Pressure ulcers among patients admitted to home care

CONTEXT: Pressure ulcers are an understudied problem in home care. OBJECTIVE: To determine the prevalence of pressure ulcers among patients ad mitted to home care services, describe the demographic and health character istics associated with pressure ulcers in this setting, and identify the pe rcentage of these patients at risk for developing pressure ulcers. DESIGN: Cross-sectional survey of patients on admission to home care agenci es. SETTING: Forty-one home care agencies in 14 states. PATIENTS: A consecutive sample of 3048 patients admitted March 1 through Ap ril 30, 1996 (86% of all admissions). Subjects had a mean age of 75 years; 63% were female and 85% white. MAIN OUTCOME MEASURES: Demographic, social, and clinical characteristics, f unctional status (Katz activities of daily living scale and Lawton instrume ntal activities of daily living scale), mental status (Katzman Short Memory -Orientation-Concentration test), pressure ulcer risk (Braden Scale), press ure ulcer status (Bates-Jensen Pressure Ulcer Status Tool), and a checklist of pressure-reducing devices and wound care products being used. RESULTS: In the total sample of 3048 patients, 9.12% had pressure injuries: 37.4% had more than one ulcer and 14.0% had three or more ulcers. Consider ing the worst ulcer for each subject, 40.3% had Stage II and 27% had Stage III or IV injuries. Characteristics associated with pressure ulcers include d recent institutional discharge, functional impairment, incontinence, and having had a previous ulcer. About 30% of subjects were at risk for new pre ssure ulcers. Pressure-relieving devices and other wound care strategies ap peared to be underutilized and often indiscriminately applied. CONCLUSIONS: There is substantial need for pressure ulcer prevention and tr eatment in home care settings.