A LONGITUDINAL-STUDY OF RISK-FACTORS ASSOCIATED WITH THE FORMATION OFPRESSURE ULCERS IN NURSING-HOMES

Objective: To determine risk factors associated with the formation of stage II-IV pressure ulcers in nursing homes. Design: Since the incide nce rate for pressure ulcer formation varies among nursing homes, the homes were divided into tertiles based on these rates. Pooled logistic regression was used to model which factors are associated with the fo rmation of pressure ulcers in both high and low incidence homes. Setti ng. 78 National HealthCorp nursing homes. Subjects- We studied 4232 nu rsing home residents free of pressure ulcers on admission to a nursing facility and at 3-months follow-up. All remained in the home for at l east 3 additional months to a maximum of 21 months. Measurement: The e ffects of age, gender, race, antipsychotic drug use, urinary incontine nce, fecal incontinence, body mass index, diabetes mellitus, disorient ation, ambulation, physical restraints, activities of daily living of bathing, feeding, or transferring, and nursing home bed size on the fo rmation of a stage II-IV pressure ulcer while the subject was a reside nt in the nursing home were studied. Main Results: Significant factors associated with the formation of pressure ulcers in high incidence ho mes (21-month incidence = 19.3%) were ambulation difficulty (OR = 3.3; CI = 2.0, 5.3), fecal incontinence (OR = 2.5; CI = 1.6, 4.0), diabete s mellitus (OR = 1.7; CI = 1.2, 2.5), and difficulty feeding oneself ( OR = 2.2; CI = 1.5, 3.3). In the low incidence homes (21-month inciden ce = 6.5%), significant factors associated with pressure ulcer inciden ce were ambulation difficulty (OR = 3.6; CI = 1.7, 7.4), difficulty fe eding oneself (OR = 3.5; CI = 2.0, 6.3), and male gender (OR = 1.9; CI 1.2, 3.6). Conclusions: Although low and high incidence homes share s imilar risk factors, such as ambulation and feeding activities of dail y living, the main difference was that diabetes and fecal incontinence played a major role only in high risk homes, while male gender was an important discriminator only in low incidence homes. Yet, it is uncle ar if these factors explain the three-fold difference in the incidence rates for pressure ulcers in these facilities. Baseline or resident c linical characteristic differences of any one factor between the high and low incidence homes varied by no more than 5%. While we identified certain conditions which are associated with pressure ulcer formation , there may be unknown or unmeasured facility effects in addition to t he characteristics of a given resident in a particular home.