title: Leg ulcers in older people: a national study addressing variation in diagnosis, pain and sleep disturbance.
abstract: BACKGROUND
  Leg ulcers commonly emerge as a symptom of other comorbidities, often in older people. As a consequence of the ulcer, pain and sleep disturbances might occur. Due to the complex illness, the responsibility of treatment is unclear between health caregivers. The interaction between ulcer type, sleep and pain has not previously been investigated. This study aimed to explore pain in older men and women (65 years and older) with different diagnoses of leg ulcers and to investigate the associations of sleep disturbances and pain in people with leg ulcer diagnosis.
  
  
  METHODS
  The study used a cross-sectional design and data from the Swedish Registry of Ulcer Treatment, collected between May 2009 and December 2013. One thousand and eight hundred and twenty four people were included, and 62.9% were women. The mean age was 83.4 years (SD 8.8). For the analyses, the chi-square test, Mann-Whitney U-test, t-test, one-way ANOVA and logistic regression was performed. Pain was measured by the Numeric Rating Scale (NRS), and sleep disturbances was assessed dichotomously.
  
  
  RESULTS
  We found the prevalence of pain intensity ≥ 5 on the NRS to be 34.8% in those reporting pain. Additionally, the pain intensity was associated with the number of ulcers (p = 0.003). Sleep disturbances were associated with pain (p < 0.001) and were found in 34.8% of the total sample. Although more women than men reported pain and scored higher on the NRS, no significant gender difference in sleep disturbances was found (p = 0.606). The mean NRS scores did not differ significantly between the ulcer types; however, arterial and venous-arterial ulcers increased the risk of sleep disturbances, as did higher pain scores.
  
  
  CONCLUSIONS
  The majority of the participants were of advanced age (>80 years) and frequently suffered from pain and sleep disturbances. Further research is needed regarding pain, sleep and wound healing in the oldest old with leg ulcers. Ulcer pain sometimes appears to receive less attention in ulcer management, as do sleep disturbances, implying that individual needs might not be satisfactorily met. National guidelines in managing leg ulcers, which also consider consequences such as sleep disturbances, pain and discomfort, are needed.
authors.affiliation: Department of Health and Care Sciences, Linnaeus University, Stagneliusg. 14, SE-392 34, Kalmar, Sweden. amanda.hellstrom@lnu.se.
authors.forename: Amanda
authors.initials: A
authors.lastname: Hellström
authors.affiliation: County Council of Värmland, Arvika, Sweden. camilla-nilsson@hotmail.com.
authors.forename: Camilla
authors.initials: C
authors.lastname: Nilsson
authors.affiliation: County Council of Blekinge, Karlskrona, Sweden. annina.nilsson@ltblekinge.se.
authors.forename: Annina
authors.initials: A
authors.lastname: Nilsson
authors.affiliation: Blekinge Institute of Technology, Blekinge Centre of Competence, Karlskrona, Sweden. cecilia.fagerstrom@bth.se.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fagerström
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D008297:Male; D010146:Pain / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D015995:Prevalence; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D013548:Sweden / Q000453:epidemiology