Prevalence and facility level correlates of need for wheelchair seating assessment among long-term care residents.
BACKGROUND
Wheelchairs are frequently prescribed for residents with mobility impairments in long-term care. Many residents receive poorly fitting wheelchairs, compromising functional independence and mobility, and contributing to subsequent health issues such as pressure ulcers. The extent of this problem and the factors that predict poor fit are poorly understood; such evidence would contribute greatly to effective and efficient clinical practice in long-term care.


OBJECTIVE
To identify the prevalence of need for wheelchair seating intervention among residents in long-term care facilities in Vancouver and explore the relationship between the need for seating intervention and facility level factors.


METHODS
Logistic regression analysis using secondary data from a cross-sectional study exploring predictors of resident mobility. A total of 263 residents (183 females and 80 males) were randomly selected from 11 long-term care facilities in the Vancouver health region (mean age 84.2 ± 8.6 years). The Seating Identification Tool was used to establish subject need for wheelchair seating intervention. Individual item frequency was calculated. Six contextual variables were measured at each facility including occupational therapy staffing, funding source, policies regarding wheelchair-related equipment, and decision-making philosophy.


RESULTS
The overall prevalence rate of inappropriate seating was 58.6% (95% CI 52.6-64.5), ranging from 30.4 to 81.8% among the individual facilities. Discomfort, poor positioning and mobility, and skin integrity were the most common issues. Two facility level variables were significant predictors of need for seating assessment: ratio of occupational therapists per 100 residents [OR 0.11 (CI 0.04, 0.31)] and expectation that residents purchase wheelchair equipment beyond the basic level [OR 2.78 (1.11, 6.97)]. A negative association between facility prevalence rate and ratio of occupational therapists (r(p) = -0.684, CI -0.143 to -0.910) was found.


CONCLUSIONS
Prevalence of need for seating assessment in long-term care is high overall but it varies considerably between facilities. Increasing access to occupational therapy services appears to mediate this need.
Department of Occupational Therapy, University of Manitoba, Winnipeg, Canada. giesbre3@cc.umanitoba.ca
Edward M
EM
Giesbrecht
W Ben
WB
Mortenson
William C
WC
Miller
D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D020380:Needs Assessment; D009735:Nursing Homes; D009788:Occupational Therapy; D014910:Wheelchairs / Q000009:adverse effects / Q000706:statistics & numerical data