Progression of Stage I Pressure Ulcers in Elderly Hip Fracture Patients

Abstract

Pressure ulcers (PUs) are a major health problem associated with significant morbidity, diminished quality of life, and increased health care costs. The study objective was to evaluate the clinical course of stage I PUs, risk factors for their progression to a higher stage, and effectiveness of pressure-redistributing support surfaces (PRSS) to prevent their progression in elderly hip fracture patients. This study involved secondary analyses of data collected in a prospective cohort study. It included 168 patients who were 65 years old or older, hospitalized for a hip fracture surgery, and developed at least one stage I PU. Patients were examined at baseline and on alternating days for 11 visits as they moved through different care settings. The primary outcome was progression of stage I PUs to a higher stage at all anatomical sites, and in hip and foot areas. The study population developed 278 stage I PUs. The crude IR and 95% confidence interval (CI) of progression was 7.8 (6.5-9.4) per 100 ulcer-days at all anatomical sites. The adjusted hazard ratio (HR) and 95% CI of progression comparing hip to foot PUs was 2.3 (1.3-4.1). Older age [75-84 years (HR: 0.3, 95% CI: 0.1-0.7) or ≥85 years (HR: 0.3, 95% CI: 0.1-0.6)] compared to younger age (65-74 years), and moderate compared to low risk of nutrition-related complications (HR: 0.5, 95% CI: 0.2-0.8) were associated with reduced risk of progression; disorientation (HR: 2.9, 95% CI: 1.4-6.2), and peripheral artery disease (HR: 2.1, 95% CI: 1.1-4.1) were associated with increased risk of progression at all anatomical sites. In hip area, being chair bound compared to walking (HR: 0.3, 95% CI: 0.1-0.8) was associated with reduced risk of progression; there was no strong evidence for an association between incontinence or low body mass index (BMI) and progression. In foot area, there was no strong evidence for an association between respiratory disease or diabetes and progression; peripheral artery disease (HR: 6.1, 95% CI: 2.2-17.3) was associated with increased risk of progression. There was no strong evidence for an association between PRSS use and progression at all anatomical sites or in hip or foot areas.