Pressure ulcers and the transition to long-term care

Abstract

Objective: To estimate the prevalence of pressure ulcers among newly admitted residents of long-term-care facilities and to determine whether patients admitted from hospitals had a higher prevalence than those admitted from home or other settings.

Design: Prospective cohort study conducted between 1992 and 1995.

Setting: 59 long-term-care facilities in Maryland.

Participants: 2015 residents aged 65 years and older newly admitted to participating long-term-care facilities.

Main outcome measure: Stage II, III, or IV pressure ulcer, first mentioned in the long-term-care facility's chart within 2 days of admission.

Main results: Of the 2015 residents studied, 208 (10.3%) had 1 or more pressure ulcers on admission to a long-term-care facility. The proportion of patients with 1 or more pressure ulcers was 11.9% among those admitted from a hospital and 4.7% among those not admitted from a hospital (P<.001). In multivariable analysis, admission from a hospital was significantly associated with pressure ulcer prevalence on admission (odds ratio, 2.2; 95% confidence interval, 1.3-3.7). A lower prevalence of pressure ulcers on admission was significantly associated with being white; a higher prevalence was associated with being chairbound or bedridden, being underweight, and having fecal incontinence.

Conclusion: Admission to a long-term-care facility from a hospital is an important marker for higher pressure ulcer risk. The identification of pressure ulcer risk factors is essential to the implementation of prevention activities, ensuring that appropriate interventions are targeted to the residents who are most likely to benefit.