Six‐month mortality risks in long‐term care residents with chronic ulcers

Abstract

Introduction Chronic ulcers are a common problem in long term care. Residents with ongoing ulcers are often frail and at risk for mortality. Aim This study evaluated the relationship between wound characteristics and other health predictors with 6-month mortality in nursing home residents. Subjects Nursing home residents seen by the wound consult service from 1998-2007 with an ongoing chronic ulcer. Methods This was a retrospective cohort study. Data was manually and electronically abstracted for each resident. 6-month mortality was collected as the primary outcome. Statistical comparisons were made using logistic regression with a final multivariant model. Results 440 residents were seen with 411 records reviewed. Ulcer area was not associated with mortality; however, chronic ulcer number was associated with 6 month mortality with an odds ratio of 1.32 [95% CI 1.07-1.63]. Other significant risk factors included heart failure, dementia, cancer, depression and blindness with all factors having an odds ratio greater than 1.75. Higher hemoglobin and venous insufficiency were protective of 6 month mortality. Discussion Ulcer number is an important predictor for 6-month mortality. The presence of multiple ulcers and comorbid health concerns may influence discussion of prognosis for healing and for potential end of life discussions.

Predictors of mortality among elderly dependent home care patients

“…Further, it is known that pressure ulcers are a major predictor of death in patients living at home or in nursing homes. Existing studies have shown that pressure ulcers double the risk of death for these patients during the subsequent year [7,8]. …”

Anxiety and Depression and Mortality Among Cognitively Intact Nursing Home Residents With and Without a Cancer Diagnosis

“…19 We recently found that cognitively intact NH residents with cancer reported lower health-related quality of life than that reported by residents without cancer. 15,16 Most people with cancer experience anxiety at some point during the course of diagnosis and treatment and often at crisis points such as the initial diagnosis or discovery of a relapse after treatment. 22 Previous longitudinal studies of older people living in NHs have included depression but not anxiety symptoms.…”

Wounds and Survival in Noncancer Patients

“…However, one recent study has demonstrated that the summation of all types of ulcers was associated with increased mortality at 6 months with a HR ¼ 1.32 (95% CI 1.07-1.63). 29 Unfortunately, that study did not disclose the proportions of the various wound classes or account for their co-occurrence.…”