Immobility and its Consequences in the Elderly

Question 1

What are the 2 most important features of the medical history when assessing the cause of someone’s immobility?

1 - What is the timing of the decline in immobility?
2 - What is limiting their mobility?
3 - What is causing the immobility
4 - Which part of the body is immobile

Answer 1

1 - What is the timing of the decline in immobility?
2 - What is limiting their mobility?

Question 2

When assessing a patients immobility, which 2 body systems should be fully examined?

1 - MSK (GALS)
2 - neurological examination (upper and lower)
3 - respiratory examination
4 - cardiac examination

Answer 2

1 - MSK (GALS)
2 - neurological examination (upper and lower)

Question 3

Which of the following are causes of acute immobility?

1 - fracture
2 - soft tissue injury
3 - acute inflammatory arthropathy
(gout or pseudogout)
4 - all of the above

Answer 3

4 - all of the above

Question 4

Gout is an acute inflammatory response causing inflammation of and the deposits of something in joints. What is it that builds up in the body that causes gout?

1 - excessive uric acid
2 - excessive ROS
3 - excessive hyaluronic acid
4 - excessive Mg+

Answer 4

1 - excessive uric acid
- uric acid is breakdown product from purines
- normally excreted from the body in urine
- but gets deposited in joints

Question 5

When uric acid levels exceed the level of its solubility, when the blood has a pH of 7,4 uric acid loses an electron and becomes a urate ion. What then binds with the urate ion to form monosodium urate crystals?

1 - K+
2 - Ca2+
3 - Na+
4 - Cl-

Answer 5

3 - Na+
- patients present with acutely swollen, painful joint with reduced range of movement

Question 6

Which joint is most commonly affected in gout?

1 - knee
2 - elbow
3 - 1st metatarsophalangeal joint (MTP)
4 - 5th metacarpophalangeal joint

Answer 6

3 - 1st metatarsophalangeal joint (MTP)

Question 7

In gout monosodium urate crystals are deposited in joints, but in pseudogout it is calcium pyrophosphate crystals. Which joint is most commonly affected in pseudogout?

1 - knee
2 - elbow
3 - 1st metatarsophalangeal joint (MTP)
4 - 5th metacarpophalangeal joint

Answer 7

1 - knee
- patients present with acutely swollen, painful joint with reduced range of movement

Question 8

In pseudogout and gout the joints should be aspirated which can help identify the cause. What else are we trying to rule out with the aspiration?

1 - osteoarthritis joint
2 - septic joint
3 - rheumatic joint
4 - osteoporosis

Answer 8

2 - septic joint

Question 9

Which 2 of the following are treatments for gout and pseudogout?

1 - colchicine
2 - steroids
3 - NSAIDs
4 - aspirin

Answer 9

1 - colchicine
2 - steroids

Question 10

Which of the following are causes of acute immobility due to neurological causes?

1 - Acute stroke
2 - Spine cord compression
3 - Cauda equina
4 - Vertigo
5 - all of the above

Answer 10

5 - all of the above

• high risk of malignancy in older patients with spinal cord compression
• sepsis and hypoactive delirium can also cause acute immobility

Question 11

Which of the following medications can cause acute immobility?

1 - Antipsychotics
2 - Sedatives
3 - Drugs precipitating bradycardia / postural hypotension
4 - all of the above

Answer 11

4 - all of the above

Question 12

Which of the following cardiorespiratory causes does NOT typically cause acute immobility?

1 - Cardiac failure
2 - Arrhythmias - tachy and brady
3 - Acute hypoxia from pneumonia, pulmonary embolism, exacerbation of COPD
4 - infective endocarditis

Answer 12

4 - infective endocarditis
- long term it might, but not acutely

Question 13

All of the following can cause chronic immobility:

1 - Neurological = Parkinson’s disease, Brain tumour, Peripheral neuropathy, Spinal stenosis
2 - Cognition = Dementia with social isolation, Depression
3 - Visual impairment = Cataract, AMD, Diabetic retinopathy
4 - Musculoskeletal = Osteoarthritis, Osteoporosis, Rotator cuff injuries and adhesive capsulitis, Sarcopenia
5 - Frailty phenotype
6 - Cardiorespiratory = COPD, Heart failure, Peripheral vascular disease

Question 14

Which of the following is not part of the frailty phenotype?

1 - unintentional weight loss
2 - reduced muscle strength
3 - reduced polypharmacy
4 - reduced gait speed
5 - self-reported exhaustion
6 - low energy expenditure

Answer 14

3 - reduced polypharmacy

• > 3 = frailty syndrome

Question 15

Which of the following is NOT a common consequence of immobility on the skin?

1 - Pressure damage
2 - Deep vein thrombosis
3 - Squamous cell carcinoma
4 - Venous stasis and peripheral oedema

Answer 15

3 - Squamous cell carcinoma

Question 16

Which 2 of the following are common consequence of immobility on the musculoskeletal system?

1 - contractures
2 - carpal tunnel syndrome
3 - muscular deconditioning and atrophy
4 - compartment syndrome

Answer 16

1 - contractures
- muscles, tendons, joints, or other tissues tighten or shorten causing a deformity

3 - muscular deconditioning and atrophy

Question 17

Pressure ulcers are an injury that breaks down the skin and underlying tissue. They are caused when an area of skin is placed under pressure. They can occur anywhere in the body if sufficient pressure is applied. How many grades of pressure ulcers are there?

1 - 6
2 - 5
3 - 4
4 - 2

Answer 17

3 - 4

Question 18

How quickly can Hyperaemia pressure ulcers form?

1 - 2-6 hours
2 - 2 weeks
3 - after 30 minutes
4 - >6 hours of continuous pressure

Answer 18

3 - after 30 minutes
- alleviated 1 hour after pressure is removed

Question 19

How quickly can ischaemic pressure ulcers form?

1 - 2-6 hours
2 - 2 weeks
3 - after 30 minutes
4 - >6 hours of continuous pressure

Answer 19

1 - 2-6 hours
- Can take up to 36 hours to be alleviated

Question 20

How quickly can necrotic pressure ulcers form?

1 - 2-6 hours
2 - 2 weeks
3 - after 30 minutes
4 - >6 hours of continuous pressure

Answer 20

4 - >6 hours of continuous pressure

Question 21

How quickly can ulcerative pressure ulcers form?

1 - 2-6 hours
2 - 2 weeks
3 - after 30 minutes
4 - >6 hours of continuous pressure

Answer 21

2 - 2 weeks

Question 22

If a patient is at risk of pressure ulcers, how quickly should they be assessed using the Waterlow score?

1 - <24h
2 - <12h
3 - <6h
4 - <1h

Answer 22

3 - <6h
- grade and measure lesions
- relieve pressure and dress the wound
- consider debriding grade 3/4 if slough
- look at nutrition of patient and consider treating if infected

Question 23

Which of the following can contribute to immobility?

1 - Orthostatic hypotension – related to physical deconditioning
2 - Constipation and faecal impaction
3 - Incontinence (functional)
4 - Hypostatic pneumonia
5 - Hypothermia
6 - Social isolation
7 - all of the above

Answer 23

7 - all of the above

Question 24

Social isolation is a large problem contributing to immobility. What % of >75y/o live alone?

1 - 25%
2 - 40%
3 - 50%
4 - 75%

Answer 24

3 - 50%
- 10% report loneliness
- Many have no close friends or partner and no or little interaction with society