Factors Associated with Development of New Joint Contractures in Long-Term Care Residents

TitleFactors Associated with Development of New Joint Contractures in Long-Term Care Residents
Publication TypeJournal Article
Year of Publication2022
AuthorsLam K, Kwan JSK, Kwan CWai, Chi I
JournalJournal of the American Medical Directors Association
ISBN Number1525-8610
Keywords*joint contracture, *long term care, age, Aged, article, controlled study, Female, geriatric patient, Hong Kong, Human, longitudinal study, major clinical study, Male, neurologic disease, nurse, nursing home, observational study, outcome assessment, physiotherapist, Prevalence, range of motion, risk factor, social worker, upper limb, very elderly, walking difficulty

Objective: Limb contractures are associated with poor outcomes and quality of life in long-term care (LTC) residents. This study examined the rate of developing new joint contracture in the LTC residents and associated risk factors to formulate effective interventions in this critical but understudied area. Design(s): This is an observational study with data obtained from the Hong Kong Longitudinal Study on LTC Residents between 2005 and 2016. Setting and Participants: Trained assessors (nurses, social workers, and therapists) used the Minimum Data Set Resident Assessment Instrument (MDS-RAI 2.0) to collect the data of the residents from 9 residential LTC facilities. Measures: Limb contractures were defined as a functional limitation in the range of motion involving the upper or lower limbs. Primary outcomes included annual prevalence of joint contractures and factors that were associated with the development of new joint contractures. Result(s): We analyzed the data for 1914 older residents (674 males, mean age 83.4 years). During the first 5 years since admission, the annual prevalence of upper limb contractures increased from 29.8% to 36.5%, and lower limb contractures increased from 41.5% to 57.4%. Overall, the increment of the prevalence rate of joint contractures per year ranged from 0.7% to 3.2% for the upper limbs and 0.3% to 6.0% per year for the lower limbs. Impaired mobility, presence of neurologic diseases, and older age were the leading independent risk factors for the development of new joint contractures. Conclusions and Implications: Joint contractures are highly prevalent among residents admitted to the LTC facilities, and many residents develop new contractures during the first 5 years of their admission. Immobility appears to be the main modifiable risk factor. Further studies are needed to identify potential strategies to prevent new contractures in this vulnerable group.Copyright © 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine