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Ishikawa Y, Adachi T, Uchiyama Y. Association of Nutritional Risk With Gait Function and Activities of Daily Living in Older Adult Patients With Hip Fractures. Ann Rehabil Med 2024; 48:115-123. [PMID: 38644638 PMCID: PMC11058366 DOI: 10.5535/arm.230015] [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: 11/02/2023] [Revised: 02/17/2024] [Accepted: 03/12/2024] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVE To investigate the association of nutritional risk with gait function and activities of daily living (ADLs) in older adult patients with hip fractures. METHODS The retrospective data of older adult patients diagnosed with hip fractures who visited the recovery-phase rehabilitation ward between January 2019 and December 2022 were reviewed. Nutritional risk was evaluated using the Geriatric Nutritional Risk Index; gait function and ADLs were assessed using the modified Harris Hip Score subitem and Functional Independence Measure, respectively. Multivariate linear regression and path analysis with structural equation modeling were used to examine the factors associated with ADLs and the associations among the study variables. RESULTS This study included 206 participants (172 females and 34 males; mean age, 85.0±7.3 years). In the multivariate analysis, gait function (β=0.488, p<0.001), cognitive function (β=0.430, p<0.001), and surgery (β=-0.143, p<0.001) were identified as independent factors. Pathway analysis revealed that nutritional risk was not directly correlated with ADLs but was directly associated with gait and cognitive functions. Gait and cognitive functions, in turn, were directly related to ADLs. CONCLUSION Nutritional risk was found to be associated with ADLs through an intermediary of gait and cognitive functions.
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Affiliation(s)
- Yasunobu Ishikawa
- Department of Rehabilitation, Nishio Hospital, Nishio, Japan
- Division of Creative Physical Therapy, Field of Prevention and Rehabilitation Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Takuji Adachi
- Division of Creative Physical Therapy, Field of Prevention and Rehabilitation Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yasushi Uchiyama
- Division of Creative Physical Therapy, Field of Prevention and Rehabilitation Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Hurtado Y, Hernández OA, De Leon DPA, Duque G. Challenges in Delivering Effective Care for Older Persons with Fragility Fractures. Clin Interv Aging 2024; 19:133-140. [PMID: 38283764 PMCID: PMC10822128 DOI: 10.2147/cia.s433999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/19/2024] [Indexed: 01/30/2024] Open
Abstract
Fragility fractures occur because of low-impact trauma or even spontaneously in individuals with osteoporosis. Caring for older persons with fragility fractures can present several challenges due to the unique needs and vulnerabilities of this population. Older individuals commonly have multiple medical conditions, such as osteoporosis, arthritis, cardiovascular diseases, and diabetes. These comorbidities can complicate fracture management and increase the risk of complications. Fracture repair through surgery may be more complex in older patients due to poor bone quality, decreased tissue elasticity, and higher chances of anesthesia complications. In addition, mobility and functional limitations post-fracture are highly prevalent in this population, affecting their independence and increasing their risk of institutionalization. Addressing these challenges requires a multidisciplinary approach involving orthopedic surgeons, geriatricians, physical and rehabilitation physicians, physiotherapists, occupational therapists, dieticians, social workers, and caregivers. Preventive measures, such as fall prevention strategies and osteoporosis management, can also play a vital role in reducing the incidence of fragility fractures in older persons.
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Affiliation(s)
- Yesid Hurtado
- Division of Endocrinology, Hospital San José, Bogotá, Colombia
| | | | | | - Gustavo Duque
- Bone, Muscle & Geroscience Research Group, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Dr. Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
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Tzen YT, Sambandam S, Delmore B, Wang J, Chu A, Wukich DK. Clinical Risk Factors of Perioperative Pressure Injury in Older Adult Patients with a Hip Fracture. Adv Skin Wound Care 2023; 36:642-650. [PMID: 37983577 DOI: 10.1097/asw.0000000000000068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To examine the clinical risk factors of perioperative pressure injury (PrI) in older adults with a hip fracture, including preoperative chronic comorbidities and postoperative complications. METHODS In this retrospective study, the authors queried the PearlDiver Patient Records database between January 2011 and January 2020. Data from 54,194 patients without preexisting PrI were included for analyses. Patients were separated into two groups: (1) one or more perioperative PrI and (2) no PrI. Clinical factors as outcome variables include 21 comorbidities and 10 complications. RESULTS Univariate analyses were computed to compare the variables between groups, and two logistic regression models were developed to find comorbidity predictors and complication predictors. Of all patients, 1,362 (2.5%) developed one or more perioperative PrI. Patients with perioperative PrIs were more likely to be older men. One-year mortality for patients with perioperative PrI was 2.5 times that of patients without PrI. The regression models showed that predictors of perioperative PrI are malnutrition, hypoalbuminemia, frailty, peripheral vascular disease, dementia, urinary tract infection, perioperative red blood cell transfusion, and atrial fibrillation. CONCLUSIONS Screening for these comorbidities and complications may assist in determining the risk of PrI in older adults undergoing hip fracture surgery. Determining PrI risk enables the appropriate prevention strategies to be applied perioperatively.
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Affiliation(s)
- Yi-Ting Tzen
- Yi-Ting Tzen, PhD, is Assistant Professor, Department of Applied Clinical Research, and Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA. Senthil Sambandam, MD, is Assistant Professor, Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, and Division of Orthopedic Surgery, Veterans Affairs North Texas Health Care System, Dallas. Barbara Delmore, PhD, RN, CWCN, MAPWCA, FAAN, is Senior Nurse Scientist, Center for Innovations in the Advancement of Care, and Clinical Assistant Professor, Hansjörg Wyss, Department of Plastic Surgery, NYU Langone Health, New York. Jijia Wang, PhD, is Assistant Professor, Department of Applied Clinical Research, University of Texas Southwestern Medical Center. Andy Chu, MS, RD, CDN, CNSC, is Registered Dietitian, Food and Nutrition Services, NYU Langone Health. Dane K. Wukich, MD, is Professor, Department of Orthopedic Surgery, University of Texas Southwestern Medical Center. Conflict of Interest: Dr Wukich serves as consultant with Orthofix Medical Inc, Stryker, and Wright Medical and receives royalties from Arthrex Inc. The authors have disclosed no other financial relationships related to this article. Submitted August 5, 2022; accepted in revised form January 4, 2023
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Khan AA, AbuAlrob H, Al-Alwani H, Ali DS, Almonaei K, Alsarraf F, Bogoch E, Dandurand K, Gazendam A, Juby AG, Mansoor W, Marr S, Morgante E, Myslik F, Schemitsch E, Schneider P, Thain J, Papaioannou A, Zalzal P. Post hip fracture orthogeriatric care-a Canadian position paper addressing challenges in care and strategies to meet quality indicators. Osteoporos Int 2023; 34:1011-1035. [PMID: 37014390 DOI: 10.1007/s00198-022-06640-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/12/2022] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Osteoporosis is a major disease state associated with significant morbidity, mortality, and health care costs. Less than half of the individuals sustaining a low energy hip fracture are diagnosed and treated for the underlying osteoporosis. OBJECTIVE A multidisciplinary Canadian hip fracture working group has developed practical recommendations to meet Canadian quality indicators in post hip fracture care. METHODS A comprehensive narrative review was conducted to identify and synthesize key articles on post hip fracture orthogeriatric care for each of the individual sections and develop recommendations. These recommendations are based on the best evidence available today. CONCLUSION Recommendations are anticipated to reduce recurrent fractures, improve mobility and healthcare outcomes post hip fracture, and reduce healthcare costs. Key messages to enhance postoperative care are also provided.
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Affiliation(s)
- Aliya A Khan
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada.
| | - Hajar AbuAlrob
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Hatim Al-Alwani
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Dalal S Ali
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Khulod Almonaei
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Farah Alsarraf
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Earl Bogoch
- Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Karel Dandurand
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Aaron Gazendam
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Angela G Juby
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| | - Wasim Mansoor
- Trillium Health Partners, University of Toronto, Toronto, ON, Canada
| | - Sharon Marr
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Emmett Morgante
- Bone Research and Education Center Patient Support Program and Education Coordinator, Oakville, ON, Canada
| | - Frank Myslik
- Division of Emergency Medicine, Western University, London, ON, Canada
| | - Emil Schemitsch
- Department of Surgery, Division of Orthopaedic Surgery, Western University, London, ON, Canada
| | - Prism Schneider
- Department of Surgery, Division of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Jenny Thain
- Department of Medicine, Division of Geriatric Medicine, Western University, London, ON, Canada
| | - Alexandra Papaioannou
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Paul Zalzal
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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Greenwood C, Nelson EA, Nixon J, Vargas-Palacios A, McGinnis E. Comparative effectiveness of heel-specific medical devices for the prevention of heel pressure ulcers: A systematic review. J Tissue Viability 2022; 31:579-592. [DOI: 10.1016/j.jtv.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/28/2022] [Accepted: 09/28/2022] [Indexed: 12/15/2022]
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Jiao Y, Yuan C, Wu T, Zhang H, Wei Y, Ma Y, Zhang X, Han L. Incidence of pressure injuries in fracture patients: A systematic review and meta-analysis. J Tissue Viability 2022; 31:726-734. [PMID: 36109261 DOI: 10.1016/j.jtv.2022.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/17/2022] [Accepted: 08/28/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To systematically evaluate the incidence of pressure injuries (PIs) in hospitalized fracture patients and to provide evidence for the prevention and treatment of PIs. METHODS A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Electronic databases including PubMed, Embase, the Cochrane Library, Web of Science, CINAHL, China Knowledge Resource Integrated Database (CNKI), WanFang Database, Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched to collect cross-sectional studies and cohort studies related to PIs among hospitalized fracture patients. All electronic literature sources were searched from inception to March 2022, and a hand-search through references was also conducted to find relevant articles. Studies were evaluated independently by two researchers and audited by a third researcher. The data were extracted and presented in tables. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. All data analysis used Stata14.0. The I2 statistic and random-effects model were used to determine the heterogeneity. RESULTS A total of 7906 articles were screened, and 18 studies with 8956 patients were ultimately involved in this review. The pooled incidence of PIs in the fracture patients was 20.4% (95%CI: 14.9 to 25.8), and the incidence of PIs only in spinal and hip fracture patients was 23.9% (95%CI: 19.6 to 28.2). The incidence of PIs in 65 years old or over was significantly high (23.3% [95%CI: 15.3 to 31.2]). The most affected body sites were sacrococcygeal regions (56.7%) and heels (19.9%). The most common stages were stage 2 (62.2%) and stage 1 (17.4%). CONCLUSION The overall incidence of PIs in fracture patients was as high as 20.4%, significantly higher than the average incidence of adults. We found that the potential for PIs in fracture patients increases with age. Hence, our discoveries recommended that healthcare givers should consider reducing the occurrence of PIs. Additionally, more research may be conducted to improve the understanding of characteristics of PIs among fracture patients and to identify PIs risk factors to prevent and treat them effectively.
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Affiliation(s)
- Yanxia Jiao
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Chenlu Yuan
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Tong Wu
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province, #204 Donggang Road, Chenguan District, 730000, China.
| | - Yuting Wei
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Xiujuan Zhang
- Department of Respiratory, Gansu Provincial Hospital, Lanzhou City, Gansu Province, #204 Donggang Road, Chenguan District, 730000, China.
| | - Lin Han
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province, #204 Donggang Road, Chenguan District, 730000, China.
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Dementia is a surrogate for frailty in hip fracture mortality prediction. Eur J Trauma Emerg Surg 2022; 48:4157-4167. [PMID: 35355091 PMCID: PMC9532301 DOI: 10.1007/s00068-022-01960-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/13/2022] [Indexed: 12/12/2022]
Abstract
Purpose Among hip fracture patients both dementia and frailty are particularly prevalent. The aim of the current study was to determine if dementia functions as a surrogate for frailty, or if it confers additional information as a comorbidity when predicting postoperative mortality after a hip fracture. Methods All adult patients who suffered a traumatic hip fracture in Sweden between January 1, 2008 and December 31, 2017 were considered for inclusion. Pathological fractures, non-operatively treated fractures, reoperations, and patients missing data were excluded. Logistic regression (LR) models were fitted, one including and one excluding measurements of frailty, with postoperative mortality as the response variable. The primary outcome of interest was 30-day postoperative mortality. The relative importance for all variables was determined using the permutation importance. New LR models were constructed using the top ten most important variables. The area under the receiver-operating characteristic curve (AUC) was used to compare the predictive ability of these models. Results 121,305 patients were included in the study. Initially, dementia was among the top ten most important variables for predicting 30-day mortality. When measurements of frailty were included, dementia was replaced in relative importance by the ability to walk alone outdoors and institutionalization. There was no significant difference in the predictive ability of the models fitted using the top ten most important variables when comparing those that included [AUC for 30-day mortality (95% CI): 0.82 (0.81–0.82)] and excluded [AUC for 30-day mortality (95% CI): 0.81 (0.80–0.81)] measurements of frailty. Conclusion Dementia functions as a surrogate for frailty when predicting mortality up to one year after hip fracture surgery. The presence of dementia in a patient without frailty does not appreciably contribute to the prediction of postoperative mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01960-9.
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Factors Predicting Pressure Injury Incidence in Older Adults Following Elective Total Hip Arthroplasty: A Longitudinal Study. Adv Skin Wound Care 2022; 35:48-55. [PMID: 34935722 DOI: 10.1097/01.asw.0000801540.04621.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify the factors associated with pressure injury (PI) development in older adult patients who underwent elective total hip arthroplasty (THA). METHODS A nonexperimental longitudinal prospective study was conducted with a sample of 40 patients undergoing elective THA. Patients were evaluated for PI at hospital admission, 24 hours postsurgery, at discharge, and 1 month after surgery. RESULTS The incidence of PIs (category 1 or category 2) in this study was 7.9% 24 hours after surgery and 24.3% at discharge. The most common PI location was the sacrum/coccyx or the ischial tuberosity. This study found significant relationships between PIs and female sex (odds ratio [OR], 8.75), body fat mass percentage (OR, 1.15), and the motor score from a Functional Independence Measure scale (OR, 0.89). Finally, the following variables were also associated with PIs (P < .1): skeletal muscle mass (OR, 0.82), lower limb with osteoarthritis weight (OR, 0.61), lower limb without osteoarthritis weight (OR, 0.62), and geriatric depression scale (OR, 1.12). CONCLUSIONS This work identifies those patients at higher risk of PI, enabling targeted prevention and treatment in the population of patients undergoing elective THA. The findings of this study are in line with extant literature and suggest that women with a higher percentage of body fat and less mobility had a higher risk of PI.
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Yang Q, Li J, Shi D, Xie H, Wang J, Shi Z, Zhang Y. Incidence and risk factors associated with hospital-acquired pressure ulcers following total hip arthroplasty: A retrospective nationwide inpatient sample database study. J Tissue Viability 2022; 31:332-338. [DOI: 10.1016/j.jtv.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 12/25/2022]
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Lai WY, Chiu YC, Lu KC, Huang IT, Tsai PS, Huang CJ. Beneficial effects of preoperative oral nutrition supplements on postoperative outcomes in geriatric hip fracture patients: A PRISMA-compliant systematic review and meta-analysis of randomized controlled studies. Medicine (Baltimore) 2021; 100:e27755. [PMID: 34964732 PMCID: PMC8615416 DOI: 10.1097/md.0000000000027755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 10/27/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Geriatric hip fracture patients often present malnutrition during admission, which leads to higher morbidity and mortality. Protein-based oral nutrition supplements may improve nutritional status. We conducted this systematic review and meta-analysis of randomized controlled trials (RCTs) according to the PRISMA guidelines to elucidate whether preoperative nutrition supplements can improve postoperative outcomes in geriatric hip fracture patients. METHODS Only RCTs conducted to compare postoperative outcomes between geriatric hip fracture patients (>60 years old) receiving preoperative oral protein-based nutrition supplement (ONS group) and those who receiving regular diet (Control group) were included. PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception until August, 2021. Postoperative outcomes, including complications, length of hospital stay, and in-hospital mortality, were assessed. RESULTS A total of 5 RCTs with 654 geriatric hip fracture patients (ONS group: 320 subjects; Control group 334 subjects) were included. Our data revealed that postoperative complications risk in the ONS group was significantly lower than in the Control group (odd's ratio: 0.48, 95% confidence intervals [CI]: 0.26-0.89, P = .02, I2 = 64%). However, no significant differences in the length of hospital stay (standardized mean difference: -0.35 days, 95% CI: -1.68 to 0.98 days, P = .61, I2 = 0%) and the risk of having postoperative in-hospital mortality (odd's ratio: 1.07, 95% CI: 0.43-2.63, P = .89, I2 = 54%) between these 2 groups were observed. Quality assessment revealed high risk of bias and significant data heterogeneity (I2>50%) in most included RCTs. CONCLUSION Preoperative protein-based oral nutrition supplements exert beneficial, but limited, effects on postoperative outcomes in geriatric patients with hip fracture undergoing surgery.
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Affiliation(s)
- Wen-Yi Lai
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chi Chiu
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuo-Ching Lu
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - I-Tao Huang
- Emergency Department, Redcliffe Hospital, QLD, Australia
- School of Public Health, Faculty of Medicine, University of Queensland, QLD, Australia
| | - Pei-Shan Tsai
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chun-Jen Huang
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Abstract
ABSTRACT Hip fractures are considered a significant public health issue, representing a substantial burden on our healthcare system and society. They are one of the leading causes of disability among older adults, especially women. Globally, an estimated 18% of women and 6% of men will be affected by hip fractures at some time in life. Hip fractures are a major cause of long-term disability among older adults and more significant than mortality, as only 60% of patients regain their preinjury level of mobility. This has detrimental effects on quality of life and activities of daily living, imposing a level of dependence that has personal, social, and systemic consequences.
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Affiliation(s)
- Meagan L Barry
- At the time this article was written, Meagan L. Barry was a student in the PA program at the University of Tennessee Health Science Center in Memphis. She now practices at Dallas (Tx.) Orthopaedic Joint Institute. Kristopher R. Maday is an associate professor and program director in the PA program at the University of Tennessee. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Berry SD, Daiello LA, Lee Y, Zullo AR, Wright NC, Curtis JR, Kiel DP. Secular Trends in the Incidence of Hip Fracture Among Nursing Home Residents. J Bone Miner Res 2020; 35:1668-1675. [PMID: 32302028 PMCID: PMC7486242 DOI: 10.1002/jbmr.4032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/28/2020] [Accepted: 04/13/2020] [Indexed: 12/30/2022]
Abstract
A recent study suggested a decline in the incidence of hip fracture among US women between 2002 and 2012, followed by a leveling in the incidence rate from 2013 to 2015. Newly admitted nursing home residents are particularly vulnerable to hip fracture, and it is unclear whether that trend is observed in this high risk group. The purpose of our study was to describe trends in hip fracture rates and postfracture mortality among 2.6 million newly admitted US nursing home residents from 2007 to 2015, and to examine whether these trends could be explained by differences in resident characteristics. Medicare claims data were linked with the Minimum Data Set (MDS), a clinical assessment performed quarterly on all nursing home residents. In each year (2007-2015), we identified newly admitted long-stay (ie, 100 days in the same facility) nursing home residents. Hip fracture was defined using Medicare Part A diagnostic codes. Follow-up time was calculated from the index date until the first event of hospitalized hip fracture, Medicare disenrollment, death, or until 1 year. Poisson regression was used to adjust rates of hip fracture for age and sex. The number of newly admitted nursing home residents ranged from 324,508 in 2007 to 257,350 in 2015. Although mean age remained similar (83 years), residents were more functionally dependent over time. There was a small absolute decrease in the incidence rate of hip fracture between 2007 (3.32/100 person-years) and 2013 (2.82/100 person-years), with an increase again in 2015 (3.03/100 person-years). Adjusting for patient characteristics somewhat attenuated these trends. One-year mortality was high following fracture in all years (42.6% in 2007, 42.1% in 2014). In summary, we observed a recent slight rise in the incidence rates of hip fracture among nursing home residents that was at least partially explained by differences in resident characteristics over time. © 2020 American Society for Bone and Mineral Research.
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Affiliation(s)
- Sarah D Berry
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
| | - Lori A Daiello
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey R Curtis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Douglas P Kiel
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
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Reyes BJ, Mendelson DA, Mujahid N, Mears SC, Gleason L, Mangione KK, Nana A, Mijares M, Ouslander JG. Postacute Management of Older Adults Suffering an Osteoporotic Hip Fracture: A Consensus Statement From the International Geriatric Fracture Society. Geriatr Orthop Surg Rehabil 2020; 11:2151459320935100. [PMID: 32728485 PMCID: PMC7366407 DOI: 10.1177/2151459320935100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The majority of patients require postacute care (PAC) after a hip fracture. Despite its importance, there is no established consensus regarding the standards of care provided to hip fracture patients in PAC facilities. METHODOLOGY A writing group was created by professionals from the International Geriatric Fracture Society (IGFS) with representation from other organizations. The focus of the statements included in this article is toward PAC providers located in nursing facilities. Contributions were integrated in a single document that underwent several reviews by each author and then underwent a final review by the lead and senior authors. After this process was completed, the document was appraised by reviewers from IGFS. RESULTS/CONCLUSION A total of 15 statements were crafted. These statements summarize the best available evidence and is intended to help PAC facilities managing older adults with hip fractures more efficiently, aiming toward overall better outcomes in the areas of function, quality of life, and with less complications that could interfere with their optimal recovery.
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Affiliation(s)
- Bernardo J. Reyes
- Charles E Schmidt College of Medicine, Florida Atlantic University,
FL, USA
| | | | - Nadia Mujahid
- Warren Alpert School of Brown University, Rhode Island, USA
| | | | - Lauren Gleason
- The University of Chicago Medical and Biological Science, IL,
USA
| | | | - Arvind Nana
- Charles E Schmidt College of Medicine, Florida Atlantic University,
FL, USA
| | - Maria Mijares
- Charles E Schmidt College of Medicine, Florida Atlantic University,
FL, USA
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14
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Omissions of Care in Nursing Home Settings: A Narrative Review. J Am Med Dir Assoc 2020; 21:604-614.e6. [DOI: 10.1016/j.jamda.2020.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
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15
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Postoperative Pressure Ulcers After Geriatric Hip Fracture Surgery Are Predicted by Defined Preoperative Comorbidities and Postoperative Complications. J Am Acad Orthop Surg 2020; 28:342-351. [PMID: 31567615 DOI: 10.5435/jaaos-d-19-00104] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The current study sought to determine the factors predictive of postoperative pressure ulcer development by analyzing extensive multicenter outcomes data from the 2016 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. METHODS The 2016 NSQIP Participant Use File and Hip Fracture Procedure Targeted file were used to identify the risk factors for the development of postoperative pressure ulcers after hip fracture surgery in a geriatric cohort. Multivariate regressions were performed to identify preoperative comorbidities and postoperative complications that are risk factors for developing postoperative pressure ulcers. RESULTS Of 8,871 geriatric hip fracture patients included in the study cohort, 457 (5.15%) developed pressure ulcers. Multivariate regressions identified the following preoperative risk factors for developing a postoperative pressure ulcer (in order of decreasing relative risk): preoperative sepsis, elevated platelet count, insulin-dependent diabetes, and preexisting pressure ulcer. Multivariate regressions also identified the following postoperative complications as risk factors for developing a postoperative pressure ulcer: postoperative sepsis, postoperative pneumonia, urinary tract infection, and postoperative delirium. DISCUSSION The identified preoperative factors and postoperative complications should help guide quality improvement programs.
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16
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Han D, Kang B, Kim J, Jo YH, Lee JH, Hwang JE, Park I, Jang DH. Prolonged stay in the emergency department is an independent risk factor for hospital-acquired pressure ulcer. Int Wound J 2019; 17:259-267. [PMID: 31773872 DOI: 10.1111/iwj.13266] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/21/2019] [Accepted: 10/25/2019] [Indexed: 11/28/2022] Open
Abstract
It is not easy to ensure optimal prevention of hospital-acquired pressure ulcer (HAPU) in crowded emergency departments (EDs). We hypothesised that a prolonged ED length of stay (LOS) is associated with an increased risk of HAPU. This is a single-centre observational study. Prospectively collected HAPU surveillance data were analysed. Adult (aged ≥20 years) patients admitted through the ED from April 1, 2013 to December 31, 2016 were included. The primary outcome was the development of HAPU within a month. Covariates included demographics, comorbidities, conditions at triage, initial laboratory results, primary ED diagnosis, critical ED interventions, and ED dispositions. The association between ED LOS and HAPU was modelled using logistic and extended Cox regression. A total of 48 641 admissions were analysed. The crude odds ratio (OR) and hazard ratio (HR) for HAPU were increased to 1.44 (95% CI, 1.20-1.72) and 1.21 (95% CI, 1.02-1.45), respectively, in ED LOS ≥24 hours relative to ED LOS <6 hours. In multivariable logistic regression, ED LOS ≥12 and ≥24 hours were associated with higher risk of HAPU, with ORs of 1.30 (95% CI, 1.05-1.60) and 1.80 (95% CI, 1.45-2.23) relative to ED LOS <6 hours, respectively. The extended Cox regression showed that the risk lasted up to a week, with HRs of 1.42 (95% CI, 1.07-1.88) and 1.92 (95% CI, 1.44-2.57) relative to ED LOS <6 hours, respectively. In conclusion, Prolonged ED LOS is independently associated with HAPU. Shorter ED LOS should be pursued as a goal in a multifaceted solution for HAPU.
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Affiliation(s)
- Dongkwan Han
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Bora Kang
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Ji Eun Hwang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Inwon Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Dong-Hyun Jang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
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17
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Wei R, Chen HL, Zha ML, Zhou ZY. Diabetes and pressure ulcer risk in hip fracture patients: a meta-analysis. J Wound Care 2019; 26:519-527. [PMID: 28880760 DOI: 10.12968/jowc.2017.26.9.519] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to assess the relationship between diabetes and pressure ulcer (PU) risk in patients with hip fractures. METHOD Searches of MEDLINE (1966-), ISI Databases (1965-) and Scopus (1996-) were performed for English language studies. The search data was 29 July 2016. Odds ratio (OR) for PUs were calculated for hip fracture patients with or without diabetes and a meta-analysis was carried out following meta-analysis of observational studies in epidemiology (MOOSE) guidelines. RESULTS A total of 8 studies with 22,180 patients were included in this study. The mean PU incidence was 15.1% in group with diabetes compared with 7.5% in the group without diabetes. When comparing with and without diabetes meta-analysis showed the summary OR was 1.825 [95% confidence interval (CI): 1.373-2.425; z=4.15, p<0.00001]. No significant publication bias was found. Sensitivity analysis included prospective studies [OR: 1.383, 95%CI: 1.035-1.847] and pooled the adjusted OR [OR: 1.282, 95%CI: 1.054-1.560] showed the result was robust. Subgroup analysis by PU stage showed the summary OR was 1.474 [95% CI 0.984-2.207] for ≥ category II PU, and 2.814 [95%CI: 2.115-3.742] for ≥category I PU. The meta-regression showed PU incidence explained 27.77% proportion of between-study variance, but statistical test showed no significance (t=-1.96, p=0.097). CONCLUSION Our meta-analysis indicates that diabetes increases the PU risk in hip fracture patients. Therefore, specific recommendations should apply for the management of diabetic patients with hip fractures at risk of PU.
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Affiliation(s)
- R Wei
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu, PR China
| | - H-L Chen
- School of Nursing, Nantong University, Nantong, Jiangsu, PR China
| | - M-Li Zha
- School of Nursing, Nantong University, Nantong, Jiangsu, PR China
| | - Z-Y Zhou
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu, PR China
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18
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Malik AT, Quatman-Yates C, Phieffer LS, Ly TV, Khan SN, Quatman CE. Factors Associated With Inability to Bear Weight Following Hip Fracture Surgery: An Analysis of the ACS-NSQIP Hip Fracture Procedure Targeted Database. Geriatr Orthop Surg Rehabil 2019; 10:2151459319837481. [PMID: 31069126 PMCID: PMC6492357 DOI: 10.1177/2151459319837481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/18/2019] [Accepted: 02/16/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction: While the benefits of early mobility for prevention of complications such as pneumonia,
thromboembolic events, and improved mortality have been well studied in postsurgical
patients, it is unclear which patients may struggle to achieve full weight-bearing on
the first postoperative day. Materials and Methods: The 2016 American College of Surgeons National Surgical Quality Improvement Program
(ACS-NSQIP) Targeted Hip Fracture Database was queried regarding the ability to achieve
weight-bearing on first postoperative day for older adults. Cases that occurred
secondary to malignancy were excluded or for which weight-bearing was unachievable on
the first postoperative day due to medical reasons were excluded. Results: A total of 6404 patients met inclusion and exclusion criteria for the study, with 1640
(25.6%) patients unable to bear weight on the first postoperative day. Following
adjusted analysis, nonmodifiable patient factors such as dependent (partial or total)
functional health status, dyspnea with moderate exertion (odds ratio [OR]: 1.31 [95%
confidence interval, CI: 1.04-1.65]), ventilator dependency, and preoperative dementia
on presentation to hospital were associated with lack of achievement of weight-bearing
on the first postoperative day. Modifiable patient factors such as presence of systemic
inflammatory response syndrome (OR: 1.35 [95% CI: 1.11-1.64]), delirium, and low
preoperative hematocrit and modifiable system factors including delayed time to surgery,
total postoperative time >90 minutes, and transfer from an outside emergency
department were also associated with inability to achieve weight-bearing on the first
postoperative day. Discussion: Medical teams can utilize the results from this study to better identify patients
preoperatively who may be at risk of not achieving early mobilization and proactively
employ implement strategies to encourage mobility as soon as possible for hip fracture
patients.
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Affiliation(s)
- Azeem Tariq Malik
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Catherine Quatman-Yates
- Division of Physical Therapy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laura S Phieffer
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thuan V Ly
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Safdar N Khan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carmen E Quatman
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Commonly Initiated Opioids and Risk of Fracture Hospitalizations in United States Nursing Homes. Drugs Aging 2018; 35:925-936. [PMID: 30187291 DOI: 10.1007/s40266-018-0583-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of this study was to estimate the comparative safety of initiating commonly used opioids among older, long-stay United States nursing home residents with fracture hospitalizations. METHODS We conducted a new-user retrospective cohort study of nursing home residents initiating short-acting oxycodone, hydrocodone, or tramadol by merging the 2011-2013 Minimum Data Set 3.0 to Medicare hospitalization and pharmacy claims. Residents (≥ 65 years, no cancer or hospice use) contributed treatment episodes (> 120 days with no prior opioid claims) and were followed for 180 days until incident fracture hospitalization (hip, femur, humerus, pelvis, radius/ulna), death (competing risk), treatment changes (e.g., discontinuation), or administrative censoring. Competing risks models with inverse probability of treatment weighting were used to estimate subdistribution hazard ratios (HRSD) and 95% confidence intervals (CI). RESULTS Overall, 110,862 residents contributed 134,432 treatment episodes: 14,373 oxycodone; 69,182 hydrocodone; and 50,877 tramadol initiators. The incidences of fracture hospitalizations per 100 person-years were 9.4 (95% CI 7.5-11.7) for oxycodone, 7.9 (95% CI 7.1-8.8) for hydrocodone, and 5.0 (95% CI 4.3-5.7) for tramadol initiators. In weighted models, oxycodone initiators had a similar rate of fractures to hydrocodone initiators (HRSD 1.08, 95% CI 0.79-1.48). Tramadol initiators had lower fracture rates than hydrocodone initiators (HRSD 0.67, 95% CI 0.56-0.80). CONCLUSIONS The lower rate of fractures that we documented among tramadol initiators compared with hydrocodone initiators is consistent, albeit attenuated compared with prior studies among community-dwelling older adults. However, overall fracture rates were lower than in community settings, potentially due to the limited risk of falling in this population with limited mobility.
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20
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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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21
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Abraham DS, Barr E, Ostir GV, Hebel JR, Golden J, Gruber-Baldini AL, Guralnik JM, Hochberg MC, Orwig DL, Resnick B, Magaziner JS. Residual Disability, Mortality, and Nursing Home Placement After Hip Fracture Over 2 Decades. Arch Phys Med Rehabil 2018; 100:874-882. [PMID: 30391413 DOI: 10.1016/j.apmr.2018.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/26/2018] [Accepted: 10/10/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To examine trends in 12-month postfracture residual disability, nursing home placement, and mortality among patients with a hip fracture between 1990 and 2011. DESIGN Secondary analysis of 12-month outcomes from 3 cohort studies and control arms of 2 randomized controlled trials. SETTING Original studies were conducted as part of the Baltimore Hip Studies (BHS). PARTICIPANTS Community-dwelling patients ≥65 years of age hospitalized for surgical repair of a nonpathologic hip fracture (N=988). MAIN OUTCOME MEASURES Twelve-month residual disability, mortality, and nursing home residency were examined in case-mix adjusted models by sex and study. Residual disability was calculated by subtracting prefracture scores of Lower Extremity Physical Activities of Daily Living from scores at 12 months postfracture. We also examined the proportion of individuals with a 12-month score higher than their prefracture score (residual disability>0). RESULTS Only small improvements were seen in residual disability between 1990 and 2011. No significant differences were seen for men between BHS2 (enrollment 1990-1991; mean residual disability=3.1 activities; 95% confidence interval [CI], 2.16-4.10) and BHS7 (enrollment 2006-2011; mean=3.1 activities; 95% CI, 2.41-3.82). In women, residual disability significantly improved from BHS2 (mean=3.5 activities; 95% CI, 2.95-3.99) to BHS3 (enrollment 1992-1995; mean=2.7 activities; 95% CI, 2.01-3.30) with no significant improvements in later studies. After adjustment, a substantial proportion (91% of men and 79% of women) had a negative outcome (residual disability, died, or nursing home residence at 12 months) in the most recently completed study (BHS7). CONCLUSIONS Over 2 decades, patients undergoing usual care post-hip fracture still had substantial residual disability. Additional clinical and research efforts are needed to determine how to improve hip fracture treatment, rehabilitation, and subsequent outcomes.
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Affiliation(s)
- Danielle S Abraham
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Erik Barr
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Glenn V Ostir
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; Institute of Gerontology, University of Georgia College of Public Health, Athens, GA
| | - J Richard Hebel
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Justine Golden
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Ann L Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Marc C Hochberg
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Denise L Orwig
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | | | - Jay S Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
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22
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Skin status for predicting pressure ulcer development: A systematic review and meta-analyses. Int J Nurs Stud 2018; 87:14-25. [DOI: 10.1016/j.ijnurstu.2018.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/15/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
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Berry SD, Rothbaum RR, Kiel DP, Lee Y, Mitchell SL. Association of Clinical Outcomes With Surgical Repair of Hip Fracture vs Nonsurgical Management in Nursing Home Residents With Advanced Dementia. JAMA Intern Med 2018; 178:774-780. [PMID: 29801122 PMCID: PMC5997966 DOI: 10.1001/jamainternmed.2018.0743] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE The decision whether to surgically repair a hip fracture in nursing home (NH) residents with advanced dementia can be challenging. OBJECTIVE To compare outcomes, including survival, among NH residents with advanced dementia and hip fracture according to whether they underwent surgical hip fracture repair. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective cohort study of 3083 NH residents with advanced dementia and hip fracture, but not enrolled in hospice care, using nationwide Medicare claims data linked with Minimum Data Set (MDS) assessments from January 1, 2008, through December 31, 2013. METHODS Residents with advanced dementia were identified using the MDS. Medicare claims were used to identify hip fracture and to determine whether the fracture was managed surgically. Survival between surgical and nonsurgical residents was compared using multivariable Cox proportional hazards with inverse probability of treatment weighting (IPTW). All analyses took place between November 2015 and January 2018. Among 6-month survivors, documented pain, antipsychotic drug use, physical restraint use, pressure ulcers, and ambulatory status were compared between surgical and nonsurgical groups. RESULTS Among 3083 residents with advanced dementia and hip fracture (mean age, 84.2 years; 79.2% female [n = 2441], 28.5% ambulatory [n = 879]), 2615 (84.8%) underwent surgical repair. By 6-month follow-up, 31.5% (n = 824) and 53.8% (n = 252) of surgically and nonsurgically managed residents died, respectively. After IPTW modeling, surgically managed residents were less likely to die than residents without surgery (adjusted hazard ratio [aHR], 0.88; 95% CI, 0.79-0.98). Among 2007 residents who survived 6 months, residents with surgical vs nonsurgical management had less docmented pain (29.0% [n = 465] vs 30.9% [n = 59]) and fewer pressure ulcers (11.2% [n = 200] vs 19.0% [n = 41]). In IPTW models, surgically managed residents reported less pain (aHR, 0.78; 95% CI, 0.61-0.99) and pressure ulcers (aHR, 0.64; 95% CI, 0.47-0.86). There was no difference between antipsychotic drug use and physical restraint use between the groups. Few survivors remained ambulatory (10.7% [n = 55] of surgically managed vs 4.8% [n = 1] without surgery). CONCLUSIONS AND RELEVANCE Surgical repair of a hip fracture was associated with lower mortality among NH residents with advanced dementia and should be considered together with the residents' goals of care in management decisions. Pain and other adverse outcomes were common regardless of surgical management, suggesting the need for broad improvements in the quality of care provided to NH residents with advanced dementia and hip fracture.
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Affiliation(s)
- Sarah D Berry
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.,Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts
| | - Randi R Rothbaum
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.,Division of Geriatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Douglas P Kiel
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.,Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice & Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island
| | - Susan L Mitchell
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.,Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts
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Nutritional Status and Nutritional Treatment Are Related to Outcomes and Mortality in Older Adults with Hip Fracture. Nutrients 2018; 10:nu10050555. [PMID: 29710860 PMCID: PMC5986435 DOI: 10.3390/nu10050555] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/09/2018] [Accepted: 04/25/2018] [Indexed: 01/16/2023] Open
Abstract
Malnutrition is very prevalent in geriatric patients with hip fracture. Nevertheless, its importance is not fully recognized. The objective of this paper is to review the impact of malnutrition and of nutritional treatment upon outcomes and mortality in older people with hip fracture. We searched the PubMed database for studies evaluating nutritional aspects in people aged 70 years and over with hip fracture. The total number of studies included in the review was 44, which analyzed 26,281 subjects (73.5% women, 83.6 ± 7.2 years old). Older people with hip fracture presented an inadequate nutrient intake for their requirements, which caused deterioration in their already compromised nutritional status. The prevalence of malnutrition was approximately 18.7% using the Mini-Nutritional Assessment (MNA) (large or short form) as a diagnostic tool, but the prevalence was greater (45.7%) if different criteria were used (such as Body Mass Index (BMI), weight loss, or albumin concentration). Low scores in anthropometric indices were associated with a higher prevalence of complications during hospitalization and with a worse functional recovery. Despite improvements in the treatment of geriatric patients with hip fracture, mortality was still unacceptably high (30% within 1 year and up to 40% within 3 years). Malnutrition was associated with an increase in mortality. Nutritional intervention was cost effective and was associated with an improvement in nutritional status and a greater functional recovery. To conclude, in older people, the prevention of malnutrition and an early nutritional intervention can improve recovery following a hip fracture.
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25
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Magny E, Vallet H, Cohen-Bittan J, Raux M, Meziere A, Verny M, Riou B, Khiami F, Boddaert J. Pressure ulcers are associated with 6-month mortality in elderly patients with hip fracture managed in orthogeriatric care pathway. Arch Osteoporos 2017; 12:77. [PMID: 28852954 DOI: 10.1007/s11657-017-0365-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/27/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Despite orthogeriatric management, 12% of the elderly experienced PUs after hip fracture surgery. PUs were significantly associated with a low albumin level, history of atrial fibrillation coronary artery disease, and diabetes. The risk ratio of death at 6 months associated with pressure ulcer was 2.38 (95% CI 1.31-4.32%, p = 0.044). INTRODUCTION Pressure ulcers in hip fracture patients are frequent and associated with a poor outcome. An orthogeriatric management, recommended by international guidelines in hip fracture patients and including pressure ulcer prevention and treatment, could influence causes and consequences of pressure ulcer. However, remaining factors associated with pressure ulcer occurrence and prognostic value of pressure ulcer in hip fracture patients managed in an orthogeriatric care pathway remain unknown. METHODS From June 2009 to April 2015, all consecutive patients with hip fracture admitted to a unit for Post-operative geriatric care were evaluated for eligibility. Patients were included if their primary presentation was due to hip fracture and if they were ≥ 70 years of age. Patients were excluded in the presence of pathological fracture or if they were already hospitalized at the time of the fracture. In our unit, orthogeriatric principles are implemented, including a multi-component intervention to improve pressure ulcer prevention and management. Patients were followed-up until 6 months after discharge. RESULTS Five hundred sixty-seven patients were included, with an overall 14.4% 6-month mortality (95% CI 11.6-17.8%). Of these, 67 patients (12%) experienced at least one pressure ulcer. Despite orthogeriatric management, pressure ulcers were significantly associated with a low albumin level (RR 0.90, 95% CI 0.84-0.96; p = 0.003) and history of atrial fibrillation (RR 1.91, 95% CI 1.05-3.46; p = 0.033), coronary artery disease (RR 2.16, 95% CI 1.17-3.99; p = 0.014), and diabetes (RR 2.33, 95% CI 1.14-4.75; p = 0.02). A pressure ulcer was associated with 6-month mortality (RR 2.38, 95% CI 1.31-4.32, p = 0.044). CONCLUSION In elderly patients with hip fracture managed in an orthogeriatric care pathway, pressure ulcer remained associated with poorly modifiable risk factors and long-term mortality.
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Affiliation(s)
- Emmanuelle Magny
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France
| | - Helene Vallet
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France
| | - Judith Cohen-Bittan
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France
| | - Mathieu Raux
- Department of Anesthesiology and Critical Care, Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France
- Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France
| | - Antony Meziere
- Department of Rehabilitation, Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France
| | - Marc Verny
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France
- Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France
| | - Bruno Riou
- Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France
- Department of Emergency Medicine and Surgery, Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France
| | - Frédéric Khiami
- Department of Orthopedic Surgery and Trauma, Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France
| | - Jacques Boddaert
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France.
- Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France.
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Complications after hip fracture surgery: are they preventable? Eur J Trauma Emerg Surg 2017; 44:573-580. [PMID: 28795198 PMCID: PMC6096618 DOI: 10.1007/s00068-017-0826-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/31/2017] [Indexed: 01/22/2023]
Abstract
Purpose Surgery for hip fractures is frequently followed by complications that hinder the rehabilitation of patients. The aim of this study was to describe the incidence rate and type of complications, including mortality, after hip fracture surgery, and to identify the risk factors of these complications that may be amenable to prevention. Methods Prospective cohort study of all consecutive patients aged ≥60 treated for a hip fracture at University Medical Center Groningen between July 2009 and June 2013. All patients were treated in a comprehensive multidisciplinary care pathway. Logistic regression analyses were used to investigate which variables were significant risk factors for the occurrence of complications. Additional analyses were conducted to investigate whether the independent variables were significant risk factors for several specific complications and mortality. Results The study population consisted of 479 patients with a mean age of 78.4 (SD 9.5) years; 33% were men. The overall complication rate was 75%. Delirium was the complication seen most frequently (19%); the incidence of surgical complications was 9%. Most risk factors for complications were not preventable (high comorbidity rate, high age and dependent living situation). However, general anesthesia (OR 1.51; 95% CI 0.97–2.35) and delay in surgery (OR 3.16; 95% CI 1.43–6.97) may be risk factors that can potentially be prevented. Overall, the mortality risk was not higher in patients with a complication, but delirium and pneumonia were risk factors for mortality. Conclusion The overall complication rate after hip fracture surgery was high. Only few complications were potentially preventable.
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Abstract
BACKGROUND Pressure ulcers, also known as bed sores, pressure sores or decubitus ulcers develop as a result of a localised injury to the skin or underlying tissue, or both. The ulcers usually arise over a bony prominence, and are recognised as a common medical problem affecting people confined to a bed or wheelchair for long periods of time. Anabolic steroids are used as off-label drugs (drugs which are used without regulatory approval) and have been used as adjuvants to usual treatment with dressings, debridement, nutritional supplements, systemic antibiotics and antiseptics, which are considered to be supportive in healing of pressure ulcers. Anabolic steroids are considered because of their ability to stimulate protein synthesis and build muscle mass. Comprehensive evidence is required to facilitate decision making, regarding the benefits and harms of using anabolic steroids. OBJECTIVES To assess the effects of anabolic steroids for treating pressure ulcers. SEARCH METHODS In March 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) comparing the effects of anabolic steroids with alternative treatments or different types of anabolic steroids in the treatment of pressure ulcers. DATA COLLECTION AND ANALYSIS Two review authors independently carried out study selection, data extraction and risk of bias assessment. MAIN RESULTS The review contains only one trial with a total of 212 participants, all with spinal cord injury and open pressure ulcers classed as stage III and IV. The participants were mainly male (98.2%, 106/108) with a mean age of 58.4 (standard deviation 10.4) years in the oxandrolone group and were all male (100%, 104/104) with a mean age of 57.3 (standard deviation 11.6) years in the placebo group. This trial compared oxandrolone (20 mg/day, administered orally) with a dose of placebo (an inactive substance consisting of 98% starch and 2% magnesium stearate) and reported data on complete healing of ulcers and adverse events. There was very low-certainty evidence on the relative effect of oxandrolone on complete ulcer healing at the end of a 24-week treatment period (risk ratio RR) 0.81, 95% confidence interval (CI) 0.52 to 1.26) (downgraded twice for imprecision due to an extremely wide 95% CI, which spanned both benefit and harm, and once for indirectness, as the participants were mostly male spinal cord injury patients). Thus, we are uncertain whether oxandrolone improves or reduces the complete healing of pressure ulcers, as we assessed the certainty of the evidence as very low.There was low-certainty evidence on the risk of non-serious adverse events reported in participants treated with oxandrolone compared with placebo (RR 3.85, 95% CI 1.12 to 13.26) (downgraded once for imprecision and once for indirectness, as the participants were mostly male spinal cord injury patients). Thus, the treatment with oxandrolone may increase the risk of non-serious adverse events reported in participants.There was very low-certainty evidence on the risk of serious adverse events reported in participants treated with oxandrolone compared with placebo (RR 0.54, 95% CI 0.25 to 1.17) (downgraded twice for imprecision due to an extremely wide 95% CI, which spanned both benefit and harm, and once for indirectness, as the participants were mostly male spinal cord injury patients). Of the five serious adverse events reported in the oxandrolone-treated group, none were classed by the trial teams as being related to treatment. We are uncertain whether oxandrolone increases or decreases the risk of serious adverse events as we assessed the certainty of the evidence as very low.Secondary outcomes such as pain, length of hospital stay, change in wound size or wound surface area, incidence of different type of infection, cost of treatment and quality of life were not reported in the included trial.Overall the evidence in this study was of very low quality (downgraded for imprecision and indirectness). This trial stopped early when the futility analysis (interim analysis) in the opinion of the study authors showed that oxandrolone had no benefit over placebo for improving ulcer healing. AUTHORS' CONCLUSIONS There is no high quality evidence to support the use of anabolic steroids in treating pressure ulcers.Further well-designed, multicenter trials, at low risk of bias, are necessary to assess the effect of anabolic steroids on treating pressure ulcers, but careful consideration of the current trial and its early termination are required when planning future research.
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Affiliation(s)
- Cho Naing
- James Cook UniversityCollege of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and MedicineTownsvilleAustralia
- International Medical UniversitySchool of Postgraduate StudiesKuala LumpurMalaysia
| | - Maxine A Whittaker
- James Cook UniversityCollege of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and MedicineTownsvilleAustralia
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Prevalence and incidence density of unavoidable pressure ulcers in elderly patients admitted to medical units. J Tissue Viability 2017; 26:85-88. [DOI: 10.1016/j.jtv.2017.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 01/29/2017] [Accepted: 03/22/2017] [Indexed: 12/31/2022]
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Carter MJ, Gilligan AM, Waycaster CR, Schaum K, Fife CE. Cost effectiveness of adding clostridial collagenase ointment to selective debridement in individuals with stage IV pressure ulcers. J Med Econ 2017; 20:253-265. [PMID: 27774840 DOI: 10.1080/13696998.2016.1252381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the cost effectiveness (from a payer's perspective) of adding clostridial collagenase ointment (CCO) to selective debridement compared with selective debridement alone (non-CCO) in the treatment of stage IV pressure ulcers among patients identified from the US Wound Registry. METHODS A 3-state Markov model was developed to determine costs and outcomes between the CCO and non-CCO groups over a 2-year time horizon. Outcome data were derived from a retrospective clinical study and included the proportion of pressure ulcers that were closed (epithelialized) over 2 years and the time to wound closure. Transition probabilities for the Markov states were estimated from the clinical study. In the Markov model, the clinical outcome is presented as ulcer-free weeks, which represents the time the wound is in the epithelialized state. Costs for each 4-week cycle were based on frequencies of clinic visits, debridement, and CCO application rates from the clinical study. The final model outputs were cumulative costs (in US dollars), clinical outcome (ulcer-free weeks), and incremental cost-effectiveness ratio (ICER) at 2 years. RESULTS Compared with the non-CCO group, the CCO group incurred lower costs ($11,151 vs $17,596) and greater benefits (33.9 vs 16.8 ulcer-free weeks), resulting in an economically dominant ICER of -$375 per ulcer. Thus, for each additional ulcer-free week that can be gained, there is a concurrent cost savings of $375 if CCO treatment is selected. Over a 2-year period, an additional 17.2 ulcer-free weeks can be gained with concurrent cost savings of $6,445 for each patient. CONCLUSIONS In this Markov model based on real-world data from the US Wound Registry, the addition of CCO to selective debridement in the treatment of pressure ulcers was economically dominant over selective debridement alone, resulting in greater benefit to the patient at lower cost.
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Affiliation(s)
| | - Adrienne M Gilligan
- b Truven Health Analytics , Rosenberg , TX , USA
- c University of North Texas Health Sciences Center , Department of Pharmacotherapy , Fort Worth , TX , USA
| | - Curtis R Waycaster
- c University of North Texas Health Sciences Center , Department of Pharmacotherapy , Fort Worth , TX , USA
- d Smith & Nephew, Inc. , Fort Worth , TX , USA
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Health-Related Quality of Life in Elderly Patients With Pressure Ulcers in Different Care Settings. J Wound Ostomy Continence Nurs 2017; 42:352-9. [PMID: 26135820 DOI: 10.1097/won.0000000000000142] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to measure and compare health-related quality of life in elderly patients with pressure ulcers in different health care settings (home care acute care facility, and long-term care facility [LTCF]). DESIGN Cross-sectional comparative study. SUBJECTS AND SETTING One hundred ten elderly patients with (n = 36) and without (n = 74) pressure ulcers living in LTCFs, hospitals, or at home. The research setting included 1 tertiary and 2 community-based hospitals, 10 LTCFs, and 18 community health centers in Brazil. METHODS The Mini-Mental State Examination, Braden Scale for Predicting Pressure Sore Risk, and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were used to assess cognitive status, pressure ulcer risk, and health-related quality of life, respectively. RESULTS Compared with those without pressure ulcers, elderly patients with pressure ulcers reported significantly lower (worse) SF-36 scores on physical functioning (P < .001) and role physical (P < .05) in all settings, and on social functioning (P = .045) and role emotional (P = .036) in LTCFs. Subjects in hospitals with pressure ulcers scored significantly higher (better) SF-36 scores on mental health (P = .046) and vitality (P = .009). Hospitalized patients without pressure ulcers had lower SF-36 scores on bodily pain (P = .007) and general health (P = .026) than those living in LTCFs or at home. Patients without pressure ulcers in LTCFs had significantly lower Mini-Mental State Examination scores (lower cognitive status) than those living in other settings (P = .001). CONCLUSIONS Elderly patients with pressure ulcers who were hospitalized and living at home or in LTCFs reported low scores on physical functioning and role physical, and LTCF residents also reported low scores on social functioning and role emotional. This shows the need for an environment that includes health care professionals prepared to implement strategies for pressure ulcer prevention.
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Berry SD, Lee Y, Zullo AR, Kiel DP, Dosa D, Mor V. Incidence of Hip Fracture in U.S. Nursing Homes. J Gerontol A Biol Sci Med Sci 2016; 71:1230-4. [PMID: 26980299 DOI: 10.1093/gerona/glw034] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/11/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hip fractures are associated with significant morbidity and mortality in the nursing home. Our objective was to describe the incidence rate (IR) of hip fracture according to age, sex, and race in a nationwide sample of long-stay nursing home residents. METHODS Using 2007-2010 Medicare claims data linked with the Minimum Data Set, we identified 892,837 long-stay residents (≥100 days in the same nursing facility) between May 1, 2007 and April 30, 2008. Hip fractures were defined using Part A diagnostic codes (ICD-9). Residents were followed from the date they became a long-stay resident until the first event of death, discharge, hip fracture, or 2 years of follow-up. RESULTS Mean age was 84 years (range 65-113 years), and 74.5% were women. 83.9% were white and 12.0% were black. The overall IR of hip fracture was 2.3/100 person years. The IR was similar in men and women across age groups. The IR of hip fracture was highest in Native Americans aged 85 years or older (3.7/100 person years), in whites (2.6/100 person years), and during the first 100 days of institutionalization (2.7/100 person years). IRs of hip fracture were lowest in blacks (1.3/100 person years). CONCLUSIONS In nursing home residents surviving 100 days or more in a facility, the incidence of hip fracture is high, particularly among older white, Native American, and newly admitted residents. This is the first nationwide study to provide sex- and age-specific estimates among U.S. nursing home residents, and it underscores the magnitude of the problem.
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Affiliation(s)
- Sarah D Berry
- Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice & Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice & Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island
| | - Doug P Kiel
- Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - David Dosa
- Department of Health Services, Policy, and Practice & Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island
| | - Vincent Mor
- Department of Health Services, Policy, and Practice & Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island
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Klemm HJ, Bailey JK, Desneves KJ, Crowe TC. Can early dietetic intervention improve outcomes in patients with hip fracture? Nutr Diet 2016. [DOI: 10.1111/1747-0080.12242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Haydn J. Klemm
- School of Exercise and Nutrition Sciences; Deakin University; Burwood Victoria Australia
| | - Jacqueline K. Bailey
- Department of Nutrition and Dietetics; Austin Health; Heidelberg Victoria Australia
| | | | - Timothy C. Crowe
- School of Exercise and Nutrition Sciences; Deakin University; Burwood Victoria Australia
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Ireland AW, Kelly PJ, Cumming RG. Total hospital stay for hip fracture: measuring the variations due to pre-fracture residence, rehabilitation, complications and comorbidities. BMC Health Serv Res 2015; 15:17. [PMID: 25609030 PMCID: PMC4308914 DOI: 10.1186/s12913-015-0697-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 01/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospital treatment for hip fracture is complex, often involving sequential episodes for acute orthopaedics, rehabilitation and care of contingent conditions. Most reports of hospital length of stay (LOS) address only the acute phase of care. This study identifies the frequency and mean duration of the component episodes within total hospital stay, and measures the impacts of patient-level and clinical service variables upon both acute phase and total LOS. METHODS Administrative datasets for 2552 subjects hospitalised between 1 July 2008 and 30 June 2009 were linked. Associations between LOS, pre-fracture accommodation status, age, sex, fracture type, hospital separation codes, selected comorbidities and complications were examined in regression models for acute phase and total LOS for patients from residential aged care (RAC) and from the community. RESULTS Mean total LOS was 30.8 days, with 43 per cent attributable to acute fracture management, 37 per cent to rehabilitation and 20 per cent to management of contingent conditions. Community patients had unadjusted total LOS of 35.4 days compared with 18.8 days for RAC patients (p <0.001). The proportion of transfers into rehabilitation (57 per cent vs 17 per cent, p <0.001) was the major determinant for this difference. In multivariate analyses, new RAC placement, discharge to other facilities, and complications of pressure ulcer, urinary or surgical site infections increased LOS by at least four days in one or more phases of hospital stay. CONCLUSION Pre-fracture residence, selection for rehabilitation, discharge destination and specific complications are key determinants for acute phase and total LOS. Calculating the dimensions of specific determinants for LOS may identify potential efficiencies from targeted interventions such as orthogeriatric care models.
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Affiliation(s)
- Anthony W Ireland
- Department of Veterans' Affairs, 300 Elizabeth St, Sydney 2000, New South Wales, Sydney, Australia.
- School of Public Health, Edward Ford Building, University of Sydney 2006, New South Wales, Sydney, Australia.
| | - Patrick J Kelly
- School of Public Health, Edward Ford Building, University of Sydney 2006, New South Wales, Sydney, Australia.
| | - Robert G Cumming
- School of Public Health, Edward Ford Building, University of Sydney 2006, New South Wales, Sydney, Australia.
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Scientific and Clinical Abstracts From the WOCN® Society's 46th Annual Conference. J Wound Ostomy Continence Nurs 2014. [DOI: 10.1097/won.0000000000000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mallinson T, Deutsch A, Bateman J, Tseng HY, Manheim L, Almagor O, Heinemann AW. Comparison of Discharge Functional Status After Rehabilitation in Skilled Nursing, Home Health, and Medical Rehabilitation Settings for Patients After Hip Fracture Repair. Arch Phys Med Rehabil 2014; 95:209-17. [DOI: 10.1016/j.apmr.2013.05.031] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 05/24/2013] [Accepted: 05/24/2013] [Indexed: 11/29/2022]
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Nursing care for the elderly with hip fracture in an acute care hospital. Wien Med Wochenschr 2013; 163:468-75. [DOI: 10.1007/s10354-013-0247-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/13/2013] [Indexed: 11/25/2022]
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Dubljanin-Raspopović E, Marković-Denić L, Marinković J, Nedeljković U, Bumbaširević M. Does early functional outcome predict 1-year mortality in elderly patients with hip fracture? Clin Orthop Relat Res 2013; 471:2703-10. [PMID: 23546850 PMCID: PMC3705055 DOI: 10.1007/s11999-013-2955-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 03/20/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip fractures in the elderly are followed by considerable risk of functional decline and mortality. QUESTIONS/PURPOSES The purposes of this study were to (1) explore predictive factors of functional level at discharge, (2) evaluate 1-year mortality after hip fracture compared with that of the general population, and (3) evaluate the affect of early functional outcome on 1-year mortality in patients operated on for hip fractures. METHODS A total of 228 consecutive patients (average age, 77.6 ± 7.4 years) with hip fractures who met the inclusion criteria were enrolled in an open, prospective, observational cohort study. Functional level at discharge was measured with the motor Functional Independence Measure (FIM) score, which is the most widely accepted functional assessment measure in use in the rehabilitation community. Mortality rates in the study population were calculated in absolute numbers and as the standardized mortality ratio. Multivariate regression analysis was used to explore predictive factors for motor FIM score at discharge and for 1-year mortality adjusted for important baseline variables. RESULTS Age, health status, cognitive level, preinjury functional level, and pressure sores after hip fracture surgery were independently related to lower discharge motor FIM scores. At 1-year followup, 57 patients (25%; 43 women and 14 men) had died. The 1-year hip fracture mortality rate compared with that of the general population was 31% in our population versus 7% for men and 23% in our population versus 5% for women 65 years or older. The 1-year standardized mortality rate was 341.3 (95% CI, 162.5-520.1) for men and 301.6 (95% CI, 212.4-391.8) for women, respectively. The all-cause mortality rate observed in this group was higher in all age groups and in both sexes when compared with the all-cause age-adjusted mortality of the general population. Motor FIM score at discharge was the only independent predictor of 1-year mortality after hip fracture. CONCLUSIONS Functional level at discharge is the main determinant of long-term mortality in patients with hip fracture. Motor FIM score at discharge is a reliable predictor of mortality and can be recommended for clinical use.
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Affiliation(s)
- Emilija Dubljanin-Raspopović
- />Clinic for Physical Medicine and Rehabilitation, Clinical Center Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000 Belgrade, Serbia
| | - Ljiljana Marković-Denić
- />Institute of Epidemiology, School of Medicine, Faculty of Medicine, University of Belgrade, Višegradska 26, 11000 Belgrade, Serbia
| | - Jelena Marinković
- />Institute of Medical Statistics and Medical Informatics, Faculty of Medicine, University of Belgrade, Dr Subotića 15, 11000 Belgrade, Serbia
| | - Una Nedeljković
- />Clinic for Physical Medicine and Rehabilitation, Clinical Center Serbia, Pasterova 2, 11000 Belgrade, Serbia
| | - Marko Bumbaširević
- />Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Serbia, Faculty of Medicine, University of Belgrade, Višegradska 26, 11000 Belgrade, Serbia
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Use of early indicators in rehabilitation process to predict one-year mortality in elderly hip fracture patients. Hip Int 2013; 22:661-7. [PMID: 23233176 DOI: 10.5301/hip.2012.10142] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2012] [Indexed: 02/04/2023]
Abstract
Hip fractures remain one of the most devastating injuries in the elderly. Early prediction of outcome following hip fracture potentially results in more efficient health care. The aims of this study were to explore predictors of ambulation status at hospital discharge in patients ≥65 years of age operated on for fracture of the hip, and to investigate the impact of ambulation status at hospital discharge on 1-year mortality after hip fracture. We studied 344 patients who underwent surgery for hip fracture during a 12 month period. Multivariate regression analysis was used to explore predictive factors for ambulatory status at discharge, and 1-year mortality adjusted on important baseline variables. Cumulative 1-year mortality was significantly lower for patients in the ambulatory group when compared to patients in the non-ambulatory group. Patients who were older, had severe cognitive impairment, lower functional level before injury, and in whom postoperative delirium and pressure ulcers occurred had a higher chance of not recovering their gait ability at hospital discharge, and being dead 1 year after hip fracture. Inability to walk at hospital discharge and presence of delirium are independent predictors of 1-year mortality. Every effort should be made to assure early mobilisation after hip fracture surgery, and prevention, prompt recognition and treatment of postoperative complications is important in order to facilitate better short-and long-term outcome.
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Sterner E, Fossum B, Berg E, Lindholm C, Stark A. Objective evaluation by reflectance spectrophotometry can be of clinical value for the verification of blanching/non blanching erythema in the sacral area. Int Wound J 2013; 11:416-23. [PMID: 23521782 DOI: 10.1111/iwj.12044] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Early detection of non blanching erythema (pressure ulcer category I) is necessary to prevent any further skin damage. An objective method to discriminate between blanching/non blanching erythema is presently not available. The purpose of this investigation was to explore if a non invasive objective method could differentiate between blanching/non blanching erythema in the sacral area of patients undergoing hip fracture surgery. Seventy-eight patients were included. The sacral area of all patients was assessed using (i) conventional finger-press test and (ii) digital reading of the erythema index assessed with reflectance spectrophotometry. The patients were examined at admission and during 5 days postsurgery. Reflectance spectrophotometry measurements proved able to discriminate between blanching/non blanching erythema. The reliability, quantified by the intra-class correlation coefficient, was excellent between repeated measurements over the measurement period, varying between 0·82 and 0·96, and a significant change was recorded in the areas from day 1 to day 5 (P < 0·0001). The value from the reference point did not show any significant changes over the same period (P = 0·32). An objective method proven to identify early pressure damage to tissue can be a valuable tool in clinical practice.
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Affiliation(s)
- Eila Sterner
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden; Department of Nursing, Sophiahemmet University, Stockholm, Sweden
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Acute nursing care of the older adult with fragility hip fracture: An international perspective (Part 2). Int J Orthop Trauma Nurs 2013. [DOI: 10.1016/j.ijotn.2012.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Baumgarten M, Rich SE, Shardell MD, Hawkes WG, Margolis DJ, Langenberg P, Orwig DL, Palmer MH, Jones PS, Sterling R, Kinosian BP, Magaziner J. Care-related risk factors for hospital-acquired pressure ulcers in elderly adults with hip fracture. J Am Geriatr Soc 2012; 60:277-83. [PMID: 22332674 DOI: 10.1111/j.1532-5415.2011.03849.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To identify care-related factors associated with hospital-acquired pressure ulcers (HAPUs). DESIGN Prospective cohort study. SETTING Nine hospitals in Baltimore Hip Studies network. PARTICIPANTS Six hundred fifty-eight individuals aged 65 and older who underwent surgery for hip fracture. MEASUREMENTS Skin examinations at baseline and on alternating days until hospital discharge. Participants were deemed to have a HAPU if they developed one or more new Stage 2 or higher pressure ulcers (PUs) during the hospital stay. RESULTS Longer emergency department stays were associated with lower HAPU incidence (>4-6 hours: adjusted incidence rate ratio (aIRR) = 0.68, 95% confidence interval (CI) = 0.48-0.96; >6 hours: aIRR = 0.68, 95% CI = 0.46-0.99, both vs ≤ 4 hours). Participants with 24 hours or longer between admission and surgery had a higher postsurgery HAPU rate than those with less than 24 hours (aIRR = 1.62, 95% CI = 1.24-2.11). Surgery with general anesthesia had a lower postsurgery HAPU rate than surgery with other types of anesthesia (aIRR = 0.66, 95% CI = 0.49-0.88). There was no significant association between HAPU incidence and timing of transport to the hospital, type of transport to the hospital, or surgery duration. CONCLUSION Most of the factors hypothesized to be associated with higher PU incidence were associated with lower incidence or were not significantly associated, suggesting that HAPU development may not be as sensitive to care-related factors as commonly believed. Rigorous studies of innovative preventive interventions are needed to inform policy and practice.
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Affiliation(s)
- Mona Baumgarten
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland 21201, USA.
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Abstract
Hip fracture is a common condition associated with a poor outcome with 20-30% one-year mortality in the elderly. Autonomy and quality of life remains key considerations in this population. Emergency management should consider associated diseases and treatments, as well as fall and fracture. Management should target particular conditions such as pain, anemia and transfusion, time to surgery and occurrence of pressure sores, and should consider these as quality criteria. In this way, a new approach must be evaluated and requires an optimal cooperation between emergency physician, orthopaedic surgeon, anaesthetists and geriatrician. Place and interest of new models of care such as orthogeriatrics unit have to be determined.
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Affiliation(s)
- Mark Thompson
- Hip Fracture, Royal Liverpool and Broadgreen University Hospital Trust
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Pham B, Teague L, Mahoney J, Goodman L, Paulden M, Poss J, Li J, Sikich NJ, Lourenco R, Ieraci L, Carcone S, Krahn M. Support surfaces for intraoperative prevention of pressure ulcers in patients undergoing surgery: A cost-effectiveness analysis. Surgery 2011; 150:122-32. [DOI: 10.1016/j.surg.2011.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 03/21/2011] [Indexed: 10/18/2022]
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Rich SE, Shardell M, Hawkes WG, Margolis DJ, Amr S, Miller R, Baumgarten M. Pressure-redistributing support surface use and pressure ulcer incidence in elderly hip fracture patients. J Am Geriatr Soc 2011; 59:1052-9. [PMID: 21649630 PMCID: PMC3601674 DOI: 10.1111/j.1532-5415.2011.03446.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the association between pressure-redistributing support surface (PRSS) use and incident pressure ulcers in older adults with hip fracture. DESIGN Secondary analysis of data from prospective cohort with assessments performed as soon as possible after hospital admission and on alternating days for 21 days. SETTING Nine hospitals in the Baltimore Hip Studies network and 105 postacute facilities to which participants were discharged. PARTICIPANTS Six hundred fifty-eight people aged 65 and older who underwent surgery for hip fracture. MEASUREMENTS Full-body examination for pressure ulcers; bedbound status; and PRSS use, recorded as none, powered (alternating pressure mattresses, low-air-loss mattresses, and alternating pressure overlays), or nonpowered (high-density foam, static air, or gel-filled mattresses or pressure-redistributing overlays except for alternating pressure overlays). RESULTS Incident pressure ulcers (IPUs), Stage 2 or higher, were observed at 4.2% (195/4,638) of visits after no PRSS use, 4.5% (28/623) of visits after powered PRSS use, and 3.6% (54/1,496) of visits after nonpowered PRSS use. The rate of IPU per person-day of follow-up did not differ significantly between participants using powered PRSSs and those not using PRSSs. The rate also did not differ significantly between participants using nonpowered PRSSs and those not using PRSSs, except in the subset of bedbound participants (incidence rate ratio=0.3, 95% confidence interval=0.1-0.7). CONCLUSION PRSS use was not associated with a lower IPU rate. Clinical guidelines may need revision for the limited effect of PRSS use, and it may be appropriate to target PRSS use to bedbound patients at risk of pressure ulcers.
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Affiliation(s)
- Shayna E. Rich
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Michelle Shardell
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
| | - William G. Hawkes
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
| | - David J. Margolis
- Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sania Amr
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Ram Miller
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Mona Baumgarten
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
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Rich SE, Margolis D, Shardell M, Hawkes WG, Miller RR, Amr S, Baumgarten M. Frequent manual repositioning and incidence of pressure ulcers among bed-bound elderly hip fracture patients. Wound Repair Regen 2011; 19:10-8. [PMID: 21134034 PMCID: PMC3059225 DOI: 10.1111/j.1524-475x.2010.00644.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Frequent manual repositioning is an established part of pressure ulcer prevention, but there is little evidence for its effectiveness. This study examined the association between repositioning and pressure ulcer incidence among bed-bound elderly hip fracture patients, using data from a 2004-2007 cohort study in nine Maryland and Pennsylvania hospitals. Eligible patients (n=269) were age ≥ 65 years, underwent hip fracture surgery, and were bed-bound at index study visits (during the first 5 days of hospitalization). Information about repositioning on the days of index visits was collected from patient charts; study nurses assessed presence of stage 2+ pressure ulcers 2 days later. The association between frequent manual repositioning and pressure ulcer incidence was estimated, adjusting for pressure ulcer risk factors using generalized estimating equations and weighted estimating equations. Patients were frequently repositioned (at least every 2 hours) on only 53% (187/354) of index visit days. New pressure ulcers developed at 12% of visits following frequent repositioning vs. 10% following less frequent repositioning; the incidence rate of pressure ulcers per person-day did not differ between the two groups (incidence rate ratio 1.1, 95% confidence interval 0.5-2.4). No association was found between frequent repositioning of bed-bound patients and lower pressure ulcer incidence, calling into question the allocation of resources for repositioning.
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Affiliation(s)
- Shayna E Rich
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Mistiaen PJ, Jolley DJ, McGowan S, Hickey MB, Spreeuwenberg P, Francke AL. A multilevel analysis of three randomised controlled trials of the Australian Medical Sheepskin in the prevention of sacral pressure ulcers. Med J Aust 2010. [DOI: 10.5694/j.1326-5377.2010.tb04091.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Patriek J Mistiaen
- NIVEL — Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Damien J Jolley
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC
| | - Sunita McGowan
- Fremantle Hospital, Fremantle, WA
- Curtin University, Perth, WA
| | - Mark B Hickey
- CSIRO Materials Science and Engineering, Melbourne, VIC
| | - Peter Spreeuwenberg
- NIVEL — Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Anneke L Francke
- NIVEL — Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Does Pressure Cause Pressure Ulcers? An Inquiry Into the Etiology of Pressure Ulcers. J Am Med Dir Assoc 2010; 11:397-405. [DOI: 10.1016/j.jamda.2010.03.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 03/09/2010] [Indexed: 11/22/2022]
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