Senior in hospital bed

Fully 11% of older patients have pressure injuries when admitted to skilled nursing facilities for post-acute stroke rehabilitation, a new study finds. Certain factors make such a diagnosis more likely, investigators say.

Providing care for pressure injuries early in stroke rehab may help improve these patients’ overall clinical outcomes and reduce associated costs, according to Shilpa Krishnan, PT, PhD, of Emory University School of Medicine in Atlanta, and colleagues.

The investigators examined data for more than 65,000 older adults aged 65 years and older who were admitted to SNFs following strokes. They aimed to determine the prevalence of pressure wounds upon admission and investigate factors that contributed to deep and superficial injury. 

The 11% of patients arriving for care with pressure wounds tracks closely with the numbers found across the long-term care facility spectrum, the researchers reported. Older adults, non-Hispanic Blacks and patients with multiple comorbidities were more likely to have these injuries. 

When compared to patients with superficial wounds, patients with deep pressure wounds were more likely to be younger than 75 years, non-Hispanic Black and have a lower socioeconomic status. Many had also experienced an intensive care unit stay, had higher functional impairments, skin integrity issues, system failure and infections.

Patients receive less PT, OT

For reasons that may be associated with higher comorbidities and pain, individuals with pressure wounds received less individual physical therapy and occupational therapy treatment than those with no pressure wounds. The researchers recommend that comorbid chronic disease be addressed during post-acute care. A reduction in stroke rehabilitation therapy secondary to a pressure wound may impede stroke recovery, they noted.

Study data came from the 2013 and 2014 Medicare’s Master Beneficiary Summary, Medicare Provider Analysis and Review, and Minimum Data Set 3.0. Pressure injury data came from SNF admission assessments.

Full findings, including more analysis of SNF skin care and restorative treatments for these patients, were published in JAMDA

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Ask the wound care expert: How can care for pressure injuries be incorporated into a facility’s system of care?