Abstract
Background
Joint contractures are a common phenomenon in older persons and are assessed by measuring the range of motion; however, little is known about the impact of joint contractures on activities of daily living (ADL).
Objectives
The aim of the study was to identify problems related to joint contracture of older persons in a geriatric setting using the international classification of functioning, disability and health (ICF) as a framework.
Material and methods
A cross-sectional study was conducted between February and July 2013 in nursing homes (n = 11) and geriatric rehabilitation hospitals (n = 3) in North Rhine-Westphalia, Germany. The study population included persons aged ≥ 65 years with at least one diagnosis of joint contracture. If the participant was unable to adequately answer the best informed next of kin or staff nurse acted as a proxy. A questionnaire with 124 ICF categories was completed through face-to-face interviews with the participants.
Results
A total of 149 participants were included in the study. The mean age was 77.6±6.9 years and 69.8 % were women. Problems in climbing (94.0 %), walking long distances (92.6 %) and kneeling (92.6 %) were most frequently identified. The most often identified facilitators in environmental factors were health services, systems and policies (93.2 %), whereas the leading barrier was climate (30.3 %).
Conclusion
Joint contractures have a huge impact on functioning and social participation and particularly on personal mobility. From the nursing and rehabilitation perspective, assessments should not only measure joint mobility but also determine and quantify the consequences of contractures on ADL.
Zusammenfassung
Hintergrund
Gelenkkontrakturen bei älteren Menschen sind ein verbreitetes Phänomen. Sie werden durch die Messung der Gelenkbeweglichkeit erfasst. Über ihre Auswirkungen auf Aktivitäten des täglichen Lebens („activities of daily living“, ADL) ist bisher wenig bekannt.
Ziel der Arbeit
Identifikation von Problemen, die sich durch Gelenkkontrakturen für ältere Menschen in einem geriatrischen Setting ergeben. Als Rahmen wird das Klassifizierungssystem ICF (International Classification of Functioning, Disability and Health) verwendet.
Material und Methoden
Zwischen Februar und Juli 2013 wurde eine Querschnittsstudie in 11 Pflegeheimen und 3 geriatrischen Rehabilitationskliniken in Nordrhein-Westfalen durchgeführt. Die Teilnehmer (≥ 65 Jahre, ≥ 1 Diagnose Gelenkkontraktur), bei eingeschränkter Selbstauskunft ihre Angehörigen/Pflegenden („proxy“) wurden mittels eines Fragebogens (124 ICF-Kategorien) in einem persönlichen Interview befragt.
Ergebnisse
Das Durchschnittsalter der 149 Teilnehmer lag bei 77,6 Jahren (SD: 6,9); 69,8 % waren weiblich. Die am häufigsten benannten Probleme bestanden beim Treppensteigen („climbing“, 94,0 %), beim Gehen langer Strecken (92,6 %) und beim Knien“(92,6 %). Die Kategorie „Dienste, Systeme und Handlungsgrundsätze des Gesundheitswesens“ (93,2 %) wurde als häufigster begünstigender Umweltfaktor benannt und die Kategorie Klima (30,3 %) als häufigste Barriere.
Diskussion
Kontrakturen haben einen erheblichen Einfluss auf die Funktionsfähigkeit und soziale Teilhabe, insbesondere auf die individuelle Mobilität. Aus pflegefachlicher und rehabilitativer Perspektive sind daher Assessment-Instrumente wünschenswert, mit denen sich über die funktionale Beweglichkeitsmessung hinaus die Auswirkungen von Kontrakturen auf die ADL ermitteln und quantifizieren lassen.
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Acknowledgement
The project is funded by the German Federal Ministry of Education and Research (grant number: 016Y1113A).
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G. Bartoszek, U. Fischer, G. Eva, M. Müller, S. Nadolny and G. Meyer declare that they have no conflicts of interest.
The study protocol was approved by the ethics committee of the German Society of Nursing Science (month of approval: January 2013). All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its most recently amended version). Informed consent was obtained from all patients included in the study.
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Bartoszek, G., Fischer, U., Grill, E. et al. Impact of joint contracture on older persons in a geriatric setting. Z Gerontol Geriat 48, 625–632 (2015). https://doi.org/10.1007/s00391-015-0895-y
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DOI: https://doi.org/10.1007/s00391-015-0895-y
Keywords
- Questionnaire
- Activities of daily living
- Outcome assessment health care
- Geriatric nursing
- Social participation