EFFECT OF PRESSURE ULCERS ON THE SURVIVAL OF LONG-TERM-CARE RESIDENTS

Background. Past studies have emphasized that patients with pressure u lcers are at high risk of dying. However, it remains unclear whether t his increased risk is related to the ulcer or to coexisting conditions . In this study we examined the independent effect of pressure ulcers on the survival of long-term care residents. Methods. We evaluated all 19,981 long-term care residents institutionalized in Department of Ve terans Affairs (VA) long-term care facilities as of April 1, 1993. Bas eline resident characteristics and survival status were obtained by me rging data from five existing VA data bases. Survival experience over a 6-month period was described using a proportional hazards model. Res ults. Pressure ulcers were present in 1,539 (7.7%) long-term care resi dents. Residents with pressure ulcers had a relative risk of 2.37 (95% CI = 2.13, 2.64) for dying as compared to those without ulcers. After adjusting for 16 other measures of clinical and functional status, th e relative risk associated with pressure ulcers decreased to 1.45 (95% CI = 1.30, 1.65). No increased risk of death was noted for residents with deeper ulcers. Conclusions. Pressure ulcers are a significant mar ker for long-term care residents at risk of dying. After adjusting for clinical and functional status, however, the independent risk associa ted with pressure ulcers declines considerably. The fact that larger u lcers are not associated with greater risk suggests that other unmeasu red clinical conditions may also be contributing to the increased mort ality associated with pressure ulcers.