Dementia severity and advanced pressure injury procedures and prognosis: A nationwide study in Japan

Gojiro Nakagami; Kojiro Morita; Asahi Fujita; Mari Abe; Yuko Mugita; Masahiro Akishita; Hideo Yasunaga

doi:10.1111/ggi.15005

Dementia severity and advanced pressure injury procedures and prognosis: A nationwide study in Japan

Geriatr Gerontol Int. 2024 Oct 25. doi: 10.1111/ggi.15005. Online ahead of print.

Authors

Gojiro Nakagami^{1

2}, Kojiro Morita^{2

3}, Asahi Fujita^{4

5}, Mari Abe¹, Yuko Mugita¹, Masahiro Akishita^{6

7}, Hideo Yasunaga⁴

Affiliations

¹ Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Department of Nursing Administration and Advanced Clinical Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁴ Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁵ Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁶ Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁷ Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.

PMID: 39460423
DOI: 10.1111/ggi.15005

Abstract

Aim: In older adults, pressure injuries (PIs) are common and, despite advancements in PI care, are associated with increased complications in patients with dementia for whom standardized treatments are unavailable. Herein, we aimed to examine the influence of dementia status on the care practice pattern and healing outcomes for PI on discharge.

Methods: This retrospective cohort study used data from the Diagnosis Procedure Combination database for 2014-2015 and the Annual Report for Functions of Medical Institutions and included patients aged ≥65 years. The DESIGN-R (depth, exudates, size, inflammation/infection, granulation, necrosis and rating) classification system was used to determine PI severity, and the Dementia Scale was used to assess dementia status. The measured outcomes included advanced PI care and healing upon discharge. Multivariable logistic regression, accounting for hospital-related clustering, was used to examine the association of dementia with these outcomes.

Results: Among 20 386 patients from 1198 hospitals included in the analysis, 32.5%, 20.1% and 47.3% had no, mild and severe dementia, respectively. After adjustment for patients' and hospital characteristics, compared with those without dementia, patients with severe dementia were significantly less likely to undergo advanced treatments, such as skin grafts (adjusted odds ratio [aOR], 0.62 [95% confidential interval [CI], 0.40-0.97]; P = 0.034) and flap surgeries (aOR, 0.57 [95% CI, 0.42-0.77]; P < 0.001), and had a reduced likelihood of PI healing (aOR, 0.80 [95% CI, 0.72-0.90]; P < 0.001).

Conclusions: Severe dementia was associated with poor PI healing outcomes, indicating potential treatment disparities. Thus, PI treatment should be provided according to the severity of dementia. Geriatr Gerontol Int 2024; ••: ••-••.

Keywords: advanced pressure injury procedures; dementia; healing outcomes; pressure injuries; retrospective cohort study.

Abstract

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