title: A retrospective cohort study of factors that affect healing in long-term care residents with chronic wounds.
abstract: Chronic ulcers such as pressure, ischemic, and venous ulcers are common in long-term care (LTC) and frequently do not heal. A retrospective medical records review of all LTC residents referred to a wound consultative service between April 1999 and January 2007 was conducted to assess predictors of 6-month healing outcome. Variables abstracted and analyzed included wound, resident demographic, and laboratory values at diagnosis and comorbid medical illnesses. The average age of study participants (n = 397) was 78.1 years (+/- 11), 47% were men, 48% had more than one wound, and the most common wound diagnosis was pressure ulcer (n = 163). After 6 months, 66% of ulcers were not healed. The odds ratio for nonhealing was significantly higher in residents who had more wounds, a larger wound area, diabetes mellitus, or peripheral vascular disease and lower in residents with increased age and hemoglobin values and/or a history of stroke, depression, dementia, degenerative arthritis, peripheral neuropathy, and falls. After adjustment in the multivariate model, only the number of wounds and hemoglobin level remained significant predictors of healing status. A higher number of chronic ulcers and lower hemoglobin counts increased the risk of nonhealing after 6 months of care. Including these variables in LTC resident assessments may help clinicians ascertain expected outcomes of care.
authors.affiliation: Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. Takahashi.paul@mayo.edu
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Takahashi
authors.forename: Lester J
authors.initials: LJ
authors.lastname: Kiemele
authors.forename: Anupam
authors.initials: A
authors.lastname: Chandra
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Cha
authors.forename: Paul V
authors.initials: PV
authors.lastname: Targonski
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007871:Leg Ulcer / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008910:Minnesota; D015999:Multivariate Analysis; D009735:Nursing Homes; D016491:Peripheral Vascular Diseases / Q000150:complications; D011237:Predictive Value of Tests; D003668:Pressure Ulcer / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014945:Wound Healing / Q000502:physiology
chemical_list: D006454:Hemoglobins