Contractures with special reference in elderly: definition and risk factors - a systematic review with practical implications.

PURPOSE: Contractures are common problems for the elderly with far reaching functional and medical consequences. The aim of this systematic literature review was to give an overview of contracture and to identify potential risk factors associated with contractures. METHODS: A systematic literature search with two objectives limited to the last 10 years was performed to identify studies dealing with definition of contracture (objective 1 = O1) and with risk factors (objective 2 = O2). Predefined information including age, sample size, study design, setting, condition, joint, definition of contracture, mode of measurement, and whether inter- and/or intra-rater reliability were assessed, as well as risk factors of contracture were extracted. RESULTS: One hundred and sixty one and 25 studies were retrieved. After applying exclusion criteria 47 studies (O1) and 3 studies (O2) remained. Only 9 studies (O1) provided a definition of contracture. In 3 studies (O2) several potential risk factors were identified. CONCLUSIONS: In most of the studies it seems that the presence of a contracture is equivalent with the presence of restriction in the range of motion (ROM) of a joint. Very little is known about risk factors for contractures. But it seems that immobility may play a pivotal role in the development of this condition. IMPLICATION FOR REHABILITATION: The prevalence of contractures in nursing home residents is estimated at 55% with significant functional and medical consequences. In most studies, which were published in the last 10 years, the presence of a contracture is equivalent with the presence of restriction in the range of motion of a joint. Immobility seems to play a role in the development of contractures. Potential avenues to prevention of contractures and subsequent functional limitations are exercise programmes for and maintenance of mobility of the elderly.

[Quality of life in the focus of quality audits in long-term care]. / Lebensqualität im Fokus des Qualitätsaudits in der Langzeitpflege.

Quality of life - an important outcome factor of long-term care - development and psychometric testing of an audit instrument, the Quality of Life Index, (QoL index"), to assess the consideration for individual quality of life aspects during the care process in long-term care settings is evaluated - even for clients with limited communication skills.A stratified random sample of n=209 residents was drawn out of the population of N=1 128 residents of 8 nursing homes and their individual QoL-aspects were assessed with SEIQoL-DW or in difficult communication situations with "LQ-Index-Informationssammlung". The LQ-Index's new items were validated via a parallel testing with the reference instrument SEIQoL-DW, the split half-reliability, the interrater reliability (Kappa) and a structured expert review according to the cognitive interview technique.All 209 participants were assessed via LQ-Index. The SEIQoL-Interview was completed and estimated valid by 18 (8.61%) residents. The psychometric testing results and the expert review indicate high feasibility, good reliability, validity and objectivity of the instrument "LQ-Index".As a result of this study a feasible and valid instrument is now available to assess the consideration for individual quality of life aspects during the care process in long-term care settings - even for clients with limited communication skills.