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Pressure Ulcers Among Elderly Patients Early in the Hospital Stay

¹ University of Maryland School of Medicine, Baltimore.
University of Pennsylvania Schools of ² Medicine and ³ Nursing, Philadelphia.
⁴ Oregon Health & Science University, Portland.
⁵ Philadelphia VA Medical Center, Pennsylvania.

Address correspondence to Mona Baumgarten, PhD, Department of Epidemiology and Preventive Medicine, Division of Gerontology, University of Maryland School of Medicine, 660 West Redwood St., Suite 200, Baltimore, MD 21201. E-mail: mbaumgar{at}epi.umaryland.edu

Background. Pressure ulcers among elderly hospital patients diminish quality of life and increase the cost of hospital care. Evidence suggests that pressure ulcers can arise after only a few hours of immobility. The goals of this study were to estimate the incidence of hospital-acquired pressure ulcers in the first 2 days of the hospital stay and to identify patient characteristics associated with higher incidence.

Methods. A prospective cohort study was performed between 1998 and 2001. A total of 3233 patients 65 years old or older admitted through the Emergency Department to the inpatient Medical Service at two study hospitals were examined by a research nurse on the third day of hospitalization. Pressure ulcers were ascertained using standard criteria and were classified as either preexisting, possibly hospital-acquired, or definitely hospital-acquired.

Results. There were 201 patients with one or more possibly or definitely hospital-acquired pressure ulcers for a cumulative incidence of 6.2% (95% confidence interval, 5.4%–7.1%). Most of the pressure ulcers were stage 2, and the majority were in the sacral area or on the heels. In multivariable analysis, pressure ulcer incidence was significantly associated with increasing age, male gender, dry skin, urinary and fecal incontinence, difficulty turning in bed, nursing home residence prior to admission, recent hospitalization, and poor nutritional status.

Conclusions. A small but significant proportion of elderly emergently admitted hospital patients acquire pressure ulcers soon after their admission. New models of care may be required to ensure that preventive interventions are provided very early in the elderly person's hospital stay.