Pressure ulcers in elderly patients with hip fracture across the continuum of care: Clinical investigations

Mona Baumgarten, David J. Margolis, Denise L. Orwig, Michelle D. Shardell, William G. Hawkes, Patricia Langenberg, Mary H. Palmer, Patricia S. Jones, Patrick F. McArdle, Robert Sterling, Bruce P. Kinosian, Shayna E. Rich, Janice Sowinski, Jay Magaziner

Research output: Contribution to journalArticlepeer-review

50 Scopus citations

Abstract

OBJECTIVES: To identify care settings associated with greater pressure ulcer risk in elderly patients with hip fracture in the postfracture period. DESIGN: Prospective cohort study. SETTING: Nine hospitals that participate in the Baltimore Hip Studies network and 105 postacute facilities to which patients from these hospitals were discharged. PARTICIPANTS: Hip fracture patients aged 65 and older who underwent surgery for hip fracture. MEASUREMENTS: A full-body skin examination was conducted at baseline (as soon as possible after hospital admission) and repeated on alternating days for 21 days. Patients were deemed to have an acquired pressure ulcer (APU) if they developed one or more new stage 2 or higher pressure ulcers after hospital admission. RESULTS: In 658 study participants, the APU cumulative incidence at 32 days after initial hospital admission was 36.1% (standard error 2.5%). The adjusted APU incidence rate was highest during the initial acute hospital stay (relative risk (RR)=2.2, 95% confidence interval (CI)=1.3-3.7) and during re-admission to the acute hospital (RR=2.2, 95% CI=1.1-4.2). The relative risks in rehabilitation and nursing home settings were 1.4 (95% CI=0.8-2.3) and 1.3 (95% CI=0.8-2.1), respectively. CONCLUSION: Approximately one-third of hip fracture patients developed an APU during the study period. The rate was highest in the acute setting, a finding that is significant in light of Medicare's policy of not reimbursing hospitals for the treatment of hospital-APUs. Hip fracture patients constitute an important group to target for pressure ulcer prevention in hospitals.

Original languageEnglish (US)
Pages (from-to)863-870
Number of pages8
JournalJournal of the American Geriatrics Society
Volume57
Issue number5
DOIs
StatePublished - May 2009
Externally publishedYes

Keywords

  • Hip fracture
  • Hospitals
  • Pressure ulcers

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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