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

Abstract

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.

Time to and predictors of dual incontinence in older nursing home admissions

“…Furthermore, our analysis is the first to quantify the risk that a resident would develop dual incontinence and model the time from admission to developing the incontinence. Our model also adjusted for Black race and Hispanic ethnicity of nursing home residents which builds on recent knowledge about racial and ethnic disparities in incontinence prevention and cure/resolution . Another strength of our study is the consideration/screening of predictors of dual incontinence not only at the resident level but at the nursing home and community levels.…”

“…Potential predictors included in the model for time to dual incontinence were age, limitations in ADLs, co‐morbidities, cognitive deficits, having only urinary or only fecal incontinence at nursing home admission (reference group was being continent), deficiencies in nursing home quality of care, and percentage of nursing home residents receiving Medicaid. Because previous analyses showed disparities for Black and Hispanic residents for other incontinence‐related outcomes, Black race, and Hispanic ethnicity were included in the model and the reference group was all other races combined (ie, White, American Indian, and Asian).…”

“…The findings of Nelson et al suggest that racial and ethnic disparities in nursing home care may contribute to the development of dual incontinence. Our team has reported racial disparities in prevention of any incontinence for older Black residents and in resolution/cure of any incontinence for older Hispanic residents . Social epidemiologists assert that analysis of individual level factors is insufficient to assess population‐level, complex problems such as incontinence in nursing homes and that group level (ie, nursing home and community) factors must be considered .…”

Couple-kissing flaps for successful repair of severe sacral pressure ulcers in frail elderly patients

“…For neurologically impaired patients or critically ill patients stayed in the intensive care unit, the incidence may be much higher—from 9% to 34.4% [ 7 – 10 ]. Pressure ulcers are a major health safety hazard as they increase the risk of expensive hospitalization and death [ 11 ]. The overall prevalence of stage 2–4 PUs at nursing home admission in the United States ranges between 5% and 20%, and the costs to treat severe PUs were found to be substantially higher and entail a substantial financial concern for all involved parties [ 11 , 12 ].…”

“…Pressure ulcers are a major health safety hazard as they increase the risk of expensive hospitalization and death [ 11 ]. The overall prevalence of stage 2–4 PUs at nursing home admission in the United States ranges between 5% and 20%, and the costs to treat severe PUs were found to be substantially higher and entail a substantial financial concern for all involved parties [ 11 , 12 ]. The more severe the pressure ulcer, the more costly and longer time to heal.…”