title: A prospective cohort study of lower-extremity pressure ulcer risk among bedfast older adults.
abstract: OBJECTIVE
  To estimate the incidence and identify risk factors for lower-extremity pressure ulcers in bedfast older adult patients.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  A 500-bed long-term-care facility in Japan.
  
  
  METHODS
  A total of 259 patients who were aged 65 years or older, confined to bed, and without lower-extremity pressure ulcers at enrollment participated in the study.
  
  
  METHODS
  Incidence of occurrence, wound characteristics, and risk factors for lower-extremity pressure ulcers. The incidence of lower-extremity pressure ulcers per 100 person-years was 16.8 (n = 33). The most common sites of lesions were the toes and heels. Cox regression analysis indicated that 3 factors were independently related to new lower-extremity pressure ulcer risk: low ankle-brachial index value (hazards ratio 0.075; 95% confidence interval [CI], 0.023-0.242), length of bedfast period (hazards ratio 1.010; 95% CI, 1.004-1.015), and male gender (hazards ratio 2.951; 95% CI, 1.450-6.009). Receiver operating characteristic curve analysis showed the area under the curve was 0.760 (95% CI, 0.675-0.844) for the ankle-brachial index. Therefore, an ankle-brachial index cutoff level of 0.8 provided high sensitivity and adequate specificity.
  
  
  CONCLUSIONS
  Lower-extremity pressure ulcers are a significant problem in bedfast older adult patients aged 65 years or older. Bedfast older adult patients who developed lower-extremity pressure ulcers in this study were believed to have arteriosclerosis; the patients' ulcers exhibited features of ischemic ulcers. The findings of the present study suggest that bedfast older adult patients with a low ankle-brachial index value, a long bedfast period, or male gender should be closely monitored for lower-extremity pressure ulcer development on admission to long-term-care facilities. In particular, the ankle-brachial index is recommended as a screening tool in this practice setting.
authors.affiliation: Department of Clinical Nursing, Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Okuwa
authors.forename: Hiromi
authors.initials: H
authors.lastname: Sanada
authors.forename: Junko
authors.initials: J
authors.lastname: Sugama
authors.forename: Michiko
authors.initials: M
authors.lastname: Inagaki
authors.forename: Chizuko
authors.initials: C
authors.lastname: Konya
authors.forename: Atsuko
authors.initials: A
authors.lastname: Kitagawa
authors.forename: Keiko
authors.initials: K
authors.lastname: Tabata
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology / Q000502:physiology; D000842:Ankle / Q000098:blood supply / Q000000981:diagnostic imaging; D001510:Bed Rest / Q000009:adverse effects*; D001916:Brachial Artery / Q000000981:diagnostic imaging; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007871:Leg Ulcer / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D008297:Male; D009730:Nursing Assessment; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012866:Skilled Nursing Facilities; D014463:Ultrasonography