The Epidemiology and Natural History of Pressure Ulcers in Elderly Nursing Home Residents

Abstract

We analyzed prospective data from 19,889 elderly residents of 51 nursing homes from 1984 to 1985 to determine the prevalence, incidence, and natural history of pressure ulcers. Among all residents admitted to nursing homes, 11.3% possessed a stage II through stage IV pressure ulcer. For those residents admitted to the nursing home without pressure ulcers during the study period, the 1-year incidence was 13.2%. This increased to 21.6% by 2 years of nursing home stay. People already residing in a nursing home at the start of the study had a 1-year incidence of 9.5%, which increased to 20.4% by 2 years. Pressure ulcers were associated with an increased rate of mortality, but not hospitalization. Longitudinal follow-up of residents with pressure ulcers demonstrated that a majority of their lesions were healed by 1 year. Most of the improvement occurred early in a person's nursing home stay. Although nursing home residents with pressure ulcers have a higher mortality, with good medical care pressure ulcers can be expected to heal.

Nursing Home Profit Status and Quality of Care: Is There Any Evidence of an Association?

“…Pressure ulcers are an excellent marker of quality of care because very few residents receiving proper care should develop this condition. Ulcers also seriously affect a resident's quality of life and have been linked to increased morbidity and mortality (Berlowitz, Bezerra, and Brandeis 2000;Brandeis et al 1990). The higher rate of pressure ulcers observed in FP homes might be reflective of the decreased staffing intensity compared to NFP homes; it is also possible that FP homes admit more residents with pressure sores.…”

Wounds and Survival in Noncancer Patients

“…[23][24][25][26] They mostly affect increasingly bed-bound patients and have a propensity to involve the sacrum and the posterior aspect of the heel. Debate exists whether they are due to neglect and negligence, or whether they are unavoidable and part of the natural history of advanced illness.…”

The prevention and management of pressure ulcers

“…At two years, 8% of Stage 2 pressure ulcers, 29% of Stage 3 pressure ulcers, and 38% of Stage 4 pressure ulcers remained unhealed. 53 More recent observation in nursing homes have confirmed poor rates of healing. Although improvement in a standardized healing score occurred in 71% of Stage 3 or 4 pressure ulcers, the median days-to-healing was 140 days.…”