Poster 100: Prevalence and Impact of Spasticity in a Single Nursing Home

Objective: To determine the prevalence, causes, provider recognition, and treatment of spasticity in the long-term care setting. When spasticity is present, to determine what activities of daily living (ADLs) are most affected, and resident preferences among the available treatments. Design: Prospective population survey. Setting: A 240-bed long term care facility in Tennessee. Participants: 215 nursing home residents (86 men, 129 women, age range, 13–108y). Interventions: Not applicable. Main Outcome Measures: The presence of spasticity was determined by physical examination. Provider recognition, etiology, and treatment were determined by medical record review. ADLs impact was determined by minimum data set (MDS) extraction and caregiver interview. Treatment preferences were determined by resident interview when the resident had an MDS cognitive recall score of 2 or higher. Results: 45 residents (21%) had spasticity. Etiologies were stroke (74%), multiple sclerosis (7%), traumatic brain injury (4%), cerebral palsy (2%), other neurologic disease (4%), and unknown (9%). 5 (11%) had a previous diagnosis of spasticity in the medical record. 6 (13%) were currently being treated with oral baclofen (4), neurotoxin injections (1) or physical therapy (1). 30% of residents with spasticity needed complete assistance (MDS score of 4) with bathing, transferring, and dressing, compared with 5% of residents without spasticity but with neurologic disease. Spasticity was identified by the primary direct caregiver as interfering with at least 1 ADLs in 32 participants (71%). Potential treatment goals included diaper change, hygiene, dressing, splint application, and transfer to wheelchair. 17 residents (62% of those with spasticity) completed the treatment preferences interview. Neurotoxin injections and oral medications were the most popular treatment options (77% were interested) and intrathecal baclofen was the least popular treatment option (42% were interested). 82% of residents were willing to consider at least 1 available treatment. Conclusions: The prevalence of spasticity is high in the long-term care setting, and when present is usually undocumented and untreated. The presence of spasticity makes delivery of ADLs care more difficult and time consuming.