Examining Risk Factors for Pressure Injury Development Among Nursing Home Residents: A Retrospective Study

To examine the relationship between resident-level (intrinsic) and facility-level (extrinsic) factors associated with pressure injury development among nursing home residents.

Exploratory, retrospective cohort design using secondary data from the Turn Everyone and Move for Pressure Ulcer Prevention study.

Data from a convenience sample of 998 residents across nine nursing homes were analysed. Resident-level factors included demographics, body mass index, comorbidities, Braden Scale scores, and clinical severity. Facility-level factors included staffing hours and location. Multivariable logistic regression identified factors associated with pressure injury development.

Of 998 residents, 61 (6.1%) developed new pressure injuries. Four significant predictors were: higher clinical severity laboratory values, underweight, fewer licensed practical nurse staffing hours, and lower Braden Scale Mobility subscale scores.

This study highlights the importance of considering both intrinsic resident-level and extrinsic facility-level factors when assessing pressure injury risk in nursing home residents. Clinical severity measures capturing individualized physiological status may provide valuable information beyond traditional risk assessment tools.

Pressure injury prevention benefits from incorporating physiological markers with traditional risk factors, enhancing early identification of high-risk residents. Effective prevention strategies address both resident vulnerability and care environment factors, particularly staffing levels. Clinical mobility assessments remain essential but gain value when integrated with physiological markers. As electronic health record use increases in nursing homes, future research can leverage these data to develop targeted interventions.

Elevated pressure injury rates in nursing homes are a persistent problem. Main findings reveal that intrinsic resident-level and extrinsic facility-level factors influence pressure injury risk. These findings enable a shift in assessment focus from primarily mobility-based to more comprehensive risk profile evaluations. Vulnerable residents will benefit from earlier risk identification that leads to targeted interventions. For healthcare systems and administrators, it highlights the importance of adequate staffing models in pressure injury prevention efforts.

Data were from resident participants in the implementation of the parent study.