Dr. Berlowitz et al., EFFECT OF PRESSURE ULCERS ON THE SURVIVAL OF LONG-TERM-CARE RESIDENTS, The journals of gerontology. Series A, Biological sciences and medical sciences, 52(2), 1997, pp. 106-110
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.