Factors Influencing Pressure Ulcer Healing in Adults Over 50: An Exploratory Study

Abstract

The purpose of this study was to determine which demographic, clinical, and treatment factors influenced chronic pressure ulcer healing, and to identify the implications for pressure ulcer care being delivered in skilled nursing facilities. A multisite retrospective chart review was conducted using a structured data abstraction form and protocol. Data collection took place in 3 geographically disperse areas of the country, with subjects having received wound care in hospitals, clinics, nursing homes, and home care. Subjects whose charts were reviewed were 50 years of age or older, had at least 1 diagnosed chronic pressure ulcer, and had 3 to 6 months of data available for abstraction. Stage I ulcers were excluded from the analysis. The structured data collection form included demographics, clinical variables, wound characteristics, and outcomes. The variables ulcer size, exudate type and amount, and necrotic tissue type were combined into a single wound severity score. Bivariate analyses showed that insurance type, secondary diagnoses of cardiovascular disease and pulmonary disease, initial ulcer size and stage, dressing type changes, use of topical antiseptics, type of debridement, category of dressing, use of hydrocolloid or wet-to-dry dressings, antibiotic administration, and appropriateness of selected dressing and management of necrosis were all significantly associated with healing within 6 months. Logistic regression models identified the following as the most significant predictors of healing: Medicaid, secondary diagnosis of cardiovascular disease, dressing type changed, topical antiseptics, antibiotic administration, pressure relief device, lack of exudate management dressing for moderate or large exudate wound, and lack of debridement of wounds with yellow slough, all decreased the odds of healing; use of exudate management dressings on wounds with no documented exudate increased the odds of healing. Pressure ulcer healing rates overall could be improved if clinicians better matched the characteristics of the wound with the decision to debride and the selection of the optimal dressing. Healing within nursing homes might be improved with less use of enzymatic debridement and antibiotics and more frequent application of hydrocolloid dressings.