7. Immobility

The immobility is defined as a decreased ability to perform activities of daily living by impairment of motor functions.

There are two types of immobility:

• Relative immobility: the old man leads a sedentary life but is able to move independently.
• Risk: bedridden
• Absolute immobility: implies bedridden and has very limited postural variability.
• Risk: institutionalization, morbidity and appearance of caregiver syndrome.

The causes of immobility in elderly patients are varied, among which are: physiological changes of aging, common diseases and environmental causes.

The problem that arises after prolonged immobilization is that changes occur in different organ systems (cardiovascular, musculoskeletal and dermal mainly) that tend to perpetuate the syndrome.

Orthostatic hypotension

One of the changes that occur in the cardiovascular system is orthostatic hypotension, which can be defined as change in normal blood pressure regulation that decreases sharply after a sudden change in body position, usually when shifting from lying down to sat. It usually lasts only a few seconds or minutes.

Causes of orthostatic hypotension include:

• Hypovolemia:
• Excessive use of diuretics
• Vasodilator medications
•  Dehydration
• Prolonged bed rest
• Nervous system damaged  by diseases such as:
• Diabetes
• Anemia
• Decreased cardiac muscle contractility or vascular responsiveness.
• Drugs:
• Antidepressants
•  Antipsychotics
• Barbiturates
• Alcohol

In relation to the symptoms that come with orthostatic hypotension appear: confusion, weakness, blurred vision, dizziness and eventually fainting (brief loss of consciousness).

The main treatment of orthostatic hypotension is tracking a number of recommendations:

• Getting up slowly after lying down and stay a few minutes sitting on the edge of the bed.
• Avoid alcohol
•     Perform Isometric exercises (squeezing a ball for a few minutes) before you stand; raise blood pressure and prevent a sharp decrease when you get up.

I think it's very important to explain to patients the prevention of falls that occur as a result of orthostatic hypotension, because many seniors get up quickly from the bed when the phone rings, when they hear a bump or when they remember that they have forgotten something. It is very important to emphasize that you should be sitting on the edge of the bed a few seconds before getting up.

Bibliography

• Medline. [Monografía de internet]. [Fecha de consulta 18 de abril de 2013]. Disponible en: http://www.nlm.nih.gov/medlineplus/spanish/ency/article/007278.htm
• Micheli, F; Nogués, M. A; Asconapé, J. J; Fernández Pardal, M. M; Biller, J. Tratado de neurología clínica. Argentina: Editorial Médica Panamericana; 2002.
• Voyatzis Norwood, D. Hipotensión ortostática. NYU Langone Medical Center [en línea] 2012 [fecha de acceso 18 de abril del 2013]. URL disponible en: http://www.med.nyu.edu/content?ChunkIID=104084
• Cleveland Clinic. [Monografía de internet]. [Fecha de consulta 18 de abril de 2013]. Disponible en http://my.clevelandclinic.org/es_/disorders/orthostatic_hypotension/hic_orthostatic_hypotension.aspx