Elderly individuals demonstrate a markedly increased risk of deep vein thrombosis (DVT) compared with younger adults. This elevated risk is considered to result from multiple contributing factors, including age-associated changes in coagulation pathways, a higher prevalence of comorbid conditions, and increased rates of hospitalization. Nevertheless, the precise mechanisms underlying this association remain incompletely defined.. Several medical conditions such as cancer, trauma, antiphospholipid syndrome, acute heart failure, chronic edema of the lower limbs, and paresis or paralysis of a lower limb, increase the risk for DVT in older adults [1] Specifically, a multicenter retrospective study indicated that individuals aged 50 and above exhibit increased susceptibility to DVT, and other research has found that the incidence of preoperative DVT in patients aged ≥ 50 years is notably higher [2]

Further analysis has indicated that age over 70 years specifically serves as a critical cut-off value for the increased development of proximal new-onset deep vein thrombosis [3] This heightened risk is often attributed to the cumulative effect of age-related physiological changes, including alterations in coagulation pathways and reduced mobility, which collectively contribute to a prothrombotic state . [4]

Endothelial thromboresistance at the valve decreases with age, shifting towards a decrease in anticoagulant properties. In addition, immobilization in the elderly can cause DVT, where immobilization conditions can cause changes in blood flow such as static and turbulence, especially behind the venous valve bag. [5]

Age is a risk factor for thrombosis and aging can also cause thrombophilia. Mechanisms underlying this relationship include hypercoagulation, endothelial damage, and venous stasis along with increased chronic inflammation.  Additional factors including comorbidities that are common in elderly patients such as cancer, chronic heart failure, and stroke can significantly contribute to the prothrombotic tendency in elderly patients. [6]

Physiological hemostasis is regulated by multiple factors that work harmoniously in maintaining a balance between inhibitors and stimulators of thrombus formation. Aging is associated with comorbidities in most elderly patients, thus increasing age has become a cause associated with basic pathophysiologic mechanisms involving: (1) endothelial injury, (2) hypercoagulobility, (3) venous stasis. [4]

Hemostasis involves a complex series of procoagulant and fibrinolytic processes controlled by inhibitory and feedback mechanisms. With aging, changes in the balance of hemostasis tend to lead to thrombophilia and an increased risk of thromboembolic events. [7]

Immobilization is associated with decreased venous blood flow, occurring in venous sacs and valves which can lead to inflammation and hypercoagulation. Immobilization or decreased independent mobility is an important and prevalent risk factor for DVT (deep vein thrombosis) in hospitalized patients. Prolonged periods of immobilization will lead to vascular stasis, which is one of the cornerstones of Virchow triage in thrombosis pathology. [8-9]

Several studies have suggested the complications of prolonged immobilization cause many adverse outcomes, including increased morbidity and mortality, prolonged hospitalization, increased hospitalization costs, and cause a global burden of disease. [10-11]

The reason for choosing this study is because the problem of elderly immobilization remains a challenge in the practice of geriatric medicine and health. This challenge is in the form of the risk of physical complications that many elderly people face.

Study Design and Population This research employed a cross-sectional analytic design utilizing secondary data extracted from medical records. The study population consisted of elderly patients aged 60 years and older who experienced immobilization and were hospitalized at Wahidin Sudirohusodo Hospital between November 2024 and April 2025. Patients were included if they met the following criteria: age ≥60 years, immobilization lasting at least three consecutive days, completion of laboratory evaluations (platelet count, prothrombin time [PT], activated partial thromboplastin time [APTT], and D-dimer), assessment using the Wells score, and availability of complete medical records. Patients were excluded if they lacked the required laboratory tests, had not undergone Wells score evaluation, were receiving anticoagulant therapy, or had incomplete medical documentation. Sampling Technique and Data Collection A convenience sampling method was applied to identify all eligible immobilized elderly patients within the specified study period. After confirming eligibility, informed consent was obtained from participants or their legal representatives. Relevant demographic, clinical, and laboratory data were then extracted from the hospital’s electronic medical record system. The use of medical record data ensured uniformity of measurement and minimized recall bias. Measurement Parameters Several clinical and laboratory parameters were assessed. Immobilization was determined by documenting the duration during which patients were unable to perform routine activities or reposition independently in bed. Hematological parameters included platelet count, measured through routine complete blood count analysis. Coagulation parameters consisted of PT, reflecting clotting time following the addition of thromboplastin and calcium, and APTT, measuring clot formation after the addition of phospholipids and calcium. D-dimer levels were quantified to evaluate fibrin degradation resulting from plasmin-mediated fibrinolysis. Deep vein thrombosis (DVT) risk was assessed using the Wells score, a validated clinical prediction tool. Instrumentation All laboratory analyses were conducted using standardized automated hematology and coagulation analyzers routinely employed by the hospital laboratory. Clinical assessment for DVT risk utilized the established Wells scoring system. These instruments and assessments served as the primary tools for data measurement in this study. Operational Definitions The following thresholds were used to define abnormal findings: D-dimer >0.5 mg/L, platelet count <150 ×10³/µL or >450 ×10³/µL, PT ≥16 seconds, and APTT ≥36 seconds. Immobilization duration was categorized into mild to moderate (3–7 days) and severe (≥8 days). Wells score categories included low risk (–2 to 0), moderate risk (1 to 2), and high risk (3 to 8). Elderly age groups were classified as young elderly (60–69 years), middle elderly (70–79 years), and old elderly (≥80 years). Statistical Analysis Data were analyzed using IBM SPSS Statistics version 25. Descriptive statistics, including means, standard deviations, and frequency distributions, were used to characterize the study sample. Associations between categorical variables were evaluated using the Chi-square test. A p-value <0.05 was considered statistically significant.

Research Sample Overview

This study was conducted on elderly patients who were immobilized. The research subjects were elderly patients who were immobilized at Wahidin Sudirohusodo Hospital with immobilization levels divided into mild (1-3 days), moderate (4-7 days), and severe (≥8 days). The elderly patients were categorized as young elderly (60–69 years), middle-aged elderly (70–79 years), and old elderly (≥80 years). The sample size was 80 people, which consists of 35 men (43.8%) and 45 women (56.3%). Based on age, the elderly were divided into 48 young elderly (68%), 25 middle elderly (31.3%), and 7 old elderly (8.8%). Based on the duration of immobilization, the participants were divided into mild immobilization (4 people, 5%), moderate immobilization (31 people, 38.8%), and severe immobilization (45 people, 56.3%).

Table 1. Characteristics of research subjects (n = 80)

Relationship between Variables   and  DVT Risk Groups

A significant association was observed between the duration of immobilization and the risk of deep vein thrombosis (DVT). Among participants with low-to-moderate immobilization (3–7 days), the majority (33 patients; 94.3%) were categorized as having a low to moderate risk of DVT, while only 2 patients (5.7%) had a high risk. In contrast, patients with severe immobilization (≥8 days) showed the opposite pattern: 43 individuals (95.6%) were classified as having a high risk of DVT, whereas only 2 patients (5.7%) demonstrated a low to moderate risk. Overall, 56.3% of the study population had a high DVT risk. Statistical analysis using the Chi-square test revealed that this association was highly significant (p = 0.000), indicating that longer immobilization duration is strongly correlated with increased DVT risk.

Table 2. Relationship between Duration of Immobilization and Risk of DVT

Evaluation of coagulation parameters among immobilized elderly patients showed varying proportions of normal and abnormal findings. Platelet counts were within normal limits in 51 patients (63.75%), whereas 29 patients (36.25%) demonstrated abnormal values. Prothrombin time (PT) was normal in the majority of patients (65 individuals; 81.25%), with only 15 patients (18.75%) showing prolonged PT. Similarly, activated partial thromboplastin time (APTT) was normal in 61 patients (76.25%), while 19 patients (23.75%) exhibited abnormal results. In contrast, D-dimer levels were elevated in most of the population, with 76 patients (95%) showing abnormal values and only 4 patients (5%) falling within the normal range. These findings indicate that abnormalities in D-dimer were the most prevalent coagulation disturbance among the study population.

Table 3. Changes in coagulation factors in immobilized patients

Analysis of the relationship between the duration of immobilization and D-dimer levels showed no statistically significant association (p = 0.314). Among patients with low-to-moderate immobilization (3–7 days), 32 individuals (91.4%) had elevated D-dimer levels (≥0.5 mg/L), while only 3 patients (8.6%) had normal levels. In the severe immobilization group (≥8 days), 44 patients (97.8%) demonstrated elevated D-dimer levels, and only 1 patient (2.2%) had a normal value. Overall, 95% of the total sample exhibited elevated D-dimer concentrations. Although elevated D-dimer levels were more frequently observed in patients with severe immobilization, the difference did not reach statistical significance.

Table 4.  Analysis of the relationship between the duration of immobilization and D-dimer levels

Dominant comorbidities  affect the risk of DVT.

The distribution of comorbidities among immobilized elderly patients showed that malignancy was the most prevalent condition, affecting 38 patients (47.5%). This was followed by hypertension, present in 22 patients (27.5%), and sepsis, identified in 16 patients (20%). Diabetes mellitus was recorded in 15 patients (18.8%), while stroke occurred in 14 patients (17.5%). Less common comorbidities included heart failure in 9 patients (11.3%), postoperative status in 7 patients (8.8%), and trauma in 3 patients (3.8%). These findings indicate that nearly half of the immobilized population had cancer-related conditions, with a substantial proportion also presenting with chronic cardiovascular and infectious comorbidities.

Table 5. Comorbidities of Immobilized Patients

In the mild to moderate immobilization groups, the majority of patients (94.3%) were classified as having low to moderate risk for deep vein thrombosis (DVT). In contrast, in the severe immobilization group (≥8 days), nearly all patients (95.6%) were categorized as high risk for DVT. Statistical analysis revealed a significant association between the duration of immobilization and increased DVT risk in elderly patients (p = 0.000; p < 0.05). These findings indicate that prolonged immobilization significantly elevates the likelihood of DVT.

Prolonged bed rest, paralysis, or any condition leading to reduced physical activity significantly increases the likelihood of DVT formation. This is particularly pertinent in older adults, who often experience diminished efficiency of the calf muscle pump and reduced physical activity due to age-related conditions like osteoporosis, contributing to peripheral blood reflux and stasis. [12,13] 

These results align with prior studies. Engbers et al. reported that immobility, particularly when prolonged, significantly increased the incidence of venous thrombosis in older populations [14]. Similarly, Pottier et al. demonstrated through meta-analysis that immobilization beyond three days significantly elevates venous thromboembolism (VTE) risk, which increases further with prolonged duration [15].

Recent study report that elderly individuals immobilized for more than 3–5 days had a higher incidence of DVT, particularly when comorbidities such as diabetes, hypertension, or cardiovascular disease were present [16]. Weill-Engerer et al. identified prolonged bed rest (>3–5 days), in conjunction with comorbid conditions, as a substantial risk factor for DVT in hospitalized elderly patients [17].

Kao et al. further demonstrated that patients on bed rest for ≥4 weeks exhibited significantly increased DVT risk [11]. Piazza et al. found that 50.5% of elderly DVT patients had a history of immobilization within 30 days before diagnosis, often related to neurological conditions such as stroke or Parkinson’s disease, suggesting a strong link between neurological impairment and DVT risk [18].

Park et al. observed that immobilization for 10–14 days following foot and ankle surgery increased DVT risk by up to 35% [19], while Zixuan et al. noted a 2.6% incidence of DVT among elderly patients with a mean immobilization period of 7 days following ankle fracture surgery [20].

Immobility contributes to DVT not only due to venous stasis but also through mechanisms such as muscle atrophy and subsequent edema, which facilitate thrombus formation [13]. It can lead to multisystem degeneration, particularly affecting the cardiovascular and pulmonary systems, by inducing hypercoagulability, reduced myocardial perfusion, orthostatic intolerance, decreased plasma volume, impaired pulmonary function, and increased platelet aggregation [21,22].

Aging itself is associated with a prothrombotic state, driven by chronic low-grade inflammation. Elevated levels of proinflammatory cytokines—such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α)—are commonly observed in older adults and are predictive of adverse health outcomes. The senescence-associated secretory phenotype (SASP) contributes to this inflammatory environment, enhancing thrombosis risk through endothelial dysfunction, venous stasis, and hypercoagulability. Comorbidities frequently observed in the elderly, including cancer, heart failure, and stroke, further exacerbate this prothrombotic state [23].

This study revealed that there is a significant correlation between the severity of immobilization and the risk of DVT in elderly patients, whereby the longer the immobilization period, the higher the risk of DVT. Prospects for Further Research Longitudinal design track patients over several months to see how changes in mobility affect DVT incidence. Comparative interventionss such as test different mobilization protocols (e.g., early physiotherapy vs. standard care) and measure their impact on clotting risk. Biomarker integration such as incorporate D‑dimer, thrombin‑generation assays, or ultrasound findings to refine risk stratification. CONFLICT OF INTEREST The authors declare no conflict of interest

1. Liu, Hao & Xing, Fei & Jiang, Jiabao & Chen, Zhao & Xiang, Zhou & Duan, Xin. (2024). Evaluating the Discriminative Capacity of a Random Forest Predictive Model for Deep Vein Thrombosis in Tibial Plateau Fracture Patients. 10.21203/rs.3.rs-4111703/v1.
2. Alanazi RM, Alanazi AA, Alenezi IQ, et al. Deep venous thrombosis in elderly patients as a surgical emergency at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Electron Physician. 2017;9(11):5754-5759. Published 2017 Nov 25. doi:10.19082/5754
3. Zhao K, Zhang J, Li J, Meng H, Hou Z, Zhang Y. Incidence of and risk factors for new-onset deep venous thrombosis after intertrochanteric fracture surgery. Sci Rep. 2021 Aug 27;11(1):17319. doi: 10.1038/s41598-021-96937-w. PMID: 34453081; PMCID: PMC8397722.
4. Zuo J, Hu Y. Admission deep venous thrombosis of lower extremity after intertrochanteric fracture in the elderly: a retrospective cohort study. J Orthop Surg Res. 2020 Nov 19;15(1):549. doi: 10.1186/s13018-020-02092-9. PMID: 33213498; PMCID: PMC7678067.
5. J. Engbers, J. W. . Blom, M. Cushman, F. R. Rosendaal, Van Hylckama Vlieg. The Contribution of Immobility in an older population. Journal of Thrombosis and Haemostasis.2013
6. Noor Nabila Ramli, Salfarina Iberahim, Noor Haslina Moh Noor et al. Haemostasis and Inflamatory Parameters as Potential Diagnostic Biomarkers for VTE in Trauma Immobilized Patients. 2022
7. Sarina L. Tschan. Daniel Bolliger. Coagulation and Aging: Implication for the Anestesiologist. Geriatric Anesthesia. 2021
8. Michelangelo Sartori, Elisabetta Favaretto, Benilde Cosmi. Relevance of Immobility as a risk factor for symptomatik proximal and isolated distal deep vein thrombosis in acutely ill medical inpatients. Vascular Medicine. 2021
9. Xinjun Wu, Zhen Li, Jing Cao. The Association between major complication of immobility during hospitalization and quality of life among bedridden patients: A 3 months prospective multi- center study.Plos One. 2018
10. Purwita W. Laksmi, Kuntjoro Harimurti, et al. Management of Immobilization and Its Complication for Elderly. Clinical Practice: Acta Med Indones- Indones J Intern Med. 2008
11. Idrus Alwi, Simon Salim, Rudy Hidayata, et al. Immobilisasi. Panduan Praktik Klinis. 2015
12. Pavihaa Lakshmi B and Vidhya S. “Exploring Effective Diagnostic and Therapeutic Strategies for Deep Vein Thrombosis in High-Risk Patients: A Study”. International Journal of Advanced Computer Science and Applications (IJACSA) 15.7 (2024). http://dx.doi.org/10.14569/IJACSA.2024.01507136
13. Torokulova, Karlygach & Bijalieva, G.S. & Akulich, E.N. & Mamytova, Elmira & Mamytova, J. & Akhmadeeva, Leila. (2024). Hospital predictors of deep vein thrombosis after ischemic stroke: A systematic review. Heart, Vessels and Transplantation. 10.24969/hvt.2024.459.
14. J. Engbers, J. W. Blom, M. Cushman, F. R. Rosendaal, A. Van Hylckama Vlieg. The Contribution of Immobility Risk Factors to the Incidence of Venous Thrombosis in an Older Population. Elsevier. 2014
15. Pottier, J.B. Hardouin, et al.Immobilization and the Risk of Venous Thromboembolism: A Meta-Analysis on Epidemiological Study. Elsevier. 2009
16. Marissa J. Engbers, et al. Functional Impairment and Risk of Venous Thrombosis in Older Adults. American Geriatric Society. 2017
17. Sébastien Weill-Engerer, MD, Sylvie Meaume, MD, et al. Risk Factors for Deep Vein Thrombosis in Inpatients Aged 65 and Older: A Case-Control Multicenter Study.American Geriatric Society. 2014
18. Piazza G, Seddighzadeh A, Goldhaber SZ. Deep-Vein Thrombosis in the Elderly. Clinical and Applied Thrombosis/ Hemostasis. 2008;14(4):393-398. doi:10.1177/1076029608317942
19. Park YU, Kim HN, Cho JH, Kim T, Kang G, Seo YW. Incidence and Risk Factors of Deep Vein Thrombosis after Foot and Ankle Surgery. Clin Orthop Surg. 2024 Dec;16(6):994-1000. doi: 10.4055/cios24163. Epub 2024 Nov 15. PMID: 39618525; PMCID: PMC11604552.
20. Zixuan L, Chen W, Li Y, Wang X, Zhang W, Zhu Y, Zhang F. Incidence of deep venous thrombosis (DVT) of the lower extremity in patients undergoing surgeries for ankle fractures. J Orthop Surg Res. 2020 Jul 31;15(1):294. doi: 10.1186/ s13018-020-01809-0. PMID: 32736663; PMCID: PMC7393865
21. Purwita W. Laksmi, Kuntjoro Harimurti, et al. Management of Immobilization and Its Complication for Elderly. Clinical Practice: Acta Med Indones- Indones J Intern Med. 2008
22. Idrus Alwi, Simon Salim, Rudy Hidayata, et al. Immobilisasi. Panduan Praktik Klinis. 2015
23. Dimitra Akrivou, Garifallia Perlepe, Paraskevi Kirgou, Konstantinos I. Gourgoulianis, Foteini Malli. Pathophysiological Aspects of Aging in Venous Thromboembolism: An Update. Medicina. 2022