Here is What Happens to Elderly Seniors That Are Sitting In a Wheelchair All Day With No Physical Activity

elderly sitting all day

There’s a wide variety of reasons why many older adults will use a wheelchair at some point in their later years, aside from paralysis. For the purpose of this article, the term “wheelchair” refers to manual and powered chairs because both come with health repercussions due to extensive use.

The following information reveals the detailed sedentary complications that come with prolonged wheelchair use among the elderly. Especially when they are physically inactive. In all honesty, the information provided should scare wheelchair users. More importantly, the listed complications can be reduced or completely prevented with the appropriate precautions or lifestyle changes. Let’s begin:

Sedentary Complications That Come With Prolonged Wheelchair Use:

Pressure Sores on Buttocks From Sitting

One of the most serious, and potentially deadly, complications that come with prolonged sitting in a wheelchair are pressure sores or pressure ulcers. Clinicians often times recommend using pressure-relieving techniques at least every 15 minutes during the period spent in a wheelchair and for this very reason.

When prolonged pressure is applied to skin, healthy or fragile, the tissue is subject to breaking down. The hot spots on the body for sores are along bony prominences including the pelvic bones along the buttocks and the heels.

Other places include all over the back of the thighs with upright sitting.  Some breakdown may be superficial (or stage I) and can be reversed with proper care. Other times, pressure sores wear through to the bone (stage 4) and are termed non-healing pressure ulcers.

What makes these ulcers lethal is the deep tissue exposure that makes the victim more susceptible to serious infections that work through the bloodstream. Such infections can be septic which results in lengthy hospital stays and/or death. I suggest you read the article we did on the 5 best wheelchair cushions to prevent to prevent tailbone pain and pressure sores in the elderly.


Shoulder
 Pain or Rotator Cuff Injury

This is more than just about rotator cuff injuries from self-propelling a manual wheelchair. Some wheelchair users don’t acknowledge what is happening to their shoulders while their arms are just lying on the arm rests. A comfortable height for armrests should allow the shoulders to sit relatively neutral and the elbows at 90 degrees or slightly greater.

When the arm rests are positioned to high or if the user slouches, the shoulders are pushed higher above the collar bone, which over time wreaks havoc on the muscle tissue.

If left in this position too long, the wheelchair user starts to irreversibly lose shoulder range (lifting or retrieving items overhead, reaching and pulling up on a grab bar, etc.). This can be problematic for performing activities of daily living like dressing, hygiene care, transferring out of bed or doing daily tasks around the home.


Poor Hygiene
 and Infection

For this complication, we’re focusing on wheelchair users who have to additionally manage incontinence difficulties. Combining wheelchair use with catheter lines, colostomy/ileostomy bags, disposable diapers, paper chucks, and other incontinence items greater increases the chances for skin breakdown and infections if left unmanaged.

Soiled and wet materials left between the skin and the seat for long periods can cause pressure sores, skin infections and irritations, and urinary tract and kidney infections.


Upper/Lower Back
 and Joint Pain

It’s no mystery that prolonged sitting in any other circumstance performs a number on the spine. Therefore, sitting in a standard, upright wheelchair should be no different.

Numerous older adults are already battling breakdown and herniation in the spine and hips including herniated discs, osteoporosis, degenerative disc disease, scoliosis, kyphosis, and sciatica.

Sitting in one position for even one hour without movement can contribute to additional back and hip pain, joint displacement, and muscle tissue breakdown.


Generalized Edema From Prolonged Wheelchair Sitting

Edema, or lymphedema, is an accumulation of fluid that often pools in the upper and lower limbs because the body is failing to maintain it in the lymphatic system. The most common causes of lymphedema include invasive surgery, cancer and cancer treatment, and organ failure.

However, fluid can also collect in the legs and feet during prolonged sitting.  This usually happens to adults who sit in an upright wheelchair with standard, non-elevating footrests because the fluid has nowhere else to go but down.

A trace amount of swelling is usually harmless and disappears with minor movement in the legs. Uncontrolled fluid build-up can damage blood veins and thin out skin making the lower limbs more susceptible to pressure sores


Muscle
 Atrophy ( Age Related Muscle Loss ) 

Lastly, sedentary wheelchair use reduces blood circulation and muscle contractions. This results in wasting away of muscle tissue because blood isn’t saturating the tissue efficiently and muscle fibers aren’t crossing each other smoothly to produce contractions to get body parts and joints to move.

This overall tissue wasting is called muscle atrophy, and it can morph into permanent damage to muscles if proactive steps aren’t taken.

Examples of movement problems include increasing difficulty transferring from a sitting to standing position, going from a sitting position to lying completely flat in bed, reaching overhead, straightening the arms at the elbows, and pointing the toes and ankles downward. At this point it will be difficult to perform any activity without the assistance of a family member or in home caregiver.

In Conclusion:

Sedentary complications from sitting in a wheelchair can happen to anyone, from those who are paralyzed from head to toe to those who use a wheelchair for only community outings.

If you are relatively new to your wheelchair or have little knowledge about complications from prolonged use, please consult with your family physician to see what you are most at-risk for and how to best prevent these unhealthy sedentary lifestyle behaviors.

 

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Author: Samuel

Samuel is a physical therapist with over 20 years medical experience. He has extensive knowledge in functional rehabilitation in the acute care hospital and in-home care settings. He has spent most of his career helping seniors transition from hospital or rehab care to living independently at home. In his free time he likes to travel and read autobiographies.

2 comments

  1. My husband is in a wheelchair due to extreme back pain he has had two major back surgeries and needs a third one but they won’t do it because it’s a 13-hour surgery and it’s heart won’t take effect he can’t walk because of the pain and also he has two knee replacements but one of them is so sloppy that dislocates I’ll probably 15 times a day he also has a bed sore what is the best thing to use to help that bed sore heal?

  2. I’ve been using a manuel wheelchair for close to 25 years ever since having an SCI when I turned 30. I have never had a pressure sore in all that time. How? Being 6’2” and weighing 190+, it was always a concern. You need a multi prong approach addressing this issue, and you’ll need to invest some money into your care systems.
    #1) For my wheelchair I’m using a ROHO 10cm air cushion. Mine is 40cm x 40cm x 10cm, but they come in different sizes. They have smaller, 5cm ones, but it’s not enough protection for me. There are many different types of WC cushions, from the inadequate simple foam cushion, to gel filled, to air. There may be some models out there that work great, but I fortunately found what works for me right away.
    #2). Make sure you are using a decubitus mattress. I use a foam type mattress which is formed into long rows of foam cubes about 15cm high. There are some which have removable foam squares to custom fit to a person’s needs, but IMO that’s a waste. Mine comes shrink wrapped in one piece, ready for use.
    #3) Your car seat is not safe. I should add that airplane seats are equally dangerous. You should always lay a cushion down on it before you drive or take off. I have used my 10cm ROHO in both scenarios, but it is very difficult to do without help. Either you transfer onto the cushion using a transfer board from your wheelchair, or you transfer into your seat, lift yourself up using armrests/center console/car door, and have your partner slide the cushion underneath you.
    #4) Pressure relief moves: yes, make it a habit.
    #5) Do not wear any pants which have a raised seam in the seat of the pants. Seams on your butt will cause pressure sores. That is a known fact. Avoid them by wearing jeans and shorts made my wheelchair apparel stores which you can find online, or by wearing spandex type running shorts and leggings (either full length or 3/4). Name brands such as UA and Nike make these, but always double check for raised seams, and also key storage pockets which usually have small zippers which can cause a problem.
    #6). Foot ware needs to be slightly oversized if your not walking. For people whose feet swell rapidly Ugh Boots lined with sheep’s wool work fantastic in preventing pressure soars. Watch out for socks with raised seams as well.

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