Are There Racial-Ethnic Disparities in Time to Pressure Ulcer Development and Pressure Ulcer Treatment in Older Adults After Nursing Home Admission?

Gurvich, Olga V; Savik, Kay; Eberly, Lynn E.; Harms, Susan; Mueller, Christine A; Wyman, Jean F.; Garrard, Judith; Virnig, Beth A

doi:10.1177/0898264314553895

Cited by 26 publications

(33 citation statements)

References 35 publications

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“…We have previously reported that the characteristics of older adult admissions in this set of NHs are comparable to those in all Medicare/Medicaid certified NHs in the U. S. in the same time period (Bliss et al, 2015). The average age of admissions was approximately 80 years old with APIs and Whites among the oldest.…”

Section: Resultsmentioning

confidence: 65%

Racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission

Gurvich

Savik

Eberly

et al. 2017

Archives of Gerontology and Geriatrics

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Background Pressure ulcers increase the risk of costly hospitalization and mortality of nursing home residents, so timely healing is important. Disparities in healthcare have been identified in the nursing home population but little is known about disparities in the healing of pressure ulcers. Purpose To assess racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission. Multi-levels predictors, at the individual resident, nursing home, and community/Census tract level, were examined in three large data sets. Methods Minimum Data Set records of older individuals admitted to one of 439 nursing homes of a national, for-profit chain over three years with a stage 2–4 pressure ulcer (n=10,861) were searched to the 90-day assessment for the first record showing pressure ulcer healing. Predictors of pressure ulcer healing were analyzed for White admissions first using logistic regression. The Peters-Belson method was used to assess racial or ethnic disparities among minority group admissions. Results A significantly smaller proportion of Black nursing home admissions had their pressure ulcer heal than expected had they been part of the White group. There were no disparities in pressure ulcer healing disadvantaging other minority groups. Significant predictors of a nonhealing of pressure ulcer were greater deficits in activities of daily living and pressure ulcer severity. Conclusions Reducing disparities in pressure ulcer healing is needed for Blacks admitted to nursing homes. Knowledge of disparities in pressure ulcer healing can direct interventions aiming to achieve equity in healthcare for a growing number of minority nursing home admissions.

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Section: Resultsmentioning

confidence: 65%

Racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission

Gurvich

Savik

Eberly

et al. 2017

Archives of Gerontology and Geriatrics

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“…Our analysis revealed that African Americans had higher rates of recurrence. Previous reports have noted that African Americans have higher rates of pressure ulcer development 26 – 28 and display a noted increase in pressure ulcer recurrence after initial healing. 29 Poorer clinical and surgical outcomes in African Americans is a well-documented occurrence across different surgical specialties, 30 , 31 but the relationship remains poorly understood and is likely due to the interplay of multiple factors.…”

Section: Discussionmentioning

confidence: 92%

Flap Reconstruction for Pressure Ulcers: An Outcomes Analysis

Bamba

Madden

Hoffman

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:Historically, complication rates after pressure ulcer reconstruction utilizing flap coverage have been high. Patients undergoing operations for pressure ulcer coverage typically have multiple risk factors for postoperative complications. The purpose of this study was to examine a large patient series in the pressure ulcer population to uncover objective evidence of the linkage between risk factors and outcomes after flap coverage.Methods:This study was a retrospective chart review of patients who underwent flap reconstruction for a pressure ulcer between 1997 and 2015. The characteristics of patients were analyzed to determine those who had complications such as pressure ulcer recurrence, wound dehiscence, and wound infection.Results:All patients (N = 276) underwent flap coverage of their pressure ulcers. The overall complication rate was 58.7% (162 patients). Wound dehiscence was the most common complication (31.2%), and the pressure ulcer recurrence rate was 28.6%. Multivariate regression for pressure ulcer recurrence revealed that body mass index <18.5 [relative risk (RR) 3.13], active smoking (RR 2.33), and ischial pressure ulcers (RR 3.46) were independent risk factors for pressure ulcer recurrence. Ischial pressure ulcers (RR 2.27) and preoperative osteomyelitis (RR 2.78) were independent risk factors for wound dehiscence. Diabetes was an independent risk factor for wound infection (RR 4.34).Conclusions:Our retrospective analysis revealed numerous factors that are associated with high rates of major postoperative complications. Risk factors must be taken into account when offering flap coverage, and risk-reducing strategies must be implemented in patients before pressure ulcer reconstruction.

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“…Procedures are described in more detail elsewhere. 31 The sociodemographic and socioeconomic characteristics of the communities in the US Census tracts of the nursing homes included the proportions or percentages of the community that was female or male under < 65 years or ≥65 years old, part of a racial or ethnic minority group, completed 1–8 years or 9–16 years of education, and resided in an urban or rural area. Others community level variables included the proportion of the tract that was working class or below poverty level, as well as the median home value in the tract.…”

Section: Methodsmentioning

confidence: 99%

Incidence and Predictors of Incontinence-Associated Skin Damage in Nursing Home Residents With New-Onset Incontinence

Bliss

Mathiason

Gurvich

et al. 2017

Journal of Wound, Ostomy &Amp; Continence Nursing

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Purpose The purpose of this study was to determine the incidence and predictors of incontinence associated dermatitis (IAD) in nursing home residents. Methods Records of a cohort of 10,713 elderly (aged 65+) newly incontinent nursing home residents in 448 nursing homes in 28 states free of IAD were followed for IAD development. Potential multi-level predictors of IAD were identified in four national datasets containing information about the characteristics of individual nursing home residents, nursing home care environment, and communities in which the nursing homes were located. A unique set of health practitioner orders provided information about IAD and the predictors of IAD prevention and pressure injuries in the extended perineal area. Analysis was based on hierarchical logistical regression. Results The incidence of IAD was 5.5%. Significant predictors of IAD were not receiving preventive interventions for IAD, presence of a perineal pressure injury, having greater functional limitations in activities of daily living, more perfusion problems, and lesser cognitive deficits. Conclusion Findings highlight the importance of prevention of IAD and treatment/prevention of pressure injuries. A Wound Ostomy and Continence (WOC) nurse offers expertise in these interventions and can educate staff about IAD predictors which can improve resident outcomes. Other recommendations include implementing plans of care to improve functional status, treat perfusion problems, and provide assistance with incontinence and skin care to residents with milder as well as greater cognitive deficits.

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Are There Racial-Ethnic Disparities in Time to Pressure Ulcer Development and Pressure Ulcer Treatment in Older Adults After Nursing Home Admission?

Cited by 26 publications

References 35 publications

Racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission

Racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission

Flap Reconstruction for Pressure Ulcers: An Outcomes Analysis

Incidence and Predictors of Incontinence-Associated Skin Damage in Nursing Home Residents With New-Onset Incontinence

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