Pressure ulcers as a risk factor of discharge to acute care unit in older hospital-at-home patients in need of geriatric management and rehabilitation

after acute illness

Mas MA, Santaeugenia S, Gámez S, Delgado V Department of Geriatric Medicine and Palliative Care

Home Care Unit Badalona, Catalonia, Spain

There is evidence of the usefulness of multidisciplinary hospital-at-home (HaH) interventions for older patients with acute geriatric conditions The aim of this study was to assess the effect of pressure ulcers on clinical outcomes of these patients

Introduction

Shepperd S, et al. Early discharge hospital at home. Cochrane Database Syst Rev. 2009;(1):CD000356 Shepperd S, et al. Admission avoidance hospital at home. Cochrane Database Syst Rev. 2008;(4): CD007491

A pilot study included older patients with medical/surgical conditions consecutively admitted to a multidisciplinari HaH unit Main clinical outcomes were analyzed based on the presence and evolution of pressure ulcers •  Functional gain •  Acute rehospitalization

Method (I)

Description of the intervention: •  Provided by a multidisciplinary home care team

(Medical, Nursing, Physiotherapy, Ocupational Therapy, Social Worker)

•  Treatment of acute and postacute conditions (early discharge and admission avoidance strategies)

•  Comprehensive Geriatric Assessment (multidimensional assessment followed by an individualized care plan)

•  Rehabilitation

Method (II)

N 121 patients

Results (I): characteristics at admission

Age 82 (6) ; Gender female 81%

Charlson Comorbidity Index 2 (1)

Main diagnostic group: -Medical 51% -Surgical 38% -Stroke 11% Delirium 14%

Lenght of intervention: 7 (3) weeks

Variables are mean (standard deviation) ^ MMSE = Mini-Mental State Examination Folstein; *MNA Mini-Nutritional Assessment

Results (II): characteristics based on pressure ulcers presence

Pressure ulcers

No pressure

ulcers

p value

Barthel Index at admission 37 (23) 50 (23) <0.05

MMSE^ at admission 20 (7) 21 (6) 0.47

MNA* at admission 16 (4) 19 (3) <0.05

Results (III): Pressure ulcers and evolution

Presence of pressure ulcers at admission (n=46) 37%

(n) % at admission

Resolution at the end

Stage I (18) 39 73%

Stage II (22) 48 82%

Stage III (4) 9 0%

Stage IV (2) 4 0%

Presence of pressure ulcers at discharge (n=18) 15%

Results (IV): Pressure ulcers and outcomes

Presence of pressure ulcer at admission was associated with: no functional gain* due to intervention ( 15 vs 4%, p <0.05) higher rate of discharge to acute care unit (14 vs 9%, p 0.113)

Results (V): Pressure ulcers and outcomes

Presence of pressure ulcer at discharge was associated with: no functional gain* due to intervention ( 33 vs 3%, p <0.05) higher rate of discharge to acute care* unit (33 vs 8%, p <0.05)

Pressure ulcers were frequent at admission to our home

unit, related to complexity of older patients attended

Resolution of ulcers due to intervention was possible in 2/3

of cases (low stage ulcers: I and II)

Conclusions (I)

In our sample presence of pressure ulcers was associated with negative functional outcomes

Pressure ulcer presence at discharge, were related to destination rehospitalization

More research is needed to support these results

Conclusions (II)

Thank you

Contact Dr. Miquel A. Mas (Badalona Serveis Assistencials)

mmas7@bsa.cat