Acquired Deforming Hypertonia in Afro-Caribbeans: A Cross-Sectional Analysis in Long-Term Care Units

TL;DR

This study finds a high prevalence of acquired deforming hypertonia in elderly Afro-Caribbean residents of long-term care units in Martinique, highlighting the need for better recognition and care protocols.

Contribution

The paper reports the first study on ADH in the Caribbean population, revealing a significantly higher prevalence compared to Caucasian populations.

Findings

ADH prevalence in the Caribbean population was 77.8%, much higher than the 25.6% reported in French Caucasians.

ADH was often bilateral or multiple and caused significant functional and health issues.

High dependence levels were strongly associated with ADH presence.

Abstract

Background: Osteoarticular deformities or contractures in institutionalized elderly individuals, described as acquired deforming hypertonia (ADH), have a multifactorial origin. The reported prevalence of ADH in French Caucasian patients in long-term care units (LTCUs) is 25.6%. To date, ADH in the Caribbean population has never been studied. We aimed to assess the prevalence and characteristics of ADH in such a population. Materials and Methods: This was a cross-sectional observational study of a French Caribbean population in Martinique in which patients aged 75 years or older were institutionalized in LTCUs during the study period. Data extraction from the medical files of eligible LTCU patients was conducted to assess the prevalence, clinical characteristics, and impact of ADH on patients’ daily care. The assessments were performed collaboratively between the patients’ geriatric team and a PM&R physician. Results: In total, 81 patients were included, with an ADH prevalence of 77.8%. Reported ADH was bilateral (86%) or multiple (66% of patients had ≥5 ADH) and was responsible for major alterations in terms of hygiene, dressing, pain, and skin damage. ADH patients had a high level of dependence (GMP = 924), and this level of dependence was significantly associated with the presence of at least one ADH (p < 0.001) regardless of prior disease. Conclusions: The incidence of ADH in our Caribbean population seems twice as high as that in Caucasian patients, underlining the necessity for this nosological framework to be better recognized, particularly in an insular context. Local campaigns for the prevention and recognition of ADH must be considered, and targeted multidisciplinary protocols need to be established for adapted care in all institutions receiving elderly people.

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