Oral presentation in the next EWMA Congress in Copenhague http://ewma2013.org/conference-info/welcome.html

1. 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

2. 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

3. 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)

4. 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)

5. 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

6. 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

7. 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%

8. 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)

9. 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)

10. 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)

11. 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)

12. Thank you
Contact Dr. Miquel A. Mas
(Badalona Serveis Assistencials)
mmas7@bsa.cat