The epidemiology and natural history of pressure ulcers in elderly nursing home residents

Article Abstract:

Pressure ulcers (decubiti or bed sores) are ulcers that occur initially on the skin, but progress into deeper tissues if they are not treated. They are caused by prolonged pressure, particularly over bony protuberances, and usually develop in patients who are unconscious, can not move their bodies easily, or who have lost touch and pressure sensation. Decubiti occur in up to one-third of patients admitted to chronic care institutions and may result in infection, pain, depression, and increased health care costs. Little is known about the natural course or epidemiology of pressure ulcers. The occurrence of ulcers was evaluated in 19,889 men and women over the age of 60, who resided in 51 nursing homes. Moderate to severe ulcers affected in 6.8 percent of the residents. New ulcers of moderate to severe grade developed in 13.2 percent of residents who were admitted to the nursing homes over a one-year period. It is suggested that newly admitted residents may be more vulnerable to this problem; they may be admitted to the nursing home in relatively poor condition because of changes in medical insurance and shortened lengths of hospitalization. The greatest degree of pressure sore healing occurred in the first three months, and during the two-year period the percentage of healed ulcers ranged from 54.5 percent of moderate decubiti to 23.3 percent of severe decubiti. Twenty percent of ulcers were not healed or improved at one-year follow-up. All nursing home residents with decubiti, whether long-term or newly admitted, had significantly higher mortality than those without ulcers. However, they did not have a higher rate of hospitalization. The results suggest that pressure ulcers are best prevented or treated early in the nursing home stay, and, despite increased mortality among affected residents, continued healing may occur with good medical care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Patient outcomes, Mortality, Bedsores, Nursing home care, Decubitus ulcer

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Risk factors for delirium in hospitalized elderly

Article Abstract:

Hospitalized patients who are over 80 years old, have a history of intellectual impairment or a fracture are more likely to become delirious. A study of 291 patients who were not delirious at admission found that those who had a history of intellectual impairment were almost nine times more likely to become delirious. Those over 80 years old were more than five times as likely to become delirious, and those who were admitted with a fracture were more than six times as likely to become delirious. Antipsychotic drugs were also associated with an increased risk for delirium: patients who were given these drugs during their hospitalization were more than twice as likely to become delirious. The likelihood of patients becoming delirious during their hospitalization can be predicted at admission, and prompt intervention can improve their care and shorten their stay in the hospital.

Complications and side effects, Hospitalization, Cognition disorders in old age, Geriatric cognitive disorders, Delirium

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Patterns of orthostatic blood pressure change and their clinical correlates in a frail, elderly population

Article Abstract:

Orthostatic hypotension appears to be common among elderly nursing home residents. Orthostatic hypotension is a drop in blood pressure when a person stands up from a sitting or lying position. Researchers analyzed the frequency of orthostatic hypotension in 911 nursing home residents. About half had one or more episodes of orthostatic hypotension. Orthostatic hypotension occurred most commonly after breakfast, especially if blood pressure was high. Treatment of hypertension could reduce the risk of orthostatic hypotension in elderly patients.

Hypertension, Physiological aspects, Hypotension, Orthostatic, Orthostatic hypotension

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