Elsevier

Geriatric Nursing

Volume 29, Issue 4, July–August 2008, Pages 259-266
Geriatric Nursing

Feature article
Contractures in Frail Nursing Home Residents

https://doi.org/10.1016/j.gerinurse.2007.09.002Get rights and content

Contractures are a common but preventable consequence of prolonged physical immobility among nursing home residents. Significant for their associated costs in institutions rendering care to frail elder residents, contractures further reduce mobility and increase the risk of other outcomes of decreased mobility, such as pressure ulcers. This secondary analysis examines the prevalence of contractures in 273 residents who participated in an interventional study focusing on reducing restrictive siderails. Almost two thirds of the participants had at least 1 contracture, with the most common locations being the shoulder and knee. Presence of pain and being non-White were significant predictors of contracture presence. This study highlights the high prevalence of contractures, the underlying factors associated with them, and the need to prevent or minimize contracture formation, including the role restorative nursing care plays in this avoidable condition.

Section snippets

Design, Participants, and Setting

This study was a descriptive correlational design using secondary data collected in an intervention study conducted in 4 medium-sized (range: 120–235 beds) nursing homes in the metropolitan Philadelphia area.14, 15 First, observation methods were used to evaluate restrictive siderail usage in each nursing home. All residents identified with restrictive siderails (defined as 2 full-length or 4 half-length raised siderails) at baseline were eligible to participate in the primary study. A total of

Results

The mean age of all residents in the sample was 83.69 years (SD = 9.39). The majority were female (72%) and White (69%), and their payor source was Medicaid (65%). Table 1 presents the prevalence of contractures. A total of 480 contractures were identified. Over 60% of the sample (n = 167) had at least 1 contracture, with 45.4% having 2 or more contractures. The most frequent joints affected were the shoulder (44%) and the knee (44%).

Table 2 compares demographic, physical and mental health

Discussion

This study identified a high prevalence of contractures among nursing home residents—twice the national average reported by Harrington and colleagues.1 The participants in this study were selected based on siderail use for the primary study14 and thus represent cognitively aware residents who were still functionally able to transfer in and out of bed and also included cognitively impaired residents who were at risk for falls. Because this study did not follow individuals over time from

Acknowledgments

This study was funded by the John A. Hartford Foundation Building Academic Geriatric Nursing Capacity Scholars Program, the John A. Hartford Foundation Institute for Geriatric Nursing, and NOVARTIS Foundation for Gerontological Research.

LAURA M. WAGNER, PhD, RN, GNP-BC, is a gerontological nursing research scientist at Kunin-Lunenfeld Applied Research Unit at Baycrest, Toronto, Ontario, Canada.

References (45)

  • S. Selikson et al.

    Risk factors associated with immobility

    J Am Geriatr Soc

    (1988)
  • P.R. Mobily et al.

    Iatrogenesis in the elderly: factors of immobility

    J Gerontol Nurs

    (1991)
  • A. Rabiner et al.

    Characteristics of nursing home residents with contractures

    Phys Occup Ther Geriatr

    (1995)
  • L.E.M. Souren et al.

    Contractures and loss of function in patients with Alzheimer's disease

    J Am Geriatr Soc

    (1995)
  • P.S. Timiras

    Disuse and aging: same problem, different outcomes

    J Gravit Physiol

    (1994)
  • K. Walsh et al.

    Mobility in old age

    Gerodontology

    (1999)
  • B.A. Nuismer et al.

    The use of low-load prolonged stretch devices in rehabilitation programs in the Pacific Northwest

    Am J Occup Ther

    (1997)
  • P. Fox et al.

    Effectiveness of a bed positioning program for treating older adults with knee contractures who are institutionalized

    Phys Ther

    (2000)
  • C.D. Mulrow et al.

    A randomized trial of physical rehabilitation for very frail nursing home residents

    JAMA

    (1994)
  • J.F. Schnelle et al.

    Exercise with physically restrained nursing home residents: maximizing benefits of restraint reduction

    J Am Geriatr Soc

    (1996)
  • E. Capezuti et al.

    Consequences of an intervention to reduce restrictive siderail use in nursing homes

    J Am Geriatr Soc

    (2007)
  • L.M. Wagner et al.

    Description of an advanced practice nursing consultative model to reduce restrictive siderail use in nursing homes

    Res Nurs Health

    (2007)
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    LAURA M. WAGNER, PhD, RN, GNP-BC, is a gerontological nursing research scientist at Kunin-Lunenfeld Applied Research Unit at Baycrest, Toronto, Ontario, Canada.

    ELIZABETH CAPEZUTI, PhD, RN, FAAN, GNP-BC, is an associate professor and the codirector of the John A. Hartford Foundation Institute for Geriatric Nursing, New York University College of Nursing, New York, New York.

    BARBARA L. BRUSH, PhD, RN, FAAN, APN-BC, is an associate professor and co-coordinator of the family nurse practitioner program, Health Promotion and Risk Reduction Programs, University of Michigan School of Nursing, Ann Arbor.

    CAROLYN CLEVENGER, DNP, RN, GNP-BC, is a clinical assistant professor, Emory University School of Nursing, Atlanta, Georgia.

    MARIE BOLTZ, PhD, RN, GNP-BC, is an assistant professor and practice director, The Hartford Institute for Geriatric Nursing, New York University College of Nursing, New York, New York.

    SUSAN RENZ, MSN, RN, GNP-BC, is a consultant in gerontology and long-term care, RS Connection, Inc. West Chester, Pennsylvania.

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