This study sought to determine if a parsimonious pressure ulcer (PU) predictive model could be identified specific to acute care to enhance the current PU risk assessment tool (Braden Scale) utilized within veteran facilities. Factors investigated include: diagnosis of gangrene, anemia, diabetes, malnutrition, osteomyelitis, pneumonia/pneumonitis, septicemia, candidiasis, bacterial skin infection, device/implant/graft complications, urinary tract infection, paralysis, senility, respiratory failure, acute renal failure, cerebrovascular accident, or congestive heart failure during hospitalization; patient's age, race, smoking status, history of previous PU, surgery, hours in surgery; length of hospitalization, and intensive care unit days. Retrospective chart review and logistic regression analyses were used to examine Braden scores and other risk factors in 213 acutely ill veterans in North Florida with (n = 100) and without (n = 113) incident PU from January-July 2008. Findings indicate four medical factors (malnutrition, pneumonia/pneumonitis, candidiasis, and surgery) have stronger predictive value (sensitivity 83%, specificity 72%, area under receiver operating characteristic [ROC] curve 0.82) for predicting PUs in acutely ill veterans than Braden Scale total scores alone (sensitivity 65%, specificity 70%, area under ROC curve 0.70). In addition, accounting for four medical factors plus two Braden subscores (activity and friction) demonstrates better overall model performance (sensitivity 80%, specificity 76%, area under ROC curve 0.88).

OBJECTIVE The aim of this study is to develop and evaluate the psychometric properties of a new performance-based instrument (the Physical and Cognitive Performance Test for Assisted Living Facilities; PCPT ALF) designed to assess the physical and cognitive skills associated with the performance of activities of daily living (ADL) and instrumental activities of daily living (IADL). DESIGN There were three stages in this study: development of instrument items and validity testing, a feasibility pilot study and a cross-sectional trial to establish construct and criterion validity and reliability. SETTING One 116-bed ALF. PARTICIPANTS Following a pilot test with 10 residents, a cross-sectional trial was conducted with 55 additional residents. MEASUREMENTS The Barthel Index and the Functional Independence Measure were used to estimate criterion validity. Construct validity was examined using exploratory factor (EFA) analyses. RESULTS Disattenuated correlations between the PCPT ALF and other tools were all above 0.72 supporting criterion validity. Internal consistency (physical ability, α = 0.95; cognitive support, α = 0.92) and one week test-retest reliability (PCPT ALF, p=0.93) were high as was inter-rater reliability (0.99=physical ability; 1.00 =cognitive support). In two EFAs, one each for the physical ability and cognitive support subscales, a one factor solution accounted for 64.1% of the variance and 63.5% of the variance, respectively. CONCLUSION The findings provide early evidence of the PCPT ALF instrument’s score validity and reliability. If confirmed, this study’s findings may be used in future work to assess the success of interventions to prevent or slow decline in the skills associated with ADL/IADL performance in ALFs.

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