Background: Studies of risk factors for clinically significant pressure ulcers in the hospital have been limited by the small number of study subjects that develop pressure ulcers, resulting in contradictory findings regarding some risk factors. Objective: To determine if three risk factors (low serum albumin level, fecal incontinence, and confusion) were significant risk factors when tested in a large data set. Methods: The study design was a longitudinal cohort study using data collected as a component of a multi-site controlled clinical trial. The data were collected at 47 Veterans Affairs Hospitals. 2,771 subjects that required high levels of nursing care were identified to have mobility impairment. Their medical records were abstracted using a standard form to identify a large number of potential risk factors. The subsequent development of stage 2 or greater pressure ulcers was recorded for a maximum of 14 days after admission. Results: 406 patients (14.7%) subsequently developed at least one stage 2 or greater pressure ulcer over a 2-week period. In a multivariate model, the presence of low albumin levels (odds ratio OR = 1.40) and confusion (OR = 1.45) were both found to be statistically significant risk factors, while fecal incontinence was not. Having a Do Not Resuscitate (DNR) order was also a significant risk factor (OR = 1.55). Two other known risk factors also entered the model: being malnourished (OR = 1.69) and requiring a urinary catheter (OR = 1.55). Conclusions: This study confirmed confusion and low albumin as pressure ulcer risk factors, but not fecal incontinence. A DNR order was found to be a new pressure ulcer risk factor not previously described in the literature.

Thus, only a small proportion of patients with documented coronary artery disease and hypercholesterolemia were being actively treated for their lipid disorder, suggesting that the published treatment guidelines have not yet been fully accepted. However, an encouraging improvement in frequency of treatment of hypercholesterolemia was documented during the 1-2-year observation period.

The Department of Veterans Affairs (VA) operates the largest, integrated health care system in the United States of America. The projected need for long-term-care in the VA health care system parallels an expected increase in need for care in the United States, but precedes the need for care in the general population by 25-30 yr. The VA's Office of Dentistry, in an effort to estimate the resource requirements of this swelling group of veterans, initiated in 1986-7 an oral health survey of long-term care patients. The overall goals were to describe the oral health status of VA nursing home care units (NHCU) residents and to develop a methodology for estimating future dental health services utilization. This study describes the oral health status of the study population. Demographic and oral health data were collected for 650 long-term care residents of six VA NHCUs between October 1986 and July 1987. Data were collected on sociodemographic status, medical history, dental caries, periodontal diseases, oral soft tissue pathology, and the presence of dental prostheses. Caries and periodontal disease were evaluated using the United States National Institute of Dental Research Survey of Employed Adults and Seniors protocols. The oral health status of the population is described using DMF and ESI indices, the prevalence of oral lesions, levels of tooth loss, oral hygiene scores, and the status of existing dentures. Findings show moderate levels of untreated dental caries and periodontal disease and significant tooth loss which increased with age. A need for preventive therapy, restorative dentistry, conservative periodontal therapy, and prosthodontic care was evident.(ABSTRACT TRUNCATED AT 250 WORDS)

The elderly make up an increasingly larger segment of the patient population in dental practices. This article reviews recent epidemiologic, demographic, and health services research, and concludes that significant segments of the elderly are at high risk for oral disease and/or limited access to dental treatment, and consequently warrant classification as high-risk groups for policy considerations. It then proposes policy options to the dental community and public decision makers. Oral care can be viewed as having three components. Two basic components are the primary care component--which includes diagnostic, preventive restorative, and periodontal care--and the acute care component--i.e., the treatment of oral pain, trauma, and infection. The third, rehabilitative component, has to do with the restoration of oral function, including prosthodontics and cosmetic dentistry. Viewing dental care in this perspective may help link funding for dental primary care services with that for other primary health services, and link restoration of function and improvement of quality of life with similar health services, like hearing, vision, and social services. In addition, approaching dental care policy makers on several levels--i.e., federal, state, and local--will contribute to our ability as a profession, in the decades ahead, to meet the oral health needs of more elders: including the frail, those at high risk for oral disease, and those with limited access to care.

By the year 2000, it is likely that more than 66% of all US males will be veterans as a result of the large World War II cohort. This growing population of older veterans will have a major influence on the use of dental services at Veterans Administration facilities. The objectives of the project reported here were to identify and examine factors that explain use of dental services by noninstitutionalized veterans older than 55 years; this was a secondary analysis of a VA commissioned survey of 3,013 community-based veterans older than 55 years. A behavioral model developed by Anderson and Aday that identified predisposing, enabling, and need factors that determined use of health care services was adopted to analyze the data. A linear regression analysis showed that need factors accounted for the greatest degree of explained variance in use of dental services (R2 = .15), whereas enabling factors accounted for the least degree of variance (R2 = .02). Perception of dental problems, positive perception of physical health, perception of ability to meet expenses, and levels of education and income were significant predictors of use of dental services. The findings of this study show the use of dental services by noninstitutionalized veterans and other noninstitutionalized older populations is influenced by similar factors. The findings can be useful in discussing and formulating dental health care policy for older veterans.