeutic management itself. This narrative review appears to be the very first one principally focused on critically comparing individual immobilisation with immobility syndrome, especially through the application of the Authors' own substantial hands-on therapeutic experience in managing various rehabilitation schemes, specifically aided by diverse virtual reality technology solutions.

Optimization Process of an Innovative Rehabilitation Device based on Pre-Clinical Results

Commercially available technical solutions used in physical rehabilitation processes have not responded effectively to the crucial needs of customized rehabilitation programs. As such, a partnership between a nursing school, technological enterprises – ORTHOS XXI and WISEWARE - and engineering institutes was established to implement a project entitled ABLEFIT to overcome the identified lack of technical solutions in the market. ABLEFIT has the main purpose of making available a rehabilitation device in the market that ensures the implementation of physical rehabilitation programs in a controlled and interactive way so that patients can regain their physical, psychological, and social functions as soon as possible. The loss of these capabilities is closely related to Prolonged Immobility Syndrome (PIS), being the morbidity and mortality associated with the complications resulting from prolonged inactivity or even a sedentary lifestyle seen both in the elderly population and in adults and young people with some type of restriction of mobility or disability. This paper describes the optimization process of the ABLEFIT device based on the pre-clinical trials performed. The optimization process starts with the design of an initial prototype, followed by the construction of a second prototype, and finally the planning of an additional iteration, which will involve the construction of a third prototype that will look identical to the version that will be available in the market. The two iterations of the ABLEFIT prototype device developed up to now provide undeniably an advanced solution to support physical rehabilitation, since they combine a biomechanical system to aid physical exercise, in passive and active modes, in bed and a wheelchair, with a control system for monitoring and storing biofeedback variables and motivational stimulus through interaction with gamification. The ABLEFIT device significantly contributes to the reduction of morbidity and mortality associated with complications resulting from prolonged inactivity.

Negative impact of behavior restriction amidst a clustered COVID-19 infection on immobility syndrome in older patients negative for COVID-19: report from a chronic care hospital in Japan.

Previous studies have reported on associations between immobility syndrome and the COVID-19 pandemic. However, little is known about the aggravation of this syndrome in older patients negative for COVID-19 infection amidst behavior restriction due to a clustered COVID-19 infection. Patients hospitalized one month before a clustered COVID-19 infection occurred in our hospital were recruited. Rehabilitation therapy was suspended for 25 days during behavior restriction. The ability of daily living of the patients was evaluated with the functional independence measure and Barthel index. Chronological changes in the functional independence measure and Barthel index scores were evaluated monthly, beginning one month before the clustered COVID-19 infection to one month after re-initiation of rehabilitation therapy. Patients with minimum scores in the functional independence measure (18) and Barthel index (0) prior to the clustered COVID-19 infection were excluded. Functional independence measure scores of 73 older patients and the Barthel index scores of 48 patients were analyzed. The mean total functional independence measure score amidst the behavior restriction significantly changed from 36.3 to 35.1 (p = 0.019), while statistical significance was not detected in the mean motor subtotal (from 21.6 to 20.9 with p = 0.247) or cognitive subtotal functional independence measure scores (from 14.6 to 14.2 with p = 0.478). During the behavior restriction, the mean Barthel index scores declined from 25.8 to 23.2 without statistical significance (p = 0.059). Behavior restriction due to a clustered COVID-19 infection may aggravate immobility syndrome in older patients who are negative for COVID-19.

Multidisciplinary Management of Arthrogryposis Multiplex Congenita Type 2A Case

Arthrogryposis multiplex congenita (AMC) is a congenital disorder characterized by nonprogressive multiple joint contractures affecting one or more areas of the body, muscle weakness, and fibrosis. This term includes a heterogeneous group of diseases, neurological, neuromuscular, and genetic or mechanical origin. Two types of classification have been developed: A clinical one (types I, II, and III) and an etiological one. A multidisciplinary approach is needed for better care and appropriate follow-up. It is a case of AMC type 2A. A girl, with an antecedent of low levels of amniotic fluid, presented at birth with multiple malformations and stiffness of several articulations: bilateral clubfoot, bilateral clubhand, temporomandibular joint involvement, postural torticollis, and congenital hip dislocation. She had also a small persistence of arterial canal and ambiguous external genitalia. The care was performed by a multidisciplinary team including a physiatrist, pediatric surgeon, physiotherapist, prosthetist, and orthotist. In infants with arthrogryposis, joint stiffness is maximal at birth. The first step is passive mobilizations before surgical joint treatment. Azbell et al. found in their study that at 9 months of age, many of this infant's impairments of body structure and function, functional activity limitations, and participation restrictions improved. The program of stretching, muscle strengthening, facilitation of motor skills, orthopedic intervention, and parent education may have contributed to this infant's progress. Prospective intervention studies exploring specific intervention strategies are needed to establish the plan of care for these patients. Arthrogryposis describes a set of joint contractures present from birth and nonprogressive. The common physiopathological mechanism is fetal immobility syndrome. Multidisciplinary care is necessary and should be early and continued to gain maximum autonomy and facilitate social integration.

Prevalence of Oropharyngeal Dysphagia and Risk of Pneumonia, Malnutrition, and Mortality in Adults Aged 60 Years and Older: A Meta-Analysis

Introduction: Oropharyngeal dysphagia (OD) is a serious health condition associated with poor survival and quality of life in adults aged 60 years and older. Comprehensive assessment and management of OD could lead to better and improved health outcomes for older adults. Therefore, we performed the first meta-analysis to determine the pooled prevalence of OD and risk of pneumonia, malnutrition, and mortality. Methods: Databases including Ovid-MEDLINE, Web of Science, Embase, PubMed, Cochrane, and CINAHL were searched up to January 2021. Data analysis was conducted using logistic-normal for prevalence rate and DerSimonian-Lard random-effects models for outcomes and associated factors of OD, providing odds ratio (OR) and corresponding 95% confidence interval (CI). Results: The pooled prevalence of OD in 39 studies with 31,488 participants was 46% associated with higher pooled OR for risk of pneumonia 2.07 (95% CI, 1.58–2.72), malnutrition 2.21 (95% CI, 1.43–3.41), and mortality 2.73 (95% CI, 1.62–4.60). Geriatric syndromes including fecal incontinence 6.84 (4.955–9.44), immobility syndrome 6.06 (5.28–6.96), pressure ulcers 4.02 (2.46–6.56), sarcopenia 3.10 (1.89–5.09), urinary incontinence 2.75 (1.81–4.19), frailty 2.66 (1.16–6.13), delirium 2.23 (1.73–2.87), and falls 1.47 (1.19–1.81) and comorbidities including dementia 3.69 (2.36–5.78) and stroke 1.92 (1.47–2.52) were associated with OD. Conclusion: Early identification and management of OD should consider geriatric syndromes and neurogenic comorbidities to prevent malnutrition and pneumonia and reduce mortality in adults aged 60 years and older.

Pulmonary thromboembolism following seated immobility

This report describes the development of deep vein thrombosis (DVT) and pulmonary embolism (PE) in a young healthy adult male who was driving an automatic car without interruption. There is mounting evidence that prolonged cramped sitting increases the risk of DVT of the legs and PE. We propose that a newer risk factor of seated immobility syndrome is the reason for this catastrophic development of DVT and PE in this patient.

Agreement of body weight of older adults measured on digital chair scale and mechanical platform scale

ABSTRACT Objective The aim of the study was to evaluate the agreement between the weight of older adults measured on a chair scale and a platform scale. Methods This is a cross-sectional study. We evaluated 131 older adults (?60 years old), walk-in patients, admitted to a university hospital. Weight was measured on a digital chair scale model MS5811 (Charder® brand) and after on a mechanical platform scale (Filizola® brand). For the agreement analysis, the intraclass correlation coefficient and the Bland-Altman plot were used. Results Most of the sample consisted of males individuals (57.3%; n= 75). The average age was 70.47±7.59 years (60-96 years old). Measured by both methods, weight showed normal distribution. The average weight measured was 67.99±14.03 kg on the chair scale and 68.04±14.02 kg on the platform scale. The intraclass correlation coefficient of weight measured by the two methods was 1.00 (IC95%=1.00-1.00; p<0.001). In the Bland-Altman plot, the mean bias for the weight measured on the chair scale and the platform scale was 0.049 (IC95%=-0.011 to 0.110; p=0.1084). Conclusions The agreement between the weight measured on a chair scale and on a platform scale was almost excellent. Thus, the chair scale can be used as an alternative method of measuring weight, especially in the older adults with postural instability, mobility restrictions or immobility syndrome.

P2‐041: ALZHEIMER DISEASE AND THE IMPORTANCE OF HOME PHYSIOTHERAPY TO PREVENT BED IMMOBILITY SYNDROME IN BEDRIDDEN PATIENTS

Alzheimer's disease is the most common type of dementia in the world and affects, mainly Alzheimer's disease is the most common type of dementia in the world and mainly affects people over 60 years of age. According to the World Health Organization, it is estimated that more than 30 million people around the world live with the disease, which is neither reversible nor cured. With the final progression of the disease, the carrier becomes dependent on the daily care of other people, being susceptible to the labeling of the team as immobility syndrome in the bed, which affects bedridden and unmoving individuals. Often, they are patients who still have undetected, neglected potentials, sufficient enough to alleviate the degree of dependence, requiring a specific physiotherapeutic look. Adequate treatment and care can provide greater survival and a better quality of life for people and relatives living with Alzheimer's dementia patients. The clinical concept of immobility is defined as the difficulty or inability to walk or change position (lying down to sit and sitting down). Immobility is inconsistent with human life. It is extremely important that the physician in charge assess and reassess the patient's current health status through a complete diagnosis, at the risk of depriving him of benefits, sometimes through extremely simple procedures. In this way, we do not accept immobilization as a definite fact. The aim of this article is to discuss the importance of home rehabilitation and physiotherapy in Alzheimer's disease at all stages of the disease, preventing the consequences of immobility. It is necessary that the whole multidisciplinary Health Team Act in order to encourage more and more early mobilization in bed. It is necessary to develop different studies and papers that show the deleterious effects of immobilization in order to create an increasing awareness of the importance of teamwork aiming at the early recovery of every patient bedridden as soon as possible.

Arthrogryposis in children: Etiological assessments and preparation of a protocol for etiological investigations

IntroductionArthrogryposis is a descriptive term defining a sign. It describes a set of joint contractures, sometimes identifiable in utero, present from birth and nonprogressive. This term includes a heterogeneous group of diseases, of neurological, neuromuscular, genetic or mechanical origin. The common physiopathological mechanism is fetal immobility syndrome. Two types of classification have been developed: a clinical one (types I, II and III) and an etiological one. The main aim of this study was to define a standardized protocol for etiological investigation based on a descriptive analysis of the various etiologies identified in a population of children followed up for arthrogryposis. Its secondary aim was to assess first the comprehensiveness and relevance of the complementary assessment and second the way in which the classifications proposed by Professor Judith Goslin Hall are applied. Material and methodsRetrospective multicenter observational study. We enrolled pediatric patients with arthrogryposis being treated at a reference center for neuromuscular diseases, i.e., in three university hospital pediatric neurology units, between February 1997 and January 2017. ResultsForty-two patients (25 boys and 17 girls) were enrolled. According to the clinical classification (Hall et al.), this population consisted of eight cases of type 1 arthrogryposis (19.1%), 14 type II (33.3%) and 20 type III (47.6%). The main etiology was neurological (19.1%), predominantly involving problems with gyration of a polymicrogyria type. Myopathic origin accounted for 9.5% of the population, predominantly involving genotyped distal arthrogryposis (ECEL1 gene). Additional tests produced a diagnosis of 25% type I, 43% type II and 75% type III. ConclusionArthrogryposis is a sign suggesting multiple etiologies. The main ones are neurological. Several genes have recently been identified, explaining the physiopathological mechanisms. The diagnostic process must be rigorous and coordinated within a multidisciplinary team, following a shared protocol for analysis.

Atención domiciliaria especializada en pacientes con demencia

Objectiveto Analyze the characteristics of patients with dementia attended by a home care support team and to establish whether there are differences from patients with other diseases. Material and methodsA prospective, comparative analytical study of 2 cohorts of patients attended at home, one with dementia and one without, comparing age, sex, principal caregiver, number of visits and time of follow-up, reason for discharge, medical comorbidity, Barthel index prior to intervention and on the first home care support team visit, Pfeiffer questionnaire, type of dementia and Global Deterioration Scale of Reisberg, amount of previous medication, presence of symptoms (pain, dyspnoea, nausea, anxiety, depression, insomnia, agitation) treatment of symptoms or modification of previous treatment, need for sedation. Data analysis with SPSS 15.0 software. ResultsOf all patients attended (N=638), 195 comprised the cohort of patients with dementia (30.7%). The most common cause was vascular dementia 40.4% (N=74). The average Global Deterioration Scale was 6±1.05, with an average score of 8.87 errors in the Pfeiffer test and average Barthel index of 11.9± 23. In the patients without dementia, significant differences were obtained in terms of functional and cognitive status (Barthel index of 52.34±38 and Pfeiffer test with an average score of 1.48 ±3.2 (P<.001)). The patients with dementia, most commonly institutionalised (37.9% versus 11.8% in non-demented), presented a greater amount of immobility syndrome (70.3% versus 24%) and pressure ulcers (19.6% compared to 3.9%), fewer symptoms other than agitation and less need for palliative sedation (8.2% versus 20.4%). These are patients with lower mortality 31.8% versus 53.1%) and a reduced need for hospitalisation (6.7% versus 17.5%), with no differences in clinical activity. ConclusionsOur results suggest that these patients have a slowly progressive symptomatic and functional profile that will require attention at times of crisis, hospital admissions could be reduced by adequate control of symptoms.

The association between patient participation and functional gain following inpatient rehabilitation.

To evaluate patients' participation during physical therapy sessions as assessed with the Pittsburgh rehabilitation participation scale (PRPS) as a possible predictor of functional gain after rehabilitation training. All patients aged 65years or older consecutively admitted to a Department of Rehabilitation and Aged Care (DRAC) were evaluated on admission regarding their health, nutritional, functional and cognitive status. Functional status was assessed with the functional independence measure (FIM) on admission and at discharge. Participation during rehabilitation sessions was measured with the PRPS. Functional gain was evaluated using the Montebello rehabilitation factor score (MRFS efficacy), and patients stratified in two groups according to their level of functional gain and their sociodemographic, clinical and functional characteristics were compared. Predictors of poor functional gain were evaluated using a multivariable logistic regression model adjusted for confounding factors. A total of 556 subjects were included in this study. Patients with poor functional gain at discharge demonstrated lower participation during physical therapy sessions were significantly older, more cognitively and functionally impaired on admission, more depressed, more comorbid, and more frequently admitted for cardiac disease or immobility syndrome than their counterparts. There was a significant linear association between PRPS scores and MRFS efficacy. In a multivariable logistic regression model, participation was independently associated with functional gain at discharge (odds ratio 1.51, 95% confidence interval 1.19-1.91). This study showed that participation during physical therapy affects the extent of functional gain at discharge in a large population of older patients with multiple diseases receiving in-hospital rehabilitation.

Construction and Validation of the Scale of Practices and Behaviors of Institutionalized Elderly to Prevent Falls

Falls are a public health problem, which directly contribute to functional decline, increased dependency and increased complications associated with immobility syndrome. The investigation has been productive in biophysiological identification of risk factors, but less successful to identify environmental risk and even less to identify behavioral risk factors. This methodological study aimed to build and validate an instrument to assess management practices and behaviors for risk of falls. The Scale of Practices and Behaviors for Institutionalized Elderly to Prevent Falls has two dimensions: 1 – communication practices and behaviors between elderly and different professionals from the institution (α=0.881; KMO=0.775), 2- safety practices and behaviors adopted by elderly (α=0.817; KMO=0.727). The instrument has good psychometric characteristics and it can be used for investigation and for clinical practice to identify practices and behaviors related to fall risk.

Effects of Yoga techniques on reducing mental symptoms of immobility syndrome in elderly women

Background and Aim: Immobility syndrome is the symptomsofphysical, metabolic, and mental disorder due todaily immobility andcauses disorder inbalanceof elderly people. The purpose of this study was to determine the effects of yoga techniques on reducing mental symptoms of immobility syndrome in elderly women. Materials and Method : The present study was a quasi experimental with pre-test and post -test analysis that contains experimental and control goups. Statistical population of the current study was 65-70 year-old women which were members of elderly women Association of city Health Office in Area 2 of Tehran. After interviewing for thestudy ofimmobilizationsyndrome and applying Genetal health questionnair (GEQ),20 elderly women with low general health were selected and randomly assigned to experimental (n=10) and control (n=10) groups. Using Symptom Check List-90-Revised (SCL-90-R) test psychological status of participants were measured. Experimental group Received 8 1-hour sessions of yoga therapy monthly for a period of 2 months. No intervention was carried out for control group. The mental health status of both groups were evaluated after Yoga-therapy.Analysis of covariance was applied to analyze the data. Results : After applying yoga techniques, scores of experimental group were decreased in indexes of SCL-90-R (P<0.001). Conclusion : The literature suggeststhatyoga techniques have beneficial effects on management of anxiety, depression, somatization, interpersonal sensitivity symptoms and could lead to appearance of a balance in physical, emotional, and mental capacities of elderly women. Hence, yoga can be used as an alternative medical system for these disorders. Key words : Yoga , mental symptoms, Immobility syndrome , Elderly women

INFLUÊNCIA DA FISIOTERAPIA NA SÍNDROME DO IMOBILISMO

The immobility syndrome is a set of changes that occur in individual bedridden for an extended period may lead changes in the musculoskeletal system, hindering the activities of daily living. The aim was to evaluate the influence of physiotherapy on immobility syndrome. Alzheimer's disease is the most frequent neurodegenerative pathology associated with age, whose cognitive and neuropsychiatric manifestations result in a disability, and in more advanced stages leads to immobilization in bed. The physical therapy is an important tool to reduce the damage caused by immobility. Twentysessions of physical therapy was performed intwo female patients, aged 87 years (patient 1) and 74 years (patient 2) layered over a month ago, both diagnosed with Alzheimer's disease. Patients presented functional disability, decreased range of motion and muscle strength. It was performed joint mobilizations of upper and lower limbs, stretching exercises and relaxation. Patient 2 receive the treatment described aboveandalsoreceived treatment with Functional Electrical Stimulation (FES) for 10 minutes. Patient 1 had no improvement in their motor frame, whilepatient 2 improved their functional capacity, their ROM, muscle contraction and muscle strengthening. Therefore, it was concluded that low frequencyFunctional Electrical Stimulationis indicated to muscular strength, ADM maintenance and controlof muscle spasticity,being indicated to patients with immobility syndrome in order to avoid complications of originatesfrom extended period of bedridden.

Purple urine bag syndrome in elderly woman with nutritional supplements

The purple urine bag syndrome is a rare entity which typically affects elderly women with prolonged urinary catheterization and weakening chronic diseases. Other predisposing factors are previous urologic pathology, immobility syndrome and chronic constipation. The purple color is due to the presence of high loads of bacteria with sulphatase--phosphatase activity which develop in an alkaline environment as well as the presence of other factors. In the case we present the administration of nutritional supplements containing tryptophan conditioned the generation of this syndrome.

Óbitos em instituição asilar

OBJECTIVE: To define the causes of death in a nursing home population. METHODS: The study selected a 508-bed nursing home with standard medical records, regular meetings concerning death certificates and 12 medical doctors in charge of supervising or issuing death certificates. The procedure standard (2006 death certificates) was considered consistent enough to undergo the analysis. The collected data were gender, age, cause(s) of death and underlying disease(s). The statistical analysis compared data between the two genders and two age ranges ( 75 years). RESULTS: There were 118 deaths in 2006 (mean age: 74.5 ± 15.2 years) - 64 women (mean age: 78.4 ± 14.4 years old) and 54 men (mean age: 69.8 ± 15.0 years old). Causes of death were sepsis (41 deaths), septic shock (25), bronchopneumonia (16), sudden death (11), multiple-organ failure (9) and other causes (16 deaths). The main underlying diseases were infections (63 deaths) - bronchopneumonia (34), sepsis (12), urinary tract infection (7) infected pressure ulcers (7), osteomyelitis (2) and bile duct infection (1); immobility syndrome (42 deaths). The proportion of women older than 75 years showed statistical significance concerning the number of deaths. The sample did not show statistical significance regarding seasonality, causes of death or underlying disease(s) when comparing infectious and noninfectious causes of death vs. men and women, aged older or younger than 75 years. CONCLUSION: Deaths in nursing homes were basically caused by a combination of immobility and infections that developed into sepsis.

Deaths in nursing homes

To define the causes of death in a nursing home population. The study selected a 508-bed nursing home with standard medical records, regular meetings concerning death certificates and 12 medical doctors in charge of supervising or issuing death certificates. The procedure standard (2006 death certificates) was considered consistent enough to undergo the analysis. The collected data were gender, age, cause(s) of death and underlying disease(s). The statistical analysis compared data between the two genders and two age ranges (< 75 years and > 75 years). There were 118 deaths in 2006 (mean age: 74.5 ± 15.2 years) - 64 women (mean age: 78.4 ± 14.4 years old) and 54 men (mean age: 69.8 ± 15.0 years old). Causes of death were sepsis (41 deaths), septic shock (25), bronchopneumonia (16), sudden death (11), multiple-organ failure (9) and other causes (16 deaths). The main underlying diseases were infections (63 deaths) - bronchopneumonia (34), sepsis (12), urinary tract infection (7) infected pressure ulcers (7), osteomyelitis (2) and bile duct infection (1); immobility syndrome (42 deaths). The proportion of women older than 75 years showed statistical significance concerning the number of deaths. The sample did not show statistical significance regarding seasonality, causes of death or underlying disease(s) when comparing infectious and noninfectious causes of death vs. men and women, aged older or younger than 75 years. Deaths in nursing homes were basically caused by a combination of immobility and infections that developed into sepsis.

Decubitus ulcers: pathophysiology and primary prevention.

Pressure sores are a serious complication of multimorbidity and lack of mobility. Decubitus ulcers have become rarer among bed-ridden patients because of the conscientious use of pressure-reducing measures and increased mobilization. Nonetheless, not all decubitus ulcers can be considered preventable or potentially curable, because poor circulation makes some patients more susceptible to them, and because cognitive impairment can make prophylactic measures difficult to apply. A systematic literature search was performed in 2004 and 2005 in the setting of a health technology assessment, and a selective literature search was performed in 2009 for papers on the prevention of decubitus ulcers. Elderly, multimorbid patients with the immobility syndrome are at high risk for the development of decubitus ulcers, as are paraplegic patients. The most beneficial way to prevent decubitus ulcers, and to treat them once they are present, is to avoid excessive pressure by encouraging movement. At the same time, the risk factors that promote the development of decubitus ulcers should be minimized as far as possible. Malnutrition, poor circulation (hypoperfusion), and underlying diseases that impair mobility should be recognized if present and then treated, and accompanying manifestations, such as pain, should be treated symptomatically. Over the patient's further course, the feasibility, implementation, and efficacy of ulcer-preventing measures should be repeatedly re-assessed and documented, so that any necessary changes can be made. Risk factors for the development of decubitus ulcers should be assessed at the time of the physician's first contact with an immobile patient, or as soon as the patient's condition deteriorates; this is a prerequisite for timely prevention. Once the risks have been assessed, therapeutic measures should be undertaken on the basis of the patient's individual risk profile, with an emphasis on active encouragement of movement and passive relief of pressure through frequent changes of position.

Predictors of In-Hospital Mortality Among Older Patients

OBJECTIVE:The objective of this study was to determine predictors of in-hospital mortality among older patients admitted to a geriatric care unit.INTRODUCTION:The growing number of older individuals among hospitalized patients demands a thorough investigation of the factors that contribute to their mortality.METHODS:This was a prospective observational study implemented from February 2004 to October 2007 in a tertiary university hospital. A consecutive sample of 922 patients was evaluated for possible inclusion in this study. Patients hospitalized for palliative care, those who declined to participate, and those with incomplete data were excluded, resulting in a group of 856 patients aged 60 to 104 years. Bivariate and multivariate analyses were performed to determine associations between in-patient mortality and gender, age, length of stay, number of prescribed medications and diagnoses at admission, history of heart failure, neoplastic disease, immobility syndrome, delirium, infectious disease, and laboratory tests at admission (serum albumin and creatinine).RESULTS:The overall mortality rate was 16.4%. The following factors were associated with higher in-hospital mortality: delirium (OR=4.13, CI=2.65–6.44, P<.001), neoplastic disease (OR=3.38, CI=2.11–5.42, P<.001), serum albumin levels at admission <3.3mg/dL (OR=3.23, CI=2.03–5.13, P<.001), serum creatinine levels at admission ≥ 1.3mg/dL (OR=2.39, CI=1.53–3.72, P<.001), history of heart failure (OR=1.97, CI=1.20–3.22, P=.007), immobility (OR=1.84, CI=1.16–2.92, P =.009), and advanced age (OR=1.03, CI=1.01–1.06, P=.019).CONCLUSIONS:This study strengthens the perception of delirium as a mortality predictor among older inpatients. Cancer, immobility, low albumin levels, elevated creatinine levels, history of heart failure and advanced age were also related to higher mortality rates in this population.