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The Gerontologist Advance Access published online on July 8, 2009
The Gerontologist, doi:10.1093/geront/gnp101
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Use of Pressure-Redistributing Support Surfaces Among Elderly Hip Fracture Patients Across the Continuum of Care: Adherence to Pressure Ulcer Prevention Guidelines

Mona Baumgarten, PhD1,2, David Margolis, MD, PhD3,4, Denise Orwig, PhD2, William Hawkes, PhD2, Shayna Rich, MS2, Patricia Langenberg, PhD2, Michelle Shardell, PhD2, Mary H. Palmer, PhD5, Patrick McArdle, PhD6, Robert Sterling, MD7, Patricia S. Jones, RN, MA2 and Jay Magaziner, PhD, MS Hyg2

2 Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore
3 Department of Dermatology, University of Pennsylvania, Philadelphia
4 Department of Biostatistics & Epidemiology, University of Pennsylvania, Philadelphia
5 Division of Adult and Geriatric Health, School of Nursing, The University of North Carolina at Chapel Hill
6 Department of Medicine, University of Maryland School of Medicine, Baltimore
7 Department of Medicine Orthopaedics, University of Maryland School of Medicine, Baltimore

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


  Abstract

Purpose: To estimate the frequency of use of pressure-redistributing support surfaces (PRSS) among hip fracture patients and to determine whether higher pressure ulcer risk is associated with greater PRSS use. Design and Methods: Patients (n = 658) aged ≥65 years who had surgery for hip fracture were examined by research nurses at baseline and on alternating days for 21 days. Information on PRSS use and pressure ulcer risk factors was recorded at each assessment visit. Other information was obtained by interview and chart review. Results: A PRSS was observed at 36.4% of the 5,940 study visits. The odds of PRSS use were lower in the rehabilitation setting (adjusted odds ratio [OR] 0.4, 95% confidence interval [CI] 0.3–0.6), in the nursing home (adjusted OR 0.2, 95% CI 0.1–0.3), and during readmission to the acute setting (adjusted OR 0.6, 95% CI 0.4–0.9) than in the initial acute setting. There was wide variation in frequency of PRSS use by admission hospital, even after adjusting for pressure ulcer risk factors. The relationships between PRSS use and pressure ulcer risk factors were not strong. Implications: In this study of hip fracture patients, adherence to guidelines for PRSS use was low and was based more on facility-related factors than on patient risk. There is an urgent need for health care providers to improve strategies for the prevention of pressure ulcers in high-risk patients.

Keywords: Pressure ulcers, Hip fracture, Support surfaces, Prevention

Received March 27, 2009; Accepted May 11, 2009

Decision Editor: William McAuley, PhD


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