title: The identification of older nursing home residents vulnerable for deterioration of grade 1 pressure ulcers.
abstract: OBJECTIVE
  The objective of this study was to identify prognostic factors associated with the development of pressure ulcer lesions (grade 2-4) in nursing home patients with non-blanchable erythema.
  
  
  BACKGROUND
  No studies could be found that identify risk factors for further development of pressure ulcer in patients with non-blanchable erythema. For some patients with non-blanchable erythema, standard preventive measures do not suffice to prevent pressure ulcers from deterioration. Identifying these patients beforehand can considerably contribute to the efficiency of pressure ulcer prevention.
  
  
  METHODS
  Secondary data analyses of a previously conducted randomised controlled trial were performed.
  
  
  METHODS
  Eighty-four wards of 16 Belgian nursing homes participated in the study. In total, 235 nursing home residents with a grade 1 pressure ulcer (non-blanchable erythema) were included. All the residents received standard preventive care. Potential prognostic factors were collected using a standardised form. The incidence of pressure ulcers was recorded according to the European pressure ulcer classification system.
  
  
  RESULTS
  The cumulative pressure ulcer incidence was 18.7% (44/235). Hypotension (relative risk = 3.42, 95% CI = 1.56-7.49), a history of a cerebral vascular accident (relative risk = 1.94, 95% CI = 1.10-3.70) and contractures (relative risk = 2.02, 95% CI 1.03-3.95) were identified as independent predictive factors for developing pressure ulcers. Remarkably, being urinary incontinent decreased the risk of developing a pressure ulcer by 76%.
  
  
  CONCLUSIONS
  In nursing home residents with non-blanchable erythema, hypotension, contractures, and a history of cerebral vascular accident were independent risk factors for the development of pressure ulcer lesions.
  
  
  CONCLUSIONS
  Patients with non-blanchable erythema who have hypotension, contractures or a history of cerebral vascular accident are in need of more intensive preventive measures. Identifying these patients can contribute considerably to a more efficient pressure ulcer prevention policy, resulting in a lower pressure ulcer lesion incidence and in lower costs.
authors.affiliation: Nursing Science, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. katrien.vanderwee@ugent.be
authors.forename: Katrien
authors.initials: K
authors.lastname: Vanderwee
authors.forename: Maria
authors.initials: M
authors.lastname: Grypdonck
authors.forename: Dirk
authors.initials: D
authors.lastname: De Bacquer
authors.forename: Tom
authors.initials: T
authors.lastname: Defloor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007297:Inpatients; D009735:Nursing Homes; D003668:Pressure Ulcer / Q000453:epidemiology*; D012307:Risk Factors