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Yap TL, Alderden J, Gadhoumi K, Horn SD, Sonenblum SE, Hays JC, Kennerly SM. Movement and Pressure Injury Prevention Care for Nursing Home Residents: Addressing the Nescience. Adv Skin Wound Care 2024; 37:369-375. [PMID: 38899818 PMCID: PMC11207196 DOI: 10.1097/asw.0000000000000165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To compare movement associated with position changes among nursing home residents who remain in lying versus upright positions for more than 2 hours and among residents living with obesity, dementia, or neither condition. METHODS The authors conducted a descriptive exploratory study using secondary data (N = 934) from the Turn Everyone And Move for Ulcer Prevention (TEAM-UP) clinical trial to examine transient movements (<60 seconds) within prolonged periods of 2 to 5 hours without repositioning. RESULTS Nursing home residents exhibit significantly more episodic transient movements when upright than lying. Residents with obesity or dementia exhibited similar frequencies of episodic transient movements compared with residents with neither obesity nor dementia. Upright or lying movements were more frequent among residents with obesity than among those with neither obesity nor dementia selectively when prolonged events ranged from 2 to 4 hours. Pairwise comparisons of movement rates among resident subgroups (living with obesity, living with dementia, or neither group) across repositioning intervals showed episodic transient movements were significantly higher across all subgroups for repositioning intervals up to 3 hours when compared with repositioning intervals of greater than 3 hours. CONCLUSIONS Findings challenge assumptions that nursing home residents are inactive and at risk for prolonged sitting. These preliminary findings, along with TEAM-UP findings where no pressure injuries occurred in up to 5 hours in prolonged positions, support establishing a standard 3-hour repositioning interval with use of high-density mattresses without a negative impact on pressure injury occurrence. There should be caution when considering repositioning intervals greater than 3 hours. Further research is indicated to explore protective effect of episodic transient movements of other subgroups.
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Affiliation(s)
- Tracey L Yap
- Tracey L. Yap, PhD, RN, CNE, WCC, FGSA, FAAN, is Professor, School of Nursing, Duke University, Durham, North Carolina, USA. Jenny Alderden, PhD, APRN, is Associate Professor, Boise State University, Boise, Idaho. Kais Gadhoumi, PhD, is Assistant Professor, School of Nursing, Duke University. Susan D. Horn, PhD, is Consultant, Salt Lake City, Utah. Sharon Eve Sonenblum, PhD, is Associate Research Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia. Judith C. Hays, PhD, FGSA, is Associate Research Professor Emerita, School of Nursing, Duke University. Susan M. Kennerly, PhD, RN, CNE, WCC, FAAN, is Professor, College of Nursing, East Carolina University, Greenville, North Carolina
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Jia YJ, Yu HR, Hu FH, Tang W, Zhang WQ, Ge MW, Shen LT, Du W, Cai B, Xu H, Xia XP, Chen HL. Body mass index and pressure injuries risk in hospitalized adult patients: A dose-response analysis. J Tissue Viability 2024:S0965-206X(24)00081-0. [PMID: 38886143 DOI: 10.1016/j.jtv.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/13/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The association between underweight and pressure injuries (PIs) has been established in several studies. However, there is a lack of well-designed research investigating the connection between overweight and obesity with these injuries. OBJECTIVE This meta-analysis aims to investigate the dose-response relationship between body mass index (BMI) and the risk of PIs in adult hospitalized patients. METHODS PubMed, Web of Science, and MEDLINE Databases were searched from inception to May 2024. Observational articles with at least three BMI categories were included in the study. BMI was defined as underweight, normal weight, overweight, and morbid obesity for the meta-analysis. The non-linear relationship between BMI and the risk of PIs in hospitalized adults was investigated using restricted cubic spline models. Fractional polynomial modeling was used. RESULTS Eleven articles reporting at least 3 categories of BMI met the inclusion criteria, including 31,389 participants. Compared to patients with normal weight, those with underweight, obesity, and morbid obesity exhibited an increased risk of PIs, with odds ratios of 1.70 (95%CI:1.50-1.91), 1.12 (95%CI:1.02-1.24), 1.70 (95%CI:1.13-2.55), respectively. A J-shaped dose-response model was established for the relationship between PI risk and BMI (Pnon-linearity < 0.001, Plinearity = 0.745). CONCLUSION The J-shaped dose-response pattern revealed that underweight, obesity and morbid obesity heightened the risk of PIs in hospitalized adults. Lower and higher BMI values may signify an increased risk for PIs, particularly among the elderly with lower BMI, providing valuable guidance for medical staff.
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Affiliation(s)
- Yi-Jie Jia
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Hai-Rong Yu
- Nursing Department, Affiliated Hospital of Nantong University, Nantong, Jiangsu, PR China
| | - Fei-Hong Hu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wen Tang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wan-Qing Zhang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Meng-Wei Ge
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Lu-Ting Shen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wei Du
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Bo Cai
- Nantong Chongchuan District Center for Disease Control and Prevention, Nantong, Jiangsu, PR China
| | - Hong Xu
- Nantong Chongchuan District Center for Disease Control and Prevention, Nantong, Jiangsu, PR China
| | - Xiao-Peng Xia
- Nantong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu, PR China.
| | - Hong-Lin Chen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China.
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Marshall V, Qiu Y, Jones A, Weller CD, Team V. Hospital-acquired pressure injury prevention in people with a BMI of 30.0 or higher: A scoping review. J Adv Nurs 2024; 80:1262-1282. [PMID: 37788102 DOI: 10.1111/jan.15882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023]
Abstract
AIM(S) To: (1) explore current best practices for hospital-acquired pressure injury prevention in high BMI patients; (2) summarize nurses' experiences in preventing and managing them; (3) explore the association between a high BMI and occurrence and severity of pressure injury. DESIGN Exploratory. METHODS Scoping review. DATA SOURCES Ovid MEDLINE, EBSCO CINAHL Plus, JBI Evidence Synthesis, Scopus, Embase, clinical registries and grey literature (search dates: January 2009 to May 2021). RESULTS Overall, 1479 studies were screened. The included studies were published between 2010 and 2022. Five interventional studies and 32 best practice recommendations (Objective 1) reported low-quality evidence. Findings of thematic analysis reported in nine studies (Objective 2) identified nurses' issues as insufficient bariatric equipment, inadequate staffing, weight bias, fatigue, obese-related terminology issues, ethical dilemmas and insufficient staff education in high BMI patients' pressure injury prevention. No association between hospital-acquired pressure injury occurrence and high BMI were reported by 18 out of 28 included studies (Objective 3). CONCLUSION Quality of evidence was low for the interventional studies and best practice recommendations. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Current (2019) International Pressure Injury Guideline to be used despite the low quality of evidence of most best practice recommendations. IMPACT STATEMENT This study addressed hospital-acquired pressure injury prevention in high BMI patients. Greater proportion of studies in this review found no association between high BMI and occurrence of hospital-acquired pressure injury. Nurses need educational interventions on pressure injury prevention in high body mass index people, sufficient staffing for repositioning and improved availability of bariatric equipment. REPORTING METHOD We adhered to relevant EQUATOR guidelines, PRISMA extension for scoping reviews. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Larger clinical trials are needed on repositioning frequency, support surfaces, prophylactic dressings and risk assessment tools to inform clinical practice guidelines on pressure injury prevention in high BMI people. PROTOCOL REGISTRATION Wound Practice and Research (https://doi.org/10.33235/wpr.29.3.133-139).
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Affiliation(s)
- Victoria Marshall
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Yunjing Qiu
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- School of Nursing and Midwifery, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
| | - Carolina D Weller
- School of Nursing and Midwifery, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Victoria Team
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
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Ogawa M, Okamura M, Inoue T, Sato Y, Momosaki R, Maeda K. Relationship between nutritional status and clinical outcomes among older individuals using long-term care services: A systematic review and meta-analysis. Clin Nutr ESPEN 2024; 59:365-377. [PMID: 38220398 DOI: 10.1016/j.clnesp.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIMS Nutritional status is a significant issue in an aging society; however, the impact of the nutritional status of older individuals using long-term care services on the caregiving burden remains unclear. This systematic review and meta-analysis aimed to investigate the impact of nutritional issues on adverse outcomes in older individuals using long-term care services. METHODS We used data from the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Web of Science, CINAHL, and Ichu-shi Web databases. Original articles published in English or Japanese between January 2000 and July 2022 were included. The inclusion criteria were interventional and observational studies on individuals using long-term care services with aged ≥65 years and a focus on body weight or weight loss. Data on adverse outcomes related to caregiving burden, including the number of people requiring care, mortality, complications, activities of daily living (ADL), and quality of life, were collected. RESULTS The literature search yielded 7873 studies, of which 35 were ultimately included. Seven observational studies investigated mortality outcomes, and seven examined ADL outcomes. The meta-analysis revealed significantly higher mortality rates in individuals classified as underweight (BMI <18.5 kg/m2) than in those with BMI ≥18.5 kg/m2 (risk ratio [RR] 1.49; 95 % confidence interval [CI] 1.31 to 1.73, 0.22; I2 93 %). Further, on categorising the participants based on a BMI cutoff of 25 kg/m2, those with a BMI of <25 kg/m2 had a significantly increased mortality rate (RR 1.21; 95 % CI 1.04-1.40; I2 = 98 %). BMI and weight loss did not affect ADL. CONCLUSIONS Our findings indicate that underweight and weight loss are significantly associated with increased mortality in older individuals using long-term care services. Therefore, appropriate weight management is recommended for this population. However, further research is necessary owing to the high heterogeneity observed in this study.
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Affiliation(s)
- Masato Ogawa
- Department of Rehabilitation Science, Osaka Health Science University, Osaka, Japan; Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
| | - Masatsugu Okamura
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany; Department of Rehabilitation Medicine, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Yoichi Sato
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan
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Felix HC, Brown CC, Narcisse MR, Vincenzo JL, Andersen JA, Bradway CW, Weech-Maldonado R. Characteristics of United States nursing homes with high percentages of stage 2-4 pressure injuries among high-risk nursing home residents with obesity. WOUND PRACTICE AND RESEARCH 2023; 31:174-181. [PMID: 38737330 PMCID: PMC11084039 DOI: 10.33235/wpr.31.4.174-181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Obesity rates in nursing homes (NHs) are increasing. Residents with obesity are at risk for poor outcomes such as pressure injuries (PIs) due to special care needs such as bariatric medical equipment and special protocols for skin care. PIs among resident populations is a sign of poor quality NH care. The purpose of this retrospective observational study was to identify characteristics of NHs with high rates of stage 2-4 PIs among their high-risk residents with obesity. Resident assessment data were aggregated to the NH level. NH structure and process of care and antecedent conditions of the residents and environment measures were used in bivariate comparisons and multivariate logistic regression models to identify associations with NHs having high rates of stage 2-4 PIs among high-risk residents with obesity. We identified three characteristics for which the effect on the odds was at least 10% for clinical significance - for-profit status, large facilities, and the hours of certified nursing assistants (CNAs) per patient day (HRPPD). This study identified several NH characteristics that are associated with higher risk for PIs, which can be targeted with evidence-based interventions to reduce the risk of these adverse safety events occurring.
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Affiliation(s)
- Holly C Felix
- Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 820, Little Rock, AR 72205, USA
| | - Clare C Brown
- Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 820, Little Rock, AR 72205, USA
| | - Marie-Rachelle Narcisse
- Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903 USA
| | - Jennifer L Vincenzo
- College of Health Professions, University of Arkansas for Medical Sciences, 1125 N. College Avenue, Fayetteville, AR 72703, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences, 2708 South 48th Street, Springdale, AR 72762, USA
| | - Christine W Bradway
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Fagin Hall, Room 312, Philadelphia, PA 19104-4217, USA
| | - Robert Weech-Maldonado
- School of Health Professions, University of Alabama at Birmingham, 1720 2nd Avenue South, SHPB 558, Birmingham, AL 35294, USA
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Gross DC, Cheever CR, Batsis JA. Understanding the development of sarcopenic obesity. Expert Rev Endocrinol Metab 2023; 18:469-488. [PMID: 37840295 PMCID: PMC10842411 DOI: 10.1080/17446651.2023.2267672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Sarcopenic obesity (SarcO) is defined as the confluence of reduced muscle mass and function and excess body fat. The scientific community is increasingly recognizing this syndrome, which affects a subgroup of persons across their lifespans and places them at synergistically higher risk of significant medical comorbidity and disability than either sarcopenia or obesity alone. Joint efforts in clinical and research settings are imperative to better understand this syndrome and drive the development of urgently needed future interventions. AREAS COVERED Herein, we describe the ongoing challenges in defining sarcopenic obesity and the current state of the science regarding its epidemiology and relationship with adverse events. The field has demonstrated an emergence of data over the past decade which we will summarize in this article. While the etiology of sarcopenic obesity is complex, we present data on the underlying pathophysiological mechanisms that are hypothesized to promote its development, including age-related changes in body composition, hormonal changes, chronic inflammation, and genetic predisposition. EXPERT OPINION We describe emerging areas of future research that will likely be needed to advance this nascent field, including changes in clinical infrastructure, an enhanced understanding of the lifecourse, and potential treatments.
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Affiliation(s)
- Danae C. Gross
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - C. Ray Cheever
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John A. Batsis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Geriatric Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
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Aldughayfiq B, Ashfaq F, Jhanjhi NZ, Humayun M. YOLO-Based Deep Learning Model for Pressure Ulcer Detection and Classification. Healthcare (Basel) 2023; 11:healthcare11091222. [PMID: 37174764 PMCID: PMC10178524 DOI: 10.3390/healthcare11091222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/15/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Pressure ulcers are significant healthcare concerns affecting millions of people worldwide, particularly those with limited mobility. Early detection and classification of pressure ulcers are crucial in preventing their progression and reducing associated morbidity and mortality. In this work, we present a novel approach that uses YOLOv5, an advanced and robust object detection model, to detect and classify pressure ulcers into four stages and non-pressure ulcers. We also utilize data augmentation techniques to expand our dataset and strengthen the resilience of our model. Our approach shows promising results, achieving an overall mean average precision of 76.9% and class-specific mAP50 values ranging from 66% to 99.5%. Compared to previous studies that primarily utilize CNN-based algorithms, our approach provides a more efficient and accurate solution for the detection and classification of pressure ulcers. The successful implementation of our approach has the potential to improve the early detection and treatment of pressure ulcers, resulting in better patient outcomes and reduced healthcare costs.
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Affiliation(s)
- Bader Aldughayfiq
- Department of Information Systems, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Saudi Arabia
| | - Farzeen Ashfaq
- School of Computer Science, SCS, Taylor's University, Subang Jaya 47500, Malaysia
| | - N Z Jhanjhi
- School of Computer Science, SCS, Taylor's University, Subang Jaya 47500, Malaysia
| | - Mamoona Humayun
- Department of Information Systems, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Saudi Arabia
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Obesity and Wound Healing: Focus on Mesenchymal Stem Cells. Life (Basel) 2023; 13:life13030717. [PMID: 36983872 PMCID: PMC10059997 DOI: 10.3390/life13030717] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/20/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
Chronic wounds represent nowadays a major challenge for both clinicians and researchers in the regenerative setting. Obesity represents one of the major comorbidities in patients affected by chronic ulcers and therefore diverse studies aimed at assessing possible links between these two morbid conditions are currently ongoing. In particular, adipose tissue has recently been described as having metabolic and endocrine functions rather than serving as a mere fat storage deposit. In this setting, adipose-derived stem cells, a peculiar subset of mesenchymal stromal/stem cells (MSCs) located in adipose tissue, have been demonstrated to possess regenerative and immunological functions with a key role in regulating both adipocyte function and skin regeneration. The aim of the present review is to give an overview of the most recent findings on wound healing, with a special focus on adipose tissue biology and obesity.
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Barch DH, Seibert JH, Kandilov A, Bernacet A, Deutsch A, Wang XJ, Scherer E, McMullen T, Mandl S, Levitt A, Frank J, Stephanopoulos C, Smith LM. Cross-setting Comparison of Risk Factors for Pressure Injuries Acquired in Post-Acute Care. Adv Skin Wound Care 2023; 36:128-136. [PMID: 36812077 DOI: 10.1097/01.asw.0000912008.97430.b4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
GENERAL PURPOSE To provide information on the association between risk factors and the development of new or worsened stage 2 to 4 pressure injuries (PIs) in patients in long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), and skilled nursing facilities (SNFs). TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Compare the unadjusted PI incidence in SNF, IRF, and LTCH populations.2. Explain the extent to which the clinical risk factors of functional limitation (bed mobility), bowel incontinence, diabetes/peripheral vascular disease/peripheral arterial disease, and low body mass index are associated with new or worsened stage 2 to 4 PIs across the SNF, IRF, and LTCH populations.3. Compare the incidence of new or worsened stage 2 to 4 PI development in SNF, IRF, and LTCH populations associated with high body mass index, urinary incontinence, dual urinary and bowel incontinence, and advanced age.
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Großschädl F, Schoberer D, Eglseer D, Lohrmann C, Everink I, Gordon AL, Schols JMGA, Bauer S. Obesity and its associated factors in older nursing home residents in three European countries-Secondary data analyses from the "International Prevalence Measurement of Care Quality". Int J Older People Nurs 2023; 18:e12530. [PMID: 36840619 DOI: 10.1111/opn.12530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND The prevalence of obesity has risen in recent decades and reached epidemic proportions worldwide. The proportion of those living with obesity is also increasing in nursing homes. This could impact the nursing care required, equipment and facilities provided, and morbidity in these settings. Limited evidence exists on clinical consequences of obesity in nursing home residents and their care. OBJECTIVE Therefore, the aim was to examine the rate and associated factors of obesity (BMI ≥30; class I (BMI 30.0-34.9 kg/m2 ), class II (BMI 35.0-39.9 kg/m2 ), and class III (BMI >40.0 kg/m2 )) amongst older nursing home residents in European countries. METHODS We analysed data from 21,836 people who reside in nursing homes in Austria, the Netherlands, and the United Kingdom. They participated in the "International Prevalence Measurement of Care Quality", a cross sectional study between 2016 and 2019, where trained nurses interviewed the residents, reviewed care records, and conducted clinical examinations. A tested and standardised questionnaire comprised questions on demographic data, measured BMI, medical diagnosis according to ICD-10, and care dependency. Descriptive and logistic regression analyses were performed. RESULTS Obesity rates were highest in Austria (17.1%) and lowest in the UK (13.0%) (p = .006). Residents with obesity were younger and less likely to be care dependent or living with dementia and had more often diabetes mellitus, endocrine, metabolic, and skin diseases compared to residents without obesity (p < .05). Most obese residents had obesity class I. Therefore, two subgroups were built (class I vs. class II + III). Residents with obesity class II + III were more frequently care dependent for mobility, getting dressed and undressed, and personal hygiene compared to residents with class I (p < .05). CONCLUSIONS This study identified several factors that are associated with obesity amongst older nursing home residents in selected European countries. IMPLICATIONS FOR PRACTICE The division into obesity classes is important for planning targeted care according to the individual needs of nursing home residents.
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Affiliation(s)
| | - Daniela Schoberer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Irma Everink
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Adam L Gordon
- Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Derby, UK.,East Midlands Academic Health Sciences Network Patient Safety Collaborative, Nottingham, UK.,NIHR Applied Research Collaboration - East Midlands (ARC-EM), Nottingham, UK
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Silvia Bauer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
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Vathulya M, Chattopadhyay D, Kandwal P, Nath UK, Kapoor A, Sinha M. Adipose Tissue in Peripheral Obesity as an Assessment Factor for Pressure Ulcers. Adv Wound Care (New Rochelle) 2022. [PMID: 36301930 DOI: 10.1089/wound.2020.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Scope and Significance: Pressure ulcers are very difficult to treat and pose an economic burden, just below cancer and cardiovascular illness, at 4.82 billion U.S. dollars. It is important to understand the pathophysiology of the condition, risk stratification, and ways of preventing it. Prevention forms the most important aspect of their management. The authors systematically evaluated the existing risk prediction scales and explored the evidence from literature regarding the role of additional factors including body mass index, obesity, subcutaneous tissue thickness, and skin integrity in pressure ulcers. With this review it is hoped that the future management of pressure ulcers will concentrate on the preventable and alterable factors in its pathophysiology. Translational Relevance: The review focuses on how adipose tissue thickness can predict the occurrence of pressure ulcer. If adequately proved that a definite thickness of peripheral adipose tissue is efficient in prevention of pressure ulcers, then methods of maintaining the thickness of this tissue will be the next effective strategy in the management of this chronic issue. Clinical Relevance: The review addresses the management of pressure ulcers to wound care providers and emphasize on confounding parameters of obesity, subcutaneous tissue thickness, and skin integrity during the treatment regimen of pressure ulcers. Objectives: The main objective of this review is to draw a consensus concerning the role of adipose tissue in pressure ulcers, based on the published research. A review of the various preexisting predictive scales for pressure ulcers is a secondary objective to highlight the shortcomings in ulcer management. This review finally aims in the future at paving a way to refine our prognosticating scales for pressure sores based on these results. Accurate preventative injury risk scales are needed so that preventative resources can be directed to the patients for whom they are the most appropriate.
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Affiliation(s)
- Madhubari Vathulya
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh (AIIMS Rishikesh), Rishikesh, India
| | - Debarati Chattopadhyay
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh (AIIMS Rishikesh), Rishikesh, India
| | - Pankaj Kandwal
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh (AIIMS Rishikesh), Rishikesh, India
| | - Uttam Kumar Nath
- Department of Medical Oncology & Hematology, All India Institute of Medical Sciences, Rishikesh (AIIMS Rishikesh), Rishikesh, India
| | - Akshay Kapoor
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh (AIIMS Rishikesh), Rishikesh, India
| | - Mithun Sinha
- Department of Surgery, IU Heath Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Krishnan S, Hong I, Couture G, Tzen YT, Reistetter T. Pressure Injury on Poststroke Admission Assessment to Skilled Nursing Facilities: Risk Factors, Management, and Impact on Rehabilitation. J Am Med Dir Assoc 2022; 23:1718.e13-1718.e20. [PMID: 35922014 DOI: 10.1016/j.jamda.2022.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To describe pressure injury (PrI) prevalence, comorbidities, and rehabilitation utilization among older adults with stroke at skilled nursing facilities' (SNFs') admission assessment. DESIGN Retrospective cohort. SETTING AND PARTICIPANTS Older Medicare beneficiaries (>65 years old) with stroke admitted to SNFs. METHODS We extracted data between 2013 and 2014 using the Master Beneficiary Summary, Medicare Provider Analysis and Review, and Minimum Data Set 3.0. PI data were assessed during admission assessment. RESULTS Of the 65,330 older adults poststroke admitted to SNFs, 11% had at least 1 PrI present on admission assessment. Individuals who were non-Hispanic Black, with a longer hospital stay, from lower socioeconomic status, with higher proportions of comorbidities (eg, underweight, urinary and bowel incontinence, diabetes, congestive heart failure, arrhythmias, and infections), and higher functional impairments were likely to present with a PrI at SNF admission assessment. Compared with individuals with superficial PrI, individuals with deep PrI were more likely to be young-old (<75 years), non-Hispanic Black, from lower socioeconomic status, present with a shorter hospital stay, an intensive care unit stay, with higher functional impairments, skin integrity issues, system failure, and infections. Compared to those without PrI or superficial PrI, individuals with any-stage PrI or deep PrI were more likely to be cotreated by physical and occupational therapist and less likely to receive individual therapy. Those with PrI poststroke had low documented turning and repositioning rates than those without PrI. CONCLUSIONS AND IMPLICATIONS Identifying modifiable risk factors to prevent PrIs poststroke in SNFs will facilitate targeted preventative interventions and improve wound care efficacy and rehabilitation utilization for optimized patient outcomes. Identifying residents with a higher risk of PrI during acute care discharge and providing early preventive care during post-acute care would possibly decrease costs and improve outcome quality.
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Affiliation(s)
- Shilpa Krishnan
- Division of Physical Therapy, Department of Rehabilitation Science, Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Health Care System, US Department of Veterans Affairs, Decatur, GA, USA.
| | - Ickpyo Hong
- Department of Occupational Therapy, Yonsei University, Wonju, Gangwon-do, South Korea
| | - Grace Couture
- Division of Physical Therapy, Department of Rehabilitation Science, Emory University School of Medicine, Atlanta, GA, USA; Emory Healthcare, Atlanta, GA, USA
| | - Yi-Ting Tzen
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Timothy Reistetter
- Department of Occupational Therapy, UT Health San Antonio, School of Health Professions, San Antonio, TX, USA
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13
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Surbhi S, Chen M, Shuvo SA, Price-Haywood E, Shi L, Mann J, Lin Y, Le PL, Burton JH, Bailey JE. Effect of continuity of care on emergency department and hospital visits for obesity-associated chronic conditions: A federated cohort meta-analysis. J Natl Med Assoc 2022; 114:525-533. [PMID: 35977848 DOI: 10.1016/j.jnma.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/09/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity-associated chronic conditions (OCC) are prevalent in medically underserved areas of the Southern US. Continuity of care with a primary care provider is associated with reduced preventable healthcare utilization, yet little is known regarding the impact of continuity of care among populations with OCC. This study aimed to examine whether continuity of care protects patients living with OCC and the subgroup with type 2 diabetes (OCC+T2D) from emergency department (ED) and hospitalizations, and whether these effects are modified by race and patient residence in health professional shortage areas (HPSA) METHODS: We conducted a retrospective federated cohort meta-analysis of 2015-2018 data from four large practice-based research networks in the Southern U.S. among adult patients with obesity and one more more additional diagnosed OCC. The outcomes included overall and preventable ED visits and hospitalizations. Continuity of care was assessed at the clinic-level using the Bice-Boxerman Continuity of Care Index RESULTS: A total of 111,437 patients with OCC and 47,071 patients with OCC+T2D from the four large practice-based research networks in the South were included in the meta-analysis. Continuity of Care index varied among sites from a mean (SD) of 0.6 (0.4) to 0.9 (0.2). Meta-analysis demonstrated that, regardless of race or residence in HPSA, continuity of care significantly protected OCC patients from preventable ED visits (IRR:0.95; CI:0.92-0.98) and protected OCC+T2D patients from overall ED visits (IRR:0.92; CI:0.85-0.99), preventable ED visits (IRR:0.95; CI:0.91-0.99), and overall hospitalizations (IRR:0.96; CI:0.93-0.98) CONCLUSION: Improving continuity of care may reduce ED and hospital use for patients with OCC and particularly those with OCC+T2D.
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Affiliation(s)
- Satya Surbhi
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, 956 Court Ave, Coleman D224 A, Memphis, TN 38163, USA.
| | - Ming Chen
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, 956 Court Ave, Coleman D224 A, Memphis, TN 38163, USA
| | - Sohul A Shuvo
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, 956 Court Ave, Coleman D224 A, Memphis, TN 38163, USA
| | - Eboni Price-Haywood
- Ochsner Xavier Institute for Health Equity and Research, Ochsner Health System, New Orleans, LA, USA
| | - Lizheng Shi
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Joshua Mann
- Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Yilu Lin
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Phi L Le
- Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jeffrey H Burton
- Ochsner Xavier Institute for Health Equity and Research, Ochsner Health System, New Orleans, LA, USA
| | - James E Bailey
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, 956 Court Ave, Coleman D224 A, Memphis, TN 38163, USA
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14
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The 2021 Update on Pressure Injuries: A Review of the Literature. Adv Skin Wound Care 2022; 35:422-428. [PMID: 35856612 DOI: 10.1097/01.asw.0000834588.32255.0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GENERAL PURPOSE To provide a review of the recent literature on the epidemiology and treatment of pressure injuries (PIs). TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Identify risk factors for developing PIs.2. Differentiate factors that could affect the healing of PIs.3. Select strategies that have an impact on the development of PIs. ABSTRACT Keeping up with the literature on pressure injuries is always a challenge for busy clinicians. In this article, the authors summarize six important articles published in 2021. Articles cover a range of topics including epidemiology, treatment, precision medicine, nurse staffing, and patient preferences for care. For each article, a description of the study results is provided along with a comment on why the results are important. This information is intended to help clinicians incorporate new data into their clinical practice.
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15
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Kennerly SM, Sharkey PD, Horn SD, Zheng T, Alderden J, Sabol VK, Rowe M, Yap TL. Characteristics of Nursing Home Resident Movement Patterns: Results from the TEAM-UP Trial. Adv Skin Wound Care 2022; 35:271-280. [PMID: 35195085 PMCID: PMC9012525 DOI: 10.1097/01.asw.0000822696.67886.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine movement patterns of nursing home residents, specifically those with dementia or obesity, to improve repositioning approaches to pressure injury (PrI) prevention. METHODS A descriptive exploratory study was conducted using secondary data from the Turn Everyone And Move for Ulcer Prevention (TEAM-UP) clinical trial examining PrI prevention repositioning intervals. K-means cluster analysis used the average of each resident's multiple days' observations of four summary mean daily variables to create homogeneous movement pattern clusters. Growth mixture models examined movement pattern changes over time. Logistic regression analyses predicted resident and nursing home cluster group membership. RESULTS Three optimal clusters partitioned 913 residents into mutually exclusive groups with significantly different upright and lying patterns. The models indicated stable movement pattern trajectories across the 28-day intervention period. Cluster profiles were not differentiated by residents with dementia (n = 450) or obesity (n = 285) diagnosis; significant cluster differences were associated with age and Braden Scale total scores or risk categories. Within clusters 2 and 3, residents with dementia were older (P < .0001) and, in cluster 2, were also at greater PrI risk (P < .0001) compared with residents with obesity; neither group differed in cluster 1. CONCLUSIONS Study results determined three movement pattern clusters and advanced understanding of the effects of dementia and obesity on movement with the potential to improve repositioning protocols for more effective PrI prevention. Lying and upright position frequencies and durations provide foundational knowledge to support tailoring of PrI prevention interventions despite few significant differences in repositioning patterns for residents with dementia or obesity.
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Affiliation(s)
- Susan M Kennerly
- Susan M. Kennerly, PhD, RN, CNE, WCC, FAAN, is Professor, College of Nursing, East Carolina University, Greenville, North Carolina, United States. Phoebe D. Sharkey, PhD, is Professor Emerita, Sellinger School of Business, Loyola University Maryland, Baltimore, Maryland. Susan D. Horn, PhD, is Adjunct Professor, School of Medicine, University of Utah, Salt Lake City. Tianyu Zheng, MS, is Biostatistician, Department of Population Health Sciences, University of Utah. Jenny Alderden, PhD, APRN, is Associate Professor, School of Nursing, Boise State University, Boise, Idaho. Valerie K. Sabol, PhD, ACNP, GNP, CNE, ANEF, FAANP, FAAN, is Professor, School of Nursing, Duke University, Durham, North Carolina. Meredeth Rowe, PhD, RN, FGSA, FAAN, is Professor, College of Nursing, University of South Florida Health, Tampa. Tracey L. Yap, PhD, RN, CNE, WCC, FGSA, FAAN, is Associate Professor, School of Nursing, Duke University
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16
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Penny H, Flores R, Pennington E, Pedersen A, Tran S. The role of macronutrients and micronutrients in wound healing: a narrative review. J Wound Care 2022; 31:S14-S22. [PMID: 35576197 DOI: 10.12968/jowc.2022.31.sup5.s14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There is an extensive amount of research and literature discussing the role of various nutrients throughout the wound healing process. Despite the importance of nutrition in wound healing, dietary protocols often remain absent from wound care standards. This may be due to a lack of comprehensive literature that summarises the complexities and considerations associated with nutrient deficiency and supplementation into an easily accessible and inclusive reference tool. The purpose of this review is to assess the nutrients with key roles in the wound healing process, and subsequently provide information that enables optimisation of nutrition in wound healing. The goal is to consolidate the complexities associated with this topic into a simple, easy-to-use reference tool. We have identified the most important nutrients required for optimal wound healing and condensed the findings into an inclusive chart to be utilised in a clinical setting. This reference tool will include patient populations at risk of deficiency, the stage of wound healing in which each nutrient is required, delivery method and recommended daily intake, outpatient recommendations for rich food sources of each nutrient, and considerations associated with each nutrient.
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Affiliation(s)
- Harry Penny
- UPMC Altoona, 1414 9th Ave, Altoona, PA 16602, US
| | | | | | | | - Son Tran
- Temple University, School of Pediatric Medicine 148 N. 8th Street, Philadelphia, PA 19107, US
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17
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Amankwaa I, Nelson K, Rook H, Hales C. Association between body mass index, multi-morbidity and activities of daily living among New Zealand nursing home older adults: a retrospective analysis of nationwide InterRAI data. BMC Geriatr 2022; 22:62. [PMID: 35042475 PMCID: PMC8767739 DOI: 10.1186/s12877-021-02696-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background Obesity is a well-established risk factor for multi-morbidity and disability among older adults in the community and acute care settings. However, nursing home residents with body mass index (BMI) below 18.5 kg/m2 and above 25.0 kg/m2 have been understudied. We examined the prevalence of multi-morbidity and disability in activities of daily living (ADL) by BMI category and further investigated the association between BMI, multi-morbidity, and disability of ADL in a large cohort of older adults in nursing homes in New Zealand. Methods A retrospective review of nursing home residents’ data obtained from the New Zealand International Resident Assessment Instrument national dataset from 2015 to 2018. One hundred ninety-eight thousand seven hundred ninety older adults (≥60 years) living in nursing homes were included. BMI was calculated as weight in kilograms (kg) divided by height in meters squared (m2). Multimorbidity was defined as the presence of ≥2 health conditions. The risk of disability was measured by a 4-item ADL self-performance scale. The prevalence ratio (PR) of the association between BMI and multi-morbidity and between BMI and disability in ADL was assessed using Poisson regression with robust variance. Results Of the 198,790 residents, 10.6, 26.6, 11.3 and 5.4% were underweight, overweight, obese, and extremely obese, respectively. 26.4, 31.3 and 21.3% had one, two and three disease conditions, respectively, while 14.3% had four or more conditions. 24.1% could perform only one ADL, and 16.1% could perform none. The prevalence of multi-morbidity increased with increasing BMI, whereas mean disability in ADL decreased with increasing BMI. The risk of multi-morbidity was higher for the overweight (PR, 95%CI: 1.03, 1.02–1.03) and obese (PR, 95% CI: 1.07, 1.06–1.08) compared to normal weight after controlling for age, sex, ethnicity, and region. BMI was inversely associated with mean ADL; β, 95% CI for overweight (− 0.30, − 0.32, − 0.28) and obese − 0.43, − 0.45, − 0.40 compared to normal weight. Conclusion Being underweight was associated with a decline in the performance of ADL in nursing home residents. In contrast, being overweight and obese positively affected functional performance, demonstrating that the obesity paradox plays an important role in this population. The observed associations highlight areas where detection and management of underweight and healthy aging initiatives may be merited.
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18
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Sefcik JS, Felix HC, Narcisse MR, Vincenzo JL, Weech-Maldonado R, Brown CC, Bradway CK. Nursing home directors of nursing experiences regarding safety among residents with obesity. Geriatr Nurs 2022; 47:254-264. [PMID: 36007426 PMCID: PMC9979081 DOI: 10.1016/j.gerinurse.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/04/2022]
Abstract
The prevalence of nursing home (NH) residents with obesity is rising. Perspectives of NH Directors of Nursing (DONs) who oversee care trajectories for residents with obesity is lacking. This study aimed to describe the experiences of NH DONs regarding care and safety for NH residents with obesity. An adapted version of Donabedian's structure-process-outcome model guided this qualitative descriptive study. Semi-structured interviews were conducted with 15 DONs. Data were analyzed using directed content analysis, and findings are presented under the model's constructs. We learned that admission decisions for NH referrals of patients with obesity are complex due to reimbursement issues, available space and resources, and resident characteristics. DONs described the need to coach and mentor Certified Nursing Assistants to provide safe quality care and that more staff education is needed. We identified novel findings regarding the challenges of short-term residents' experience transitioning out of care due to limited resources.
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Affiliation(s)
- Justine S. Sefcik
- College of Nursing and Health Professions, Drexel University, 1601 Cherry St., Room 377, Philadelphia, PA 19102, USA,Corresponding author. (J.S. Sefcik)
| | - Holly C. Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot 820-12, Little Rock AR 72205, USA
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences, 2708 S. 48th Street, Springdale, AR 72762, USA
| | - Jennifer L. Vincenzo
- Department of Physical Therapy, College of Health Professions, University of Arkansas for Medical Sciences, 1125 N. College Ave, Fayetteville, AR 72703, USA
| | - Robert Weech-Maldonado
- Department of Health Services Administration, University of Alabama at Birmingham, 1720 2nd Ave. S., Birmingham, AL 35294, USA
| | - Clare C. Brown
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot 820-12, Little Rock AR 72205, USA
| | - Christine K. Bradway
- Biobehavioral Health Sciences Department, University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
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Jacq G, Valera S, Muller G, Decormeille G, Youssoufa A, Poiroux L, Allaert F, Barrois B, Rigaudier F, Ferreira P, Huard D, Heming N, Aissaoui N, Barbar S, Boissier F, Grimaldi D, Hraiech S, Lascarrou JB, Piton G, Michel P. Prevalence of pressure injuries among critically ill patients and factors associated with their occurrence in the intensive care unit: The PRESSURE study. Aust Crit Care 2021; 34:411-418. [PMID: 33483180 DOI: 10.1016/j.aucc.2020.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/24/2020] [Accepted: 12/13/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The prevalence of pressure injuries (PIs) in critically ill patients has been extensively studied, but there is uncertainty regarding the risk factors. The main objective of this study was to describe the prevalence of PIs in critically ill patients. Secondary objectives were to describe PI, use of preventive measures for PI, and factors associated with occurrence of PI in the intensive care unit (ICU). MATERIAL AND METHODS This was a 1-day point-prevalence study performed on a weekday in June 2017 in ICUs in France. On the same day, we noted the presence or absence of PI in all hospitalised patients of the participating ICUs, data on the ICUs, and the characteristics of patients and of PI. RESULTS Eighty-six participating ICUs allowed the inclusion of 1228 patients. The prevalence of PI on the study day was 18.7% (95% confidence interval: 16.6-21.0). PIs acquired in the ICU were observed in 12.5% (95% confidence interval: 10.6-14.3) of critically ill patients on the study day. The most frequent locations of PI were the sacrum (57.4%), heel (35.2%), and face (8.7%). Severe forms of PI accounted for 40.8% of all PIs. Antiulcer mattresses were used in 91.5% of the patients, and active and/or passive mobilisation was performed for all the patients. Multiple logistic regression analysis identified longer length of stay in the ICU, a higher Simplified Acute Physiology Score, higher body weight, motor neurological disorder, high-dose steroids, and absence of oral nutrition on the study day as factors independently associated with occurrence of PI in the ICU. CONCLUSION This large point-prevalence study shows that PIs are found in about one of five critically ill patients despite extensive use of devices for preventing PI. Acquisition of PI in the ICU is strongly related to the patient's severity of illness on admission to the ICU and length of stay in the ICU.
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20
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Association of overweight and obesity with the prevalence and incidence of pressure ulcers: A systematic review and meta-analysis. Clin Nutr 2021; 40:5089-5098. [PMID: 34455268 DOI: 10.1016/j.clnu.2021.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND & AIM Pressure ulcers challenge the health status, complicate medical conditions, and affect quality of life. The aim of this systematic review and meta-analysis was to investigate the role of obesity and body weight status, as potentially modifiable risk factors, in the incidence and prevalence of pressure ulcers. METHODS A systematic search of observational studies was performed to assess documents published between January 1990 and December 2019 in PubMed and Scopus. Finally, 17 articles with total sample size of 2228724 in the prevalence and 218178 in the incidence study were included in the meta-analysis. RESULTS The pooled data analysis showed no significant effect of obesity on odds of pressure ulcers' prevalence (OR 0.91, 95% CI 0.65 to 1.27, P = 0.579, I2 = 84.8%) or incidence (OR 0.97, 95% CI 0.56 to 1.66, P = 0.905, I2 = 89.8%) compared with non-obese individuals. Overweight was associated with significantly lower odds of prevalence of pressure ulcers compared to non-overweight individuals (OR 0.54, 95% CI 0.33 to 0.88, P = 0.014, I2 = 90.2%). The subgroup analyses showed significantly higher odds of prevalence (OR 2.38, 95% CI 1.72 to 3.29, P < 0.001, I2 = 63.4%) and incidence (OR 2.28, 95% CI 1.77 to 2.94, P < 0.001, I2 = 27.9%) of pressure ulcers in the underweight compared to normal weight groups. Pooled data analyses showed significantly lower odds of prevalence (OR 0.6, 95% CI 0.37 to 0.96, P = 0.034, I2 = 82%) and incidence (OR 0.72, 95% CI 0.53 to 0.98, P = 0.039, I2 = 67.1%) of pressure ulcers in the overweight than normal weight individuals. The findings showed no significant differences in the odds of prevalence or incidence of pressure ulcers in the obese and morbidly obese compared to normal weight individuals. CONCLUSION This systematic review and meta-analysis showed no significant effect of obesity or morbid obesity on the odds of pressure ulcers. Additionally, overweight was associated with lower odds of pressure ulcers while underweight significantly increased the odds of pressure injuries.
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21
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Morata L, Sole ML, Guido-Sanz F, Ogilvie C, Rich R. Manual vs Automatic Prone Positioning and Patient Outcomes in Acute Respiratory Distress Syndrome. Am J Crit Care 2021; 30:104-112. [PMID: 33644805 DOI: 10.4037/ajcc2021674] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Prone positioning is a standard treatment for moderate to severe acute respiratory distress syndrome (ARDS), but the outcomes associated with manual versus automatic prone positioning have not been evaluated. OBJECTIVE To retrospectively evaluate outcomes associated with manual versus automatic prone positioning as part of a pronation quality improvement project implemented by a multidisciplinary team. METHODS A retrospective, descriptive-comparative approach was used to analyze data from 24 months of a prone positioning protocol for ARDS. The study involved 37 patients, with 16 undergoing manual and 21 undergoing automatic prone positioning. Descriptive and nonparametric statistical analyses were used to evaluate outcomes associated with manual versus automatic prone positioning. RESULTS Outcomes were similar between the 2 groups regarding time to initiation of prone positioning, discharge disposition, and length of stay. Manually pronated patients were less likely to experience interruptions in therapy (P = .005) and complications (P = .002). Pressure injuries were the most common type of complication, with the most frequent locations in automatically pronated patients being the head (P = .045), thorax (P = .003), and lower extremities (P = .047). Manual prone positioning resulted in a cost avoidance of $78 617 per patient. CONCLUSION Manual prone positioning has outcomes similar to those of automatic prone positioning with less risk of interruptions in therapy, fewer complications, and lower expense. Further research is needed to determine whether manual prone positioning is superior to automatic prone positioning in patients with ARDS.
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Affiliation(s)
- Lauren Morata
- Lauren Morata is a clinical nurse specialist and clinical quality consultant, Lakeland Regional Health, Lakeland, Florida
| | - Mary Lou Sole
- Mary Lou Sole is dean and professor, College of Nursing, University of Central Florida, Orlando, Florida
| | - Frank Guido-Sanz
- Frank Guido-Sanz is an assistant professor, College of Nursing, University of Central Florida, Orlando, Florida
| | - Carrie Ogilvie
- Carrie Ogilvie is an associate vice-president of critical care and trauma services, Lakeland Regional Health, Lakeland, Florida
| | - Rebecca Rich
- Rebecca Rich is a critical care clinical pharmacy specialist, Lakeland Regional Health, Lakeland, Florida
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22
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Dashputre AA, Surbhi S, Podila PSB, Shuvo SA, Bailey JE. Can primary care access reduce health care utilization for patients with obesity-associated chronic conditions in medically underserved areas? J Eval Clin Pract 2020; 26:1689-1698. [PMID: 32078219 DOI: 10.1111/jep.13360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/08/2020] [Accepted: 01/12/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The prevalence and burdens of obesity-associated chronic conditions (OCC) are rising nationwide, particularly in health professional shortage areas (HPSA). This study examined the impact of access to primary care on health care utilization for vulnerable populations with OCC in the South. METHODS Adult patients with obesity (BMI ≥ 30 kg/m2 ), greater than or equal to one additional OCC, and self-reported primary care access data were retrospectively identified from hospital and emergency department (ED) electronic medical records of a major health care system in the South. Multivariable logistic regression assessed factors associated with self-reported access to primary care. Multivariable zero-inflated negative binomial models assessed effect of HPSA residence on relationships between self-reported access to primary care and health care utilization. RESULTS A total of 29 674 patients were identified. Hypertension (76.1%), type 2 diabetes mellitus (34.1%), and hyperlipidemia (32.9%) were the most prevalent OCC. Males (odds ratio [OR]: 0.43; 95% confidence interval [CI], 0.40-0.47), unmarried (OR: 0.69; 95% CI, 0.63-0.76), and uninsured (OR: 0.29; 95% CI, 0.27-0.32) had lower odds of access to primary care. For patients living in HPSA (vs non-HPSA), access to primary care was associated with higher incidence of overall ED use (relative risk [RR]: 1.38; 95% CI, 1.19-1.61) and lower incidence of potentially preventable hospital use (RR: 0.59; 95% CI, 0.38-0.92). CONCLUSION Paradoxically, access to primary care may increase ED use while reducing potentially preventable hospital utilization for patients with OCC in HPSA. Increasing access to primary care alone, without strengthening its capacity to serve the needs of vulnerable patients, may be insufficient to reduce hospital utilization.
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Affiliation(s)
- Ankur A Dashputre
- Institute for Health Outcomes and Policy, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee.,Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Satya Surbhi
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, Tennessee.,Division of General Internal Medicine, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Pradeep S B Podila
- Faith & Health Division, Methodist Le Bonheur Healthcare, Memphis, Tennessee
| | - Sohul A Shuvo
- Institute for Health Outcomes and Policy, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee.,Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, Tennessee
| | - James E Bailey
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, Tennessee.,Division of General Internal Medicine, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.,Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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Harris JA, Engberg J, Castle NG. Organizational and Geographic Nursing Home Characteristics Associated With Increasing Prevalence of Resident Obesity in the United States. J Appl Gerontol 2020; 39:991-999. [PMID: 31018750 PMCID: PMC7192234 DOI: 10.1177/0733464819843045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nursing home resident obesity increases the complexity of nursing care, and nursing homes report avoiding residents with obesity when choosing which prospective residents to accept. The objective of this study was to examine the associations between nursing home obesity prevalence rate and nursing home organizational, staffing, resident, and geographic factors within a profit maximization framework. The study cohort included U.S. Centers for Medicare and Medicaid Services data from U.S. nursing homes in 2013. Study findings supported hypothesized associations between obesity prevalence rate and higher occupancy, higher bed capacity, and multi-facility affiliation, but findings did not support a relationship between obesity prevalence rate and for-profit status.
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Harris JA, Castle NG. Obesity and Nursing Home Care in the United States: A Systematic Review. THE GERONTOLOGIST 2020; 59:e196-e206. [PMID: 29253135 DOI: 10.1093/geront/gnx128] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Obesity is increasing among people residing in nursing homes, and resident obesity substantially affects services needed, equipment and facilities provided, and morbidity in this setting. The purpose of this article is to describe the scope and depth of evidence regarding the impact of obesity among nursing home residents in the United States. RESEARCH DESIGN AND METHODS A systematic literature review was performed in PubMed, EMBASE, CINAHL, and Web of Science databases as well as additional hand-searched documents. Included articles were published from 1997 to March 2017. The characteristics and content of the included articles were systematically reviewed and reported. RESULTS Twenty-eight studies met inclusion criteria for review. The median study size was 636 residents (interquartile range 40-11,248); 18 (64%) studies were retrospective and 10 (36%) were prospective in nature. Ten (36%) studies examined medical and functional morbidity, 10 (36%) examined health system effects, and 5 (18%) examined the risk of admission to nursing homes. Most studies found that obesity poses serious issues to resident health and the provision of health care, as well as broad health system and nursing challenges in the provision of high-quality nursing home care and services. DISCUSSION AND IMPLICATIONS Although obesity affects about one in four nursing home residents in the United States, relatively limited evidence exists on the complex challenges of obesity for their residents and their care. A continued focus on resident quality of life, health system improvement, and nursing best practices for properly caring for individuals with obesity is needed.
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Affiliation(s)
| | - Nicholas George Castle
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
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Body Mass Index and 30-Day Adverse Outcomes Among Newly Admitted Residents to Skilled Nursing Facilities. J Am Med Dir Assoc 2019; 20:312-316. [DOI: 10.1016/j.jamda.2018.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/28/2018] [Accepted: 10/16/2018] [Indexed: 11/22/2022]
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Zhang N, Field T, Mazor KM, Zhou Y, Lapane KL, Gurwitz JH. The Increasing Prevalence of Obesity in Residents of U.S. Nursing Homes: 2005–2015. J Gerontol A Biol Sci Med Sci 2019; 74:1929-1936. [DOI: 10.1093/gerona/gly265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Indexed: 01/06/2023] Open
Abstract
Abstract
Background
Obesity prevalence has been increasing over decades among the U.S. population. This study analyzed trends in obesity prevalence among long-stay nursing home residents from 2005 to 2015.
Methods
Data came from the Minimum Data Sets (2005–2015). The study population was limited to long-stay residents (ie, those residing in a nursing home ≥100 days in a year). Residents were stratified into body mass index (BMI)-based groups: underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30); residents with obesity were further categorized as having Class I (30 ≤ BMI < 35), Class II (35 ≤ BMI < 40), or Class III (BMI ≥ 40) obesity. Minimum Data Sets assessments for 2015 were used to compare clinical and functional characteristics across these groups.
Results
Obesity prevalence increased from 22.4% in 2005 to 28.0% in 2015. The prevalence of Class III obesity increased from 4.0% to 6.2%. The prevalence of underweight, normal weight, and overweight decreased from 8.5% to 7.2%, from 40.3% to 37.1%, and from 28.9% to 27.8%, respectively. In 2015, compared with residents with normal weight, residents with obesity were younger, were less likely to be cognitively impaired, had high levels of mobility impairment, and were more likely to have important medical morbidities.
Conclusions and Relevance
There was a steady upward trend in obesity prevalence among nursing home residents for 2005–2015. Medical and functional characteristics of these residents may affect the type and level of care required, putting financial and staffing pressure on nursing homes.
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Affiliation(s)
- Ning Zhang
- Department of Health Policy and Promotion, School of Public Health and Health Sciences, University of Massachusetts Amherst, Worcester
- Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Terry Field
- Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Kathleen M Mazor
- Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Yanhua Zhou
- Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
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Sanaullah A, Ahmed MH. What the future holds for the primary surgical repair as treatment of a massive pressure ulcer? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:21. [PMID: 30788368 PMCID: PMC6351375 DOI: 10.21037/atm.2018.11.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 11/19/2018] [Indexed: 08/30/2023]
Affiliation(s)
- Aabid Sanaullah
- Department of Orthopaedic and Trauma, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
| | - Mohamed H. Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
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Jaul E, Barron J, Rosenzweig JP, Menczel J. An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatr 2018; 18:305. [PMID: 30537947 PMCID: PMC6290523 DOI: 10.1186/s12877-018-0997-7] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 11/27/2018] [Indexed: 01/03/2023] Open
Abstract
Background The prevalence of pressure ulcers particularly in the frail older adult population continues to be high and very costly especially in those suffering from chronic diseases and has brought a higher awareness to comprehensive, preventive and therapeutic measures for treatment of pressure ulcers. Internal risk factors highlighted by comorbidities play a crucial role in the pathogenesis of pressure ulcers. Main body Focusing on the impact of common chronic diseases (comorbidities) in aging on pressure ulcers (e.g., cardiovascular diseases, diabetes, chronic pulmonary diseases, renal diseases and neurodegenerative disorders) and the significant complicating conditions e.g., anemia, infectious diseases, malnutrition, hospitalization, incontinence and polypharmacy, frailty and disability becomes important in developing a more complete, inclusive and multidisciplinary approach to prevention of PU in older patients. Objective To describe chronic and acute conditions which are risk factors in elderly patients for developing PU. Methods We present an overview of comorbidities seen with PU in three diverse patient locations. The inclusion criteria are sites (community, acute hospital and long term facilities), older patients, chronic diseases and pressure ulcers grade 2 and over. Using a recently developed conceptual framework accepted by European and National Pressure Ulcer Advisory Panels, we examined chronic diseases to identify the risk factors of chronic conditions and complicating conditions which potentially influence risk for PU development. Conclusion Multiple chronic diseases and complicating factors which associated with immobility, tissue ischemia, and undernutrition are caused to PU in community settings, hospitals, and nursing facilities.
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Affiliation(s)
- Efraim Jaul
- Skilled Geriatric Nursing Department, Herzog Medical Center, 3900, 91035, Jerusalem, Israel. .,Affiliated with the Hebrew University Medical School, Jerusalem, Israel.
| | - Jeremy Barron
- Chronic Ventilation Department, Herzog Medical Center, Jerusalem, Israel.,Johns Hopkins University, Baltimore, MD, USA
| | - Joshua P Rosenzweig
- Clinical Research Center for Brain Sciences, Herzog Medical Center, Jerusalem, Israel
| | - Jacob Menczel
- Chairman of Geriatric Division Herzog Medical Center, Jerusalem, Israel
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Felix HC, Bradway C, Bird TM, Pradhan R, Weech-Maldonado R. Safety of Obese Persons in Nursing Homes. Med Care 2018; 56:1032-1034. [PMID: 30418962 PMCID: PMC6234852 DOI: 10.1097/mlr.0000000000000997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Holly C. Felix
- Associate Professor of Health Policy, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 820, Little Rock, Arkansas 72205, / 501-526-6633 / 501-562-6620 fax
| | - Christine Bradway
- Associate Professor of Gerontological Nursing, University of Pennsylvania School of Nursing, 418 Curie Boulevard, Fagin Hall, Room 312, Philadelphia, Pennsylvania 19104-4217, / 215-573-3051
| | - T. Mac Bird
- Assistant Professor of Health Policy, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 820, Little Rock, Arkansas 72205, / 501-526-6633 / 501-562-6620 fax
| | - Rohit Pradhan
- Assistant Professor of Health Policy, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 820, Little Rock, Arkansas 72205, / 501-526-6633 / 501-562-6620 fax
| | - Robert Weech-Maldonado
- Professor & LR Jordan Endowed Chair of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 1720 2nd Ave. S., SHPB 558, Birmingham, AL 35294, / 205-996-5838 / 205 975-6608 fax
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Syed Q, Sharif S, Frohardt C. Bingo Candies in Long-term Care: A Quality Improvement Project. J Am Med Dir Assoc 2018; 20:217-218. [PMID: 30448157 DOI: 10.1016/j.jamda.2018.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 11/24/2022]
Affiliation(s)
| | - Sara Sharif
- King Edward Medical University, Lahore, Pakistan
| | - Claire Frohardt
- Food & Nutrition Department, Wesley Woods Budd Terrace Rehab, Atlanta, GA
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Kosar CM, Thomas KS, Gozalo PL, Mor V. Higher Level of Obesity Is Associated with Intensive Personal Care Assistance in the Nursing Home. J Am Med Dir Assoc 2018; 19:1015-1019. [PMID: 29935981 PMCID: PMC6237619 DOI: 10.1016/j.jamda.2018.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 03/29/2018] [Accepted: 04/20/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine whether higher obesity level was associated with extensive staffing assistance (from 2 or more persons) for completing activities of daily living (ADL) among older nursing home residents. DESIGN Retrospective cross-sectional study. SETTING US government-certified nursing homes. PARTICIPANTS Medicare beneficiaries residing in a nursing home on April 1, 2015. Exclusion criteria were age less than 65 years and body mass index (BMI) below 18.5 (underweight). MEASURES Residents were divided by obesity level according to established BMI cutoffs, as follows: nonobese (BMI = 18.5-29.9) or mild (BMI = 30.0-34.9), moderate (BMI = 35.0-39.9), or severe (BMI ≥40) obesity. Level of staffing assistance for completing each of 10 ADL (bed mobility, transfer, walking in room, walking in corridor, on- and off-unit locomotion, dressing, eating, toileting, and personal hygiene) was dichotomized as below 2 and 2 or more. Robust Poisson regression was used to test whether obesity conferred excess risk for needing 2 or more staff to complete each ADL. Adjusted models included individual-level covariates and nursing home fixed effects. RESULTS A total of 1,063,383 nursing home residents were identified, including 309,263 (29.0%) with obesity. Adjusted relative risks (95% confidence intervals) for 2-person assistance with bed mobility associated with mild, moderate, and severe obesity were 1.17 (1.15, 1.18), 1.28 (1.25, 1.31), and 1.40 (1.36, 1.43), respectively. Adjusted relative risks for 2-person assistance with transferring associated with mild, moderate, and severe obesity were 1.15 (1.13, 1.17), 1.24 (1.22, 1.27), and 1.36 (1.33, 1.39), respectively. Obesity was associated with 2-person assistance for all other ADL except for eating. CONCLUSIONS Higher obesity level was significantly associated with assistance from 2 or more staff for completing 9 of 10 ADL. Given increasing obesity rates in nursing homes, payment mechanisms that do not adjust for obesity or comprehensively account for excess ADL assistance may need revision to prevent adverse impacts on the long-term care system.
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Affiliation(s)
- Cyrus M Kosar
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI.
| | - Kali S Thomas
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI; Department of Veteran Affairs Medical Center, Providence, RI
| | - Pedro L Gozalo
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI
| | - Vincent Mor
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI; Department of Veteran Affairs Medical Center, Providence, RI
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Jung HY, Li Q, Rahman M, Mor V. Medicare Advantage enrollees' use of nursing homes: trends and nursing home characteristics. THE AMERICAN JOURNAL OF MANAGED CARE 2018; 24:e249-e256. [PMID: 30130025 PMCID: PMC6225776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To examine temporal trends in the prevalence of nursing home (NH) patients participating in Medicare Advantage (MA) and to identify the characteristics of both these patients and the NHs that provide care for them. STUDY DESIGN Retrospective cohort study. METHODS Data sources included the Medicare enrollment file, Minimum Data Set, and facility-level data from the Certification and Survey Provider Enhanced Reporting system. Longitudinal trends of NH use by MA enrollees were examined over the period 2000 to 2013 and logistic regression models were used to identify facility characteristics associated with having a high proportion of MA patients. RESULTS The proportion of MA enrollees in NHs more than doubled between 2000 and 2013, increasing 125% during this period. Notable differences in facility characteristics were found between NHs that serve high proportions of MA enrollees and other NHs. High-MA NHs tended to be larger facilities affiliated with chains. These NHs also had better quality indicators, such as higher staffing levels, lower use of antipsychotics, and lower odds of rehospitalization. Additionally, high-MA NHs were more likely to be in counties with higher Medicare managed care penetration and less market concentration. CONCLUSIONS MA plans may be selectively contracting with NHs, as evidenced by the larger shares of MA patients who have been placed in facilities with better performance on quality measures. This may reflect MA plans concentrating enrollees in specific facilities and building "networks" of postacute and long-term care providers that provide better and more efficient care.
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Affiliation(s)
- Hye-Young Jung
- Department of Healthcare Policy and Research, Weill Cornell Medical College, 402 E 67th St, New York, NY 10065.
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Harris JA, Engberg J, Castle NG. Obesity and intensive staffing needs of nursing home residents. Geriatr Nurs 2018; 39:696-701. [PMID: 29884559 DOI: 10.1016/j.gerinurse.2018.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/18/2018] [Indexed: 01/20/2023]
Abstract
The objective of this study is to examine how increasing body mass index (BMI) among nursing home residents affects the amount of staffing assistance needed for activities of daily living (ADL). We analyzed 1,627,141 US nursing home residents reported in the 2013 Minimum Data Set in seven BMI categories, from underweight (BMI < 18.5 kg/m2) to obesity Class IIIB (≥50 kg/m2). Logistic regression models estimated the odds of nursing home-reported need for extensive (≥2 staff member) assistance needed for ADLs. The adjusted odds increased from 1.07 (95% Confidence Interval (95%CI) 1.06-1.08) for Class I, 1.16 (95%CI 1.14-1.17) for Class II, 1.33 (95%CI 1.31-1.35) for Class IIIA, and 1.90 (95%CI 1.86-1.95) for Class IIIB obesity residents compared to residents of normal weight. As a nursing home resident's BMI increases, especially for BMI ≥40 kg/m2, the need for extensive staffing assistance with ADLs also increases substantially.
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Affiliation(s)
- John Alexander Harris
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
| | | | - Nicholas George Castle
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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Dorner B, Friedrich EK. Position of the Academy of Nutrition and Dietetics: Individualized Nutrition Approaches for Older Adults: Long-Term Care, Post-Acute Care, and Other Settings. J Acad Nutr Diet 2018; 118:724-735. [DOI: 10.1016/j.jand.2018.01.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Indexed: 01/04/2023]
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Zhang N, Lu SF, Zhou Y, Zhang B, Copeland L, Gurwitz JH. Body Mass Index, Falls, and Hip Fractures Among Nursing Home Residents. J Gerontol A Biol Sci Med Sci 2018; 73:1403-1409. [DOI: 10.1093/gerona/gly039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 02/27/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ning Zhang
- Department of Health Policy and Promotion, School of Public Health and Health Sciences, University of Massachusetts Amherst
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Susan F Lu
- Kranner School of Management, Purdue University, West Lafayette, Indiana
| | - Yanhua Zhou
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Bo Zhang
- Department of Quantitative health Sciences, University of Massachusetts Medical School, Worcester
| | | | - Jerry H Gurwitz
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
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Muntlin Athlin Å. Methods, metrics and research gaps around minimum data sets for nursing practice and fundamental care: A scoping literature review. J Clin Nurs 2017; 27:2230-2247. [DOI: 10.1111/jocn.14155] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Åsa Muntlin Athlin
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
- Adelaide Nursing School; University of Adelaide; SA Australia
- Department of Emergency Care and Internal Medicine; Uppsala University Hospital; Uppsala Sweden
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Li S, Middleton A, Ottenbacher KJ, Goodwin JS. Trajectories Over the First Year of Long-Term Care Nursing Home Residence. J Am Med Dir Assoc 2017; 19:333-341. [PMID: 29108886 DOI: 10.1016/j.jamda.2017.09.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the trajectories in the first year after individuals are admitted to long-term care nursing homes. DESIGN Retrospective cohort study. SETTING US long-term care facilities. PARTICIPANTS Medicare fee-for-service beneficiaries newly admitted to long-term care nursing homes from July 1, 2012, to December 31, 2013 (N=535,202). MEASUREMENTS Demographic characteristics were from Medicare data. Individual trajectories were conducted using the Minimum Data Set for determining long-term care stays and community discharge, and Medicare Provider and Analysis Reviews claims data for determining hospitalizations, skilled nursing facility stays, inpatient rehabilitation, long-term acute hospital and psychiatric hospital stays. RESULTS The median length of stay in a long-term care nursing home over the 1 year following admission was 127 [interquartile range (IQR): 24, 356] days. The median length of stay in any institution was 158 (IQR: 38, 365). Residents experienced a mean of 2.1 ± 2.8 (standard deviation) transitions over the first year. The community discharge rate was 36.5% over the 1-year follow-up, with 20.8% discharged within 30 days and 31.2% discharged within 100 days. The mortality rate over the first year of nursing home residence was 35.0%, with 16.3% deaths within 100 days. At 12 months post long-term care admission, 36.9% of the cohort were in long-term care, 23.4% were in community, 4.7% were in acute care hospitals or other institutions, and 35.0% had died. CONCLUSION After a high initial community discharge rate, the majority of patients newly admitted to long-term care experienced multiple transitions while remaining institutionalized until death or the end of 1-year follow-up.
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Affiliation(s)
- Shuang Li
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
| | - Addie Middleton
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX; Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - Kenneth J Ottenbacher
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX; Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - James S Goodwin
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX; Department of Internal Medicine, Division of Geriatric Medicine, University of Texas Medical Branch, Galveston, TX.
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Zhang N, Rodriguez-Monguio R, Barenberg A, Gurwitz J. Are Obese Residents More Likely to Be Admitted to Nursing Homes That Have More Deficiencies in Care? J Am Geriatr Soc 2017; 64:1085-90. [PMID: 27225360 DOI: 10.1111/jgs.14105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether obese older adults who qualify for nursing home (NH) placement are as likely as nonobese adults to be admitted to NHs that provide adequate quality of care. DESIGN Retrospective study. SETTING NHs in New York State. PARTICIPANTS Individuals aged 65 and older newly admitted to a NH in New York State in 2006-07. MEASUREMENTS Total and healthcare-related deficiency citations for each facility were obtained from the Online Survey, Certification, and Reporting file. Bivariate and multivariate regression analyses were used to assess the association between obesity (body mass index (BMI) 30.0-39.9 kg/m(2) ) and morbid obesity (BMI ≥ 40.0 kg/m(2) ) separately and admission to facilities with more deficiencies. RESULTS NHs that admitted a higher proportion of morbidly obese residents were more likely to have more deficiencies, whether total or healthcare related. These NHs also had greater odds of having severe deficiencies, or falling in the top quartile ranking of total deficiencies. After sequentially controlling for the choice of facilities within the inspection region, resident characteristics, and facility covariates, the association between morbid obesity and admission to higher-deficiency NHs persisted. CONCLUSION Residents with morbid obesity were more likely to be admitted to NHs of poorer quality based on deficiency citations. The factors driving these disparities and their impact on the care of obese NH residents require further elucidation.
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Affiliation(s)
- Ning Zhang
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts.,Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Rosa Rodriguez-Monguio
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Andrew Barenberg
- Department of Economics, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Jerry Gurwitz
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts
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Blanco-Blanco J, Gea-Sánchez M, Valenzuela-Pascual F, Barallat-Gimeno E, Espart A, Escobar-Bravo MÁ. Are the classic signs of infection in concordance with results from percutaneous aspiration to diagnose infection in pressure injuries? J Adv Nurs 2016; 73:1433-1442. [DOI: 10.1111/jan.13225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Joan Blanco-Blanco
- GESEC Research Group, Faculty of Nursing and Physiotherapy; University of Lleida, Health Care Research Group (GRECS); Biomedical Research Institute of Lleida; Spain
| | | | | | | | - Anna Espart
- GESEC Research Group; FIF-UdL; GRECS; IRBLleida; Spain
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Obesity in Older Adults: Prevalence, Health Risk and Management of Care Among Nursing Home Residents. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0137-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Obesity is highly prevalent in the United States and is becoming increasingly common worldwide. The anatomic and physiological changes that occur in obese individuals may have an impact across the spectrum of critical illness. Obese patients may be more susceptible to hypoxemia and hypercapnia. During mechanical ventilation, elevated end-expiratory pressures may be required to improve lung compliance and to prevent ventilation-perfusion mismatch due to distal airway collapse. Several studies have shown an increased risk of organ dysfunction such as the acute respiratory distress syndrome and acute kidney injury in obese patients. Predisposition to ventricular hypertrophy and increases in blood volume should be considered in fluid management decisions. Obese patients have accelerated muscle losses in critical illness, making nutrition essential, although the optimal predictive equation to estimate nutritional needs or formulation for obese patients is not well established. Many common intensive care unit medications are not well studied in obese patients, necessitating understanding of pharmacokinetic concepts and consultation with pharmacists. Obesity is associated with higher risk of deep venous thrombosis and catheter-associated bloodstream infections, likely related to greater average catheter dwell times. Logistical issues such as blood pressure cuff sizing, ultrasound assistance for procedures, diminished quality of some imaging modalities, and capabilities of hospital equipment such as beds and lifts are important considerations. Despite the physiological alterations and logistical challenges involved, it is not clear whether obesity has an effect on mortality or long-term outcomes from critical illness. Effects may vary by type of critical illness, obesity severity, and obesity-associated comorbidities.
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Mehta C, George JV, Mehta Y, Wangmo N. Pressure ulcer and patient characteristics--A point prevalence study in a tertiary hospital of India based on the European Pressure Ulcer Advisory Panel minimum data set. J Tissue Viability 2015; 24:123-30. [PMID: 25981928 DOI: 10.1016/j.jtv.2015.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/10/2015] [Accepted: 04/16/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pressure ulcers is a frequent problem in hospitalized patients. Several prevalence studies have been conducted across the globe. Little information is available regarding prevalence of pressure ulcers in India. PURPOSE The aim was to identify the prevalence of pressure ulcers in one of the tertiary hospital in northern India and the factors associated with its development. DESIGN A cross sectional point prevalence study. INSTRUMENTS European Pressure Ulcer Advisory Panel (EPUAP) data collection form. METHODS Ethics approval was obtained prior to start of the study. Total of 358 patients were enrolled in the study. All patients above 18 years of age admitted in intensive care units and wards were included in the study. Patients admitted in emergency, day care, coronary care unit were excluded because of their short duration of hospital stay (varies from 24 to 72 h usually). All patients admitted before midnight on the predetermined day were included. The Braden scale was used to identify the risk of developing pressure ulcers. European Pressure ulcer advisory panel (EPUAP) minimum data set was used to collect prevalence data. RESULTS The overall prevalence rate was 7.8%.The sacrum and heel were more commonly affected. Grade III pressure ulcers were the most common (42.8%). CONCLUSION The pressure ulcer prevalence rate in our hospital was lower than that published in international studies. Severe forms of pressure ulcers were commonly encountered This data provides background information that may help us in developing protocols for applying effective practices for prevention of pressure ulcers.
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Affiliation(s)
- Chitra Mehta
- Institute of Critical Care and Anesthesia, Medanta - The Medicity, Gurgaon, Haryana 122001, India
| | - Joby V George
- Institute of Critical Care and Anesthesia, Medanta - The Medicity, Gurgaon, Haryana 122001, India.
| | - Yatin Mehta
- Institute of Critical Care and Anesthesia, Medanta - The Medicity, Gurgaon, Haryana 122001, India
| | - Namgyal Wangmo
- Institute of Critical Care and Anesthesia, Medanta - The Medicity, Gurgaon, Haryana 122001, India
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Zarowitz B, Allen C, O’Shea T, Dalal MR, Haumschild M, DiGenio A. Type 2 diabetes mellitus treatment patterns in US nursing home residents. Postgrad Med 2015; 127:429-37. [DOI: 10.1080/00325481.2015.1035621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Carrie Allen
- 1 Omnicare Senior Health Outcomes, Inc., Cincinnati, OH, USA
| | - Terrence O’Shea
- 1 Omnicare Senior Health Outcomes, Inc., Cincinnati, OH, USA
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Wollina U, Dreßler M, Lohmann T. Bariatric surgery - a dermatologic perspective. J Eur Acad Dermatol Venereol 2014; 29:835-41. [PMID: 25376665 DOI: 10.1111/jdv.12820] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/01/2014] [Indexed: 12/12/2022]
Abstract
Bariatric surgery has become a standard option in morbid obesity for patients not responding to conventional treatment. A major and stable weight loss can be achieved. Since obesity and weight loss may affect skin diseases, we performed this review to analyse the impact of bariatric surgery on a number of skin diseases. We categorized the skin diseases into three main groups: (i) diseases with a possible benefit from bariatric surgery, (ii) diseases that may develop after bariatric surgery and (iii) diseases that may persist. We hope that dermatologists will achieve an updated knowledge of benefits and possible hazards of this type of surgically induced weight loss.
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Affiliation(s)
- U Wollina
- Departments of Dermatology and Allergology, Hospital Dresden Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
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Chan TC, Luk JKH, Chu LW, Chan FHW. Association between body mass index and cause-specific mortality as well as hospitalization in frail Chinese older adults. Geriatr Gerontol Int 2014; 15:72-9. [PMID: 24418288 DOI: 10.1111/ggi.12230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 12/29/2022]
Abstract
AIM A U-shaped relationship between body mass index (BMI) and all-cause mortality has been reported, but there are few studies examining the association between BMI and cause-specific mortality and hospitalization. We carried out a longitudinal study to examine these associations in Chinese older adults with multiple comorbidities, which could provide a reference for the recommended BMI in this population. METHODS From 2004 to 2013, a retrospective cohort of Chinese older adults was selected from a geriatric day hospital in Hong Kong. They were divided into groups according to their BMI: BMI <16; BMI 16-18; BMI 18.1-20; BMI 20.1-22; BMI 22.1-24; BMI 24.1-26; BMI 26.1-28; BMI 28.1-30 and BMI >30. Other assessments included medical, functional, cognitive, social and nutritional assessment. RESULTS A total of 1747 older adults (mean age 80.8 ± 7.1 years, 44.1% male, 46.1% living in nursing homes, Charlson Comorbidity Index 2.0 ± 1.6) with a median follow up of 3.5 years were included. Older adults with BMI 24-28 had the lowest all-cause, infection-related and cardiovascular mortality (P < 0.001). Multivariate analysis showed that there was an inverted J-shaped association between BMI and hazard ratio for all-cause and infection-related mortality in both nursing home and community-dwelling older adults. The rate of all-cause hospitalization was lower in older adults with BMI 22-28 (P = 0.002). Multivariate analysis showed that there was an inverted J-shaped association between the odds ratio of recurrent hospitalization and BMI. CONCLUSION Chinese older adults with BMI 24-28 had lower all-cause mortality, infection-related mortality, cardiovascular-related mortality and all-cause hospitalization. This study provides a reference for the recommended BMI in this population.
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Affiliation(s)
- Tuen-Ching Chan
- Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong; Division of Geriatric Medicine, Department of Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
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