Contractures: Prevalence and Associated Factors in Hospitals and Nursing Homes-Results From Two Consecutive Multicenter Cross-Sectional Studies.

INTRODUCTION

Contractures frequently may occur in nursing homes and hospitals among predominantly immobile patients and significantly reducing their mobility and quality of life. This study examines the prevalence of contractures among older people in nursing homes and hospitals and shows how often which joint is affected and identifies associated factors.

DESIGN

Two consecutive multicenter cross-sectional studies (2017 and 2018) involving 2012 individuals aged 65 and older in 12 hospitals and 10 nursing homes.

METHODS

Bootstrapping was used to calculate the confidence intervals of the prevalence of contractures in different groups. A multivariable logistic regression model was run comprising all relevant independent associated factors for the presence of contractures.

RESULTS

The overall prevalence of contractures was 11.6% (95% CI 10.2-13.1). In hospitals, the prevalence was 7.7% (95% CI 6.3-9.2), and in nursing homes, it was 19.3% (95% CI 16.3-22.4). Overall, contractures of the upper extremities were more common among nursing home residents (NH) than among hospital patients (H). This pattern was particularly evident for the hands (NH: 30.8 right, 32.9% left vs. H: 21.5% right, 17.7 left), elbows (NH: 21.9 right, 26.0% left vs. H: 10.8% right, 9.5 left), and shoulders (NH: 28.8 right, 29.5% left vs. H: 18.4% right, 14.6 left). For the lower extremities, a more heterogeneous pattern was observed.

STATISTICAL ANALYSIS: The logistic regression model showed that the odds ratio for having at least one contracture for nursing home residents compared with hospital patients was 3.50 (95% CI 2.30-5.19), for age (years) 0.97 (95% CI 0.95-0.99), for urinary incontinence 1.65 (95% CI 1.14-2.38), and for bedridden status 4.15 (95% CI 2.88-5.97).

CONCLUSION

This study highlights a high prevalence of contractures, particularly in nursing homes compared with hospitals. Identified associated factors such as urinary incontinence and bedridden status may represent potential targets for preventive and nursing interventions, although causal relationships cannot be inferred from this cross-sectional design. Improved understanding of the prevalence and associated factors of contractures can help enhance quality of care and reduce contracture risk in older, immobile patients, especially in long-term care settings.