The Epidemiology and Natural History of Pressure Ulcers in Elderly Nursing Home Residents

TLDR

The study aimed to determine the prevalence, incidence, and natural history of pressure ulcers among elderly nursing home residents. The authors analyzed prospective data from 19,889 residents across 51 nursing homes between 1984 and 1985. Among 19,889 residents, 11.3% had stage II–IV ulcers, with 1‑year incidence rates of 13.2% for new admissions and 9.5% for existing residents, rising to 21.6% and 20.4% at two years; ulcers were linked to higher mortality but not hospitalization, yet most lesions healed within a year, especially early in the stay, indicating that with adequate care pressure ulcers can resolve despite increased mortality.

Abstract

We analyzed prospective data from 19,889 elderly residents of 51 nursing homes from 1984 to 1985 to determine the prevalence, incidence, and natural history of pressure ulcers. Among all residents admitted to nursing homes, 11.3% possessed a stage II through stage IV pressure ulcer. For those residents admitted to the nursing home without pressure ulcers during the study period, the 1-year incidence was 13.2%. This increased to 21.6% by 2 years of nursing home stay. People already residing in a nursing home at the start of the study had a 1-year incidence of 9.5%, which increased to 20.4% by 2 years. Pressure ulcers were associated with an increased rate of mortality, but not hospitalization. Longitudinal follow-up of residents with pressure ulcers demonstrated that a majority of their lesions were healed by 1 year. Most of the improvement occurred early in a person's nursing home stay. Although nursing home residents with pressure ulcers have a higher mortality, with good medical care pressure ulcers can be expected to heal.