Disability and Underlying Diseases of the Institutionalized Elderly

Analysis of Causes of Immobilization

Abstract

Degree of disability of the elderly, especially direct causes of immobilization and complications were analyzed in institutionalized elderly. Subjects were a total of 540 cases (174 men and 366 women) with their ages ranging between 62 and 101 (mean of 82.8) years in Tokyo Metropolitan Itabashi Nursing Home. Underlying diseases were classified into those of nervous system (cerebrovascular disease, Parkinson syndrome etc), locomotor system (fracture of the neck of the femur, osteoarthritis etc), dementia and various other diseases. Degree of disability was classified by walking ability into 4 groups; grade 4 for immobilization, grade 3 for mobility around bed, grade 2 for using walker or wheelchair, grade 1 for walking (with or without cane). (1) Classification of disability: There were 182 cases (33.7%) of grade 4, 52 cases (9.6%) of grade 3, 169 cases (31.3%) of grade 2, and 137 cases (25.4%) of grade 1. (2) Disability and age: There were more than 40% of grade 4 disability in nonagenarians. (3) Disability and diseases: In 182 cases of grade 4, there were 289 neurological diseases (158.8%), 123 locomotor diseases (67.6%) and various other diseases (129.7%). The incidence of these disease groups was 101.9%, 69.2%, 126.9% in grade 3, 87%, 72.2%, 155% in grade 2, and 86.1%, 38.7%, 183.2% in grade 1, respectively. Incidence of neurological diseases was especially high in grade 4, and that of various diseases in grade 1. (4) Causes of immobilization: A total of 182 cases of immobilized elderly could be explained by neurological diseases in 51 (28%), locomotor diseases in 38 (20.9%), dementia in 11 (6%), combination of these 3 groups of diseases in 74 (40.7%) and others in 8 (4.4%). In other words, immobilization was induced by single disease in 79, and by plural diseases (including same and different organs) in 103 cases. In conclusion, the main causes of immobilization were neurological diseases, such as cerebrovascular diseases, and locomotor diseases, such as fracture of the neck of the femur. There were, however, many other causes, and mechanism was more complex by combination of diseases.