Immobilization

Dr. Rose Dinda Martini, SpPD

The Guinness Book of World Records the fastest 100-year-old to run

100 meters.

Geriatric Giant

Immobility
Instability
Incontinence (urinary & alvi)
Intellectual impairment (MCI, Dementia)
Infection (Pneumonia, etc)
Impairment of hearing & vision
Impaction (constipation)
Isolation (depression)
Inanition (malnutrition)
Impecunity (poverty)
Iatrogenesis
Insomnia
Immune deficiency
Impotence

Kane, Ouslander Abrass. (from

1988), Essentials of Clinical
Geriatrics.2004 . p.13-14.

Solomon

The Bed
Look at a patient lying long in bed. What a
pathetic picture he makes! The blood clotting in
his veins, the lime draining from his bones, the
scybala stacking up in his colon, the flesh rotting
from his seat, the urine leaking from his
distended bladder, and the spirit evaporating
from his soul.
(R Asher: The Dangers of Going to Bed: BMJ 1947)

Penyulit Akibat Imobilisasi

Neurologi

Respirasi

Kardio
Vaskular

Muskulo
Skeletal

Gastro
intestinal

Urologi

Depresi

Pneumonia
Atelektasis

DVT
PE
Hipotensi
postural

Lemah otot
Kontraktur
Osteo
porosis

Konstipasi ISK
Inkontinensia Batu
alvi
saluran
kemih

Lain-Lain
Ulkus dekubitus
Hipoalbuminemia

Complications of immobilization
Ulcus decubitus (pressure ulcer)
Muscle atrophy & joint contracture
Baroreseptor desensitization
Orthostatic hypotension
Atelectasis & Pneumonia
Decrease bone density, Hypercalcemia, Osteoporosis
Constipation
Deep vein thrombosis & Pulmonary embolism
Resnick NM, Dosa D. Geriatric Medicine. Harrisons
Principles of Internal Medicine. Ed.16. 2005: 43-53

Faktor Risiko dan Etiologi

Neurologi

Respirasi

-PPOK
-Stroke
-Parkinson
-Gangguan
Serebelum

Kardio
Vaskular

Muskulo
Skeletal

Visual

Eksternal Lain-Lain

-SKA
-CHF
-PAD

-OA
-Osteo
porosis

-Katarak
-Alat
-Glaukoma bantu
yang tidak
adekuat

-Malnutrisi
-Depresi
-Efek Samping
Obat

Imobilization
Keadaan tidak bergerak atau tirah
baring selama 3 hari atau lebih dengan
gerak anatomik yang hilang akibat
perubahan fungsi.

Pasien Imobilisasi

DAERAH PREDILEKSI

BMJ 2006;332;472-475

KLASIFIKASI

Stadium 1 Stadium 2

Stadium 3 Stadium 4

Dermatologic Therapy, Vol. 19, 2006,

Prevalensi Imobilisasi di RSUPNCM

PATOFISIOLOGI

BMJ 2006;332;472-475

PATOGENESIS
Tekanan
Gesekan

Daya Regang
Kelembaban

DVT and PE

Factors That Trigger Thrombosis

Local trauma to the

Stasis of blood

vessel wall

(Immobilization)

(surgical)

TRIAD OF
VIRCHOW

Hypercoagulability
(Deficiency of Protein C,
Protein S, AT III)

Pathophyisiology of DVT
Aging process
coagulation factors
Vein valve rigidity

Blood turbulance
Accumulation of
coagulation factors

Immobilization
Loss of muscle
contraction
Stasis
Hypoxia

DVT

Endothelial dysfunction
Coagulation factor
secretion

Emboli Paru

Emboli Paru
dapat terjadi di bagian mana saja pada paru-paru

Pulmonary Embolism (PE)

Pendekatan Klinis

Evaluasi
Anamnesis

Keterangan
Riwayat dan lama disabilitas atau imobilisasi
Kondisi medis yang merupakan faktor risiko dan penyebab imobilisasi
Kondisi pre morbid
Nyeri
Obat-obatan yang dikonsumsi
Dukungan pramuwerdha
Interaksi sosial
Faktor psikologis
Faktor lingkungan

Pemeriksaan Fisik

Status kardiopulmonal
Kulit
Muskuloskeletal: kekuatan dan tonus otot, lingkup gerak sendi, lesi dan deformitas
kaki
Neurologis: kelemahan fokal, evaluasi persepsi dan sensorik
Gastrointestinal
Genitourinarius

Status Fungsional

Pemeriksaan Indeksi Aktivitas Kehidupan Sehari-hari (AKS) Barthel

Status Mental
Status Kognitif

Penapisan dengan Geriatric Depression Scale (GDS)

Penapisan dengan Mini Mental State Examination (MMSE), Abbreviated Mental Test
(AMT)
Mobilitas di tempat tidur, kemampuan transfer, mobilitas di kursi roda, keseimbangan
saat duduk dan berdiri, cara berjalan, nyeri saat bergerak

Tingkat Mobilitas

Pemeriksaan
Penunjang

Penilaian berat ringannya kondisi medis penyebab imobilisasi (foto lutu, ekokardiografi)
dan komplikasi akibat imobilisasi (pemeriksaan albumin, elektrolit, glukosa darah,
hemostasis)

SITI SETIATI, Geriatri IPD FKUI/RSUPN-CM, 2003

Instabilitas
Jatuh

Obat
Inkontinensia urin

Fraktur
Hipotermia

Infeksi

Kesadaran

Imobilisasi

Ulkus
Trombosis vena
Pneumonia
ISK
Atrofi otot
Asupan
cairan
Asupan makanan

Depresi

Gangguan
tidur

Dehidrasi

konstipasi

Malnutrisi