Prevalence of pressure ulcers on hospital admission among nursing home residents transferred to the hospital

Authors

  • Eithne Keelaghan MD, MS,

    1. Maryland Department of Health and Mental Hygiene, Baltimore, Maryland,
    2. Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland, and
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  • David Margolis MD, PhD,

    1. Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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  • Min Zhan PhD,

    1. Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland, and
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  • Mona Baumgarten PhD

    1. Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland, and
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Reprint requests:
Dr. Mona Baumgarten, PhD, 660 West Redwood Street, Suite 200, Baltimore, MD 21201.
Tel: +410 706 1531;
Fax: +410 706 4433;
Email: mbaumgar@epi.umaryland.edu

ABSTRACT

The purpose of this study was to compare the prevalence of pressure ulcers among newly hospitalized nursing home residents and among newly hospitalized patients from nonnursing home settings. Study participants were at least 65 years old and admitted through the emergency department to one of two study hospitals. Research nurses ascertained the presence of pressure ulcers (stage 1–4) by visual skin assessment on the third day following admission to the hospital unit. Other data were collected by clinical examination, interview, and medical record review. The prevalence of preexisting pressure ulcers at the time of admission was 26.2% among those admitted from a nursing home and 4.8% among those admitted from another living situation (odds ratio 5.5, 95% confidence interval 4.3–7.1). After adjustment for confounders, the association between admission from a nursing home and pressure ulcer prevalence on admission was reduced (odds ratio 1.51, 95% confidence interval 1.03–2.23). These results indicate that admission from a nursing home is a potent marker for pressure ulcer risk and that the excess risk is largely mediated by the higher prevalence of pressure ulcer risk factors among patients admitted from a nursing home. The results highlight the importance of continuity of care across transitions between care settings.

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