Annals of Long Term Care

Black/White Differences in Pressure Ulcer Incidence in Nursing Home Residents

Mona Baumgarten, PhD, David Margolis, MD, PhD, Carol van Doorn, PhD, Ann L. Gruber-Baldini, PhD, J. Richard Hebel, PhD, Sheryl Zimmerman, PhD, and Jay Magaziner, PhD

Objectives: To compare black and white nursing home residents with respect to the incidence of nursing home (NH)-acquired pressure ulcers (PUs) and to examine the role of resident characteristics and facility characteristics in explaining differences between the racial groups.

Design: Prospective cohort study conducted between 1992 and 1995.

Setting: Fifty-nine Maryland NHs.

Participants: A total of 1,938 residents (301 black, 1,637 white) aged 65 and older newly admitted to participating NHs.

Measurements: The outcome variable was the first occurrence of a Stage 2, 3, or 4 PU as determined based on medical record review. The predictor variable was race (black, white). Eight resident characteristics (age, sex, number of activity of daily living dependencies, bedfast, PU on admission to facility, incontinence, dementia, and whether the resident was on Medicaid) and three facility characteristics (number of beds, for-profit ownership status, and urban/nonurban location) were considered as possible confounding variables.

Results: The incidence of PUs was 0.38 per person-year in the NH. The rate for blacks was significantly higher than for whites (0.56 vs 0.35 per person-year) (P<.001). In multivariate analysis, controlling for eight resident characteristics and three facility characteristics, race was significantly associated with PU incidence (hazard ratio comparing blacks with whites=1.31, 95% confidence interval=1.021.66).

Conclusion: Blacks have a higher incidence of NH-acquired PUs than whites; resident characteristics appear to mediate the higher risk. Future research should aim to identify modifiable factors that explain differences between racial groups in PU risk and to develop solutions to prevent the suffering and cost associated with PUs. J Am Geriatr Soc 2004;52(8): 1293-1298.

Ethnic Differences in the Prevalence and Pattern of Dementia-Related Behaviors

Kaycee M. Sink, MD, Kenneth E. Covinsky, MD, MPH, Robert Newcomer, PhD, and Kristine Yaffe, MD

Objectives: To determine the prevalence of dementia-related behaviors in a large, multiethnic sample of community-dwelling patients with moderate to severe dementia and to determine whether differences in patient or caregiver characteristics could explain any differences in prevalence of these behaviors between white and nonwhite patients.

Design: Cross-sectional study.

Setting: Community-based.

Participants: A total of 5,776 Medicare patients (5,090 white, 469 black, 217 Latino; mean age 78.9) enrolled in the Medicare Alzheimer’s Disease Demonstration and Evaluation study at eight sites across the United States between 1989 and 1991.

Measurements: Trained interviewers collected information on patient demographic characteristics, cognitive and functional status, and caregiver characteristics such as relationship to patient, functional status, depression, and burden. Ethnicity was obtained by self-report. Caregivers were asked if the patient typically demonstrated any of eight dementia-related behaviors. To determine the independent association between ethnicity and dementia-related behaviors, logistic regression models were developed for each of the behaviors, adjusting for patient and caregiver characteristics.

Results: Overall, 92% of patients had one or more dementia-related behaviors. Sixty-one percent of black and 57% of Latino patients were reported to have four or more behaviors, compared with 46% of white patients (P<.001). The prevalence of specific behaviors ranged from 24% for combativeness to 67% for wandering.