Predictors of pressure ulcer healing among long-term care residents

OBJECTIVES: To identify predictors of pressure ulcer healing among long-term care residents. DESIGN: A retrospective cohort study. SETTING: Department of Veterans Affairs (VA) long-term care facilities. PARTICIPANTS: All long-term care residents with a pressure ulcer on April 1, 1993, who remained institutionalized as of October 1, 1993. Patients and pressure ulcer status were identified from the Patient Assessment File, a VA administrative database. MEASUREMENTS: Pressure ulcers were considered healed if patients were without an ulcer on October 1, 1993. Predictors of pressure ulcer healing were selected from among patient characteristics in the Patient Assessment File. RESULTS: Pressure ulcers were present in 7.7% of the long term care residents institutionalized as of April 1, 1993. Among the 819 pressure ulcer patients remaining institutionalized as of October 1, 1993, ulcers had healed in 442 (53.0%). Seventy-two percent of patients with Stage 2 ulcers were ulcer-free at 6 months. compared with 45.2% of patients with Stage 3 ulcers and 30.6% of those with Stage 4 ulcers (P<.001). Significant (P<.05) independent predictors of healing included pressure ulcer size (Odds ratio (OR) = 5.2 for Stage 2 ulcers, OR = 1.5 for Stage 3 ulcers), older age (OR = 1.5), and receiving rehabilitation services (OR = 1.3 for each additional type of therapy). Both immobility (OR = .3) and incontinence (OR = .7) were associated with ulcers not healing. CONCLUSIONS: Most Stage 2 pressure ulcers, and many larger ulcers encountered in long-term care settings will heal. Baseline patient characteristics are important predictors of healing. Interventions may then be targeted at patients whose ulcers are unlikely to heal, and observed facility performance may be compared with expected outcomes.