Mobility Decline and Immobility

Mobility decline changes more than gait. When an older adult stops shifting weight or contracting the leg muscles, pressure lasts longer, the calf-muscle pump weakens, and standing becomes less well tolerated. Strength and muscle mass begin to decline immediately during immobilization, with the steepest loss occurring in the earliest days. Because older adults often begin with less physiologic reserve, a short period of bed rest can produce a disproportionate loss of function. The bedside task is to connect these effects rather than assess walking in isolation. Skin, circulation, breathing, bowel and bladder function, posture, balance, and the ability to perform transfers may all change at once. A new finding such as unilateral calf swelling, non-blanchable erythema, dizziness on standing, or unexplained dyspnea changes the priority of care.