title: Pressure ulcers in the nursing home.
abstract: OBJECTIVE
  To review the literature on the causes, epidemiology, prevention, and treatment of pressure ulcers in nursing homes and to summarize this information for clinicians caring for nursing home residents.
  
  
  METHODS
  A MEDLINE search of English-language articles published between 1980 and October 1994 using the terms decubitus ulcer and elderly. References from identified articles were also examined.
  
  
  METHODS
  Articles were excluded if the title indicated that patients were not nursing home residents (unless data from nursing homes were limited or unavailable), that patients were not elderly, or that the ulcers were related to peripheral vascular disease or neuropathy.
  
  
  METHODS
  Selected studies either contained original data or were meta-analyses. Prevalence studies were required to have an identifiable denominator; risk factor and incidence studies were required to have an identifiable cohort and a specified duration of follow-up. Preference was given to risk factors identified through multivariate analyses. Studies of preventive and therapeutic interventions were required to have an identifiable control group; preference was given to randomized controlled trials.
  
  
  RESULTS
  Seventeen percent to 35% of patients have pressure ulcers at the time of admission to a nursing home, and the prevalence of pressure ulcers among nursing home residents ranges from 7% to 23%. Among high-risk patients, the incidence of pressure ulcers is estimated to be 14/1000 patient-days. Residents at higher risk for developing ulcers are those who have limited ability to reposition themselves, cannot sense the need to reposition, have fecal incontinence, or cannot feed themselves. Occlusive dressings are as effective and less costly than traditional wet-to-dry saline dressings for treating earlier stages of pressure ulcers. There is no consensus on the use of specialized beds in the nursing home for promoting the healing of advanced-stage ulcers or for reducing the incidence of ulcers in high-risk patients. Specific interventions should not detract from careful, total assessment and management of the patient.
  
  
  CONCLUSIONS
  Pressure ulcers in the nursing home are common problems associated with significant morbidity and mortality. Because resident characteristics can identify residents likely to develop ulcers, preventive measures can be implemented early. Therapy for advanced stages of pressure ulcers is expensive and prolonged. Involvement of the physician with the multidisciplinary nursing home team is essential for prevention and therapy.
authors.affiliation: Veterans Affairs Medical Center (111GIM), Indianapolis, IN 46202, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Smith
mesh_terms: D000368:Aged; D006707:Homes for the Aged; D006801:Humans; D015994:Incidence; D009735:Nursing Homes; D003668:Pressure Ulcer / Q000150:complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D015995:Prevalence; D012307:Risk Factors