|Title||Nursing home characteristics and the development of pressure sores and disruptive behaviour|
|Publication Type||Journal Article|
|Year of Publication||1999|
|Authors||Ooi W.L, Morris J.N, Brandeis G.H, Hossain M., Lipsitz L.A|
|Journal||Age & Ageing|
|Keywords||*Attention Deficit and Disruptive Behavior Disorders/ep [Epidemiology], *Health Care Surveys/td [Trends], *Nursing Homes/td [Trends], Aged, Aged, 80 and over, Comorbidity, Decubitus Ulcer, Female, Follow-Up Studies, Human, Incidence, Male, Middle Aged, Multivariate Analysis, Prevalence, Risk Factors, Support, U.S. Gov't, P.H.S.|
OBJECTIVE: To determine how nursing home characteristics affect pressure sores and disruptive behaviour. METHOD: Residents (n = 5518, aged > or =60 years) were selected from 70 nursing homes in the National Health Care chain. Homes were classified as high- or low-risk based on incidence tertiles of pressure sores or disruptive behaviour (1989-90). Point-prevalence and cumulative incidence of pressure sores and disruptive behaviour were examined along with other functional and service variables. RESULTS: The overall incidence of pressure sores was 11.4% and the relative risk was 4.3 times greater in high- than low-risk homes; for disruptive behaviour, the incidence was 27% and the relative risk was 7.1 times greater in the high-risk group. At baseline, fewer subjects in homes with a high risk of pressure sores were white or in restraints, but more had received physician visits monthly and had had problems with transfers and eating. High-risk homes also had fewer beds and used less non-licensed nursing staff time. At follow-up (1987-90), 52% of homes in the low-risk group and 35% of those in the high-risk group had maintained their risk status; low-risk homes were more likely to have rehabilitation and maintenance activities. Having multiple clinical risk factors was associated with more pressure sores in high- (but not low-) risk homes, suggesting a care-burden threshold. By logistic regression, the best predictor of pressure sores was a home's prior (1987-88) incidence status. Interestingly, 67% of homes with a high risk of pressure sores were also high-risk for disruptive behaviour, while only 27% of homes with a low risk of pressure sores were high-risk for disruptive behaviour. A threshold effect was also observed between multiple risk factors and behaviour. More homes with a high risk of disruptive behaviour (68%) remained at risk over 4 years, and the best predictor of outcome was a home's previous morbidity level. CONCLUSION: Nursing-home characteristics may have a greater impact than clinical factors on pressure sores and disruptive behaviour in long-stay, institutionalized elders.
|Alternate Journal||Age Ageing|