Severe Spastic Contractures and Diabetes Mellitus Independently Predict Subsequent Minimal Trauma Fractures Among Long-Term Care Residents

Autor: Chi Wai Kwan, Man Fuk Leung, Kuen Lam, Joseph Kwan
Rok vydání: 2016
Předmět:
Activities of daily living
Geriatrics & Gerontology
Nursing(all)
1110 Nursing
Contractures
Nursing care
Fractures
Bone
0302 clinical medicine
Spastic
risk factors
030212 general & internal medicine
Longitudinal Studies
General Nursing
Aged
80 and over
Medicine(all)
Incidence (epidemiology)
Incidence
Health Policy
spasticity
NURSING-HOME RESIDENTS
General Medicine
Middle Aged
Muscle Spasticity
Hong Kong
medicine.symptom
Life Sciences & Biomedicine
medicine.medical_specialty
Contracture
Modified Ashworth scale
1117 Public Health and Health Services
LIKELIHOOD
03 medical and health sciences
BONES
PEOPLE
medicine
Diabetes Mellitus
Humans
Spasticity
Muscle contracture
Aged
Science & Technology
business.industry
HIP FRACTURE
1103 Clinical Sciences
Long-Term Care
Nursing Homes
minimal trauma fracture
DEFINITION
Geriatrics
Physical therapy
RISK-FACTORS
Geriatrics and Gerontology
business
030217 neurology & neurosurgery
Forecasting
Zdroj: Journal of the American Medical Directors Association. 17(11):1025-1030
ISSN: 1525-8610
DOI: 10.1016/j.jamda.2016.06.029
Popis: Objective The study aimed to examine the epidemiology of hypertonic contractures and its relationship with minimal trauma fracture (MTF), and to determine the incidence and predictors of (MTF) in long-term care residents. Design This was a longitudinal cohort study of prospectively collected data. Participants were followed from March 2007 to March 2016 or until death. Setting A 300-bed long-term care hospital in Hong Kong. Participants All long-term care residents who were in need of continuous medical and nursing care for their activities of daily living. Measurements Information on patients' demographic data, severe contracture defined as a decrease of 50% or more of the normal passive range of joint movement of the joint, and severe limb spasticity defined by the Modified Ashworth Scale higher than grade 3, medical comorbidities, functional status, cognitive status, nutritional status including body mass index and serum albumin, past history of fractures, were evaluated as potential risk factors for subsequent MTF. Results Three hundred ninety-six residents [148 males, mean ± standard deviation (SD), age = 79 ± 16 years] were included for analysis. The presence of severe contracture was highly prevalent among the study population: 91% of residents had at least 1 severe contracture, and 41% of residents had severe contractures involving all 4 limbs. Moreover, there were a significant proportion of residents who had severe limb spasticity with the elbow flexors (32.4%) and knee flexors (33.9%) being the most commonly involved muscles. Twelve residents (3%) suffered from subsequent MTF over a median follow-up of 33 (SD = 30) months. Seven out of these 12 residents died during the follow-up period, with a mean survival of 17.8 months (SD = 12.6) after the fracture event. The following 2 factors were found to independently predict subsequent MTF in a multivariate Cox regression: bilateral severe spastic knee contractures (hazard ratio = 16.5, P < .0001, confidence interval 4.8–56.4) and diabetes mellitus (hazard ratio = 4.0. P = .018, confidence interval 1.3–12.7). Conclusions Severe spasticity and contractures are common morbidities in long-term care residents, and bilateral severe spastic knee contractures and diabetes mellitus are 2 independent predictors of subsequent MTF. Spasticity management and prevention of contractures, combined with educational programs for caregivers to identify the high-risk residents and apply proper handling techniques during routine care, may be helpful in reducing the risk of MTF in long-term care residents. Further large-scale longitudinal studies are needed to confirm these findings.
Databáze: OpenAIRE
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