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J Adv Nurs. 2009 Dec;65(12):2608-20. doi: 10.1111/j.1365-2648.2009.05117.x. Epub 2009 Oct 12.

Pressure ulcer development in older residents in nursing homes: influencing factors.

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School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.



This paper is a report of a study assessing pressure ulcer incidence and factors affecting pressure ulcer development among older nursing home residents.


Previous researchers have shown that demographic, clinical, health status, risk and human resources factors affect pressure ulcer development among older people in various healthcare settings, but none has investigated their interactive effects among older nursing home residents.


This was a prospective cohort study involving 346 residents aged 65 years or over from four private nursing homes in Hong Kong. We collected information on participant demographics and assessed their clinical characteristics, health status and pressure ulcer risk factors. Subsequently, we assessed their skin condition every 2 days for 4 weeks to detect pressure ulcers that developed after the initial assessment. The data were collected between December 2006 and September 2007.


The pressure ulcer incidence was 25.16%. The model in which the factors of clinical characteristics, health status, pressure ulcer risk and human resources were controlled was more reliable in predicting pressure ulcer development than the other two models. It showed that bedfast or chairfast residents, especially those with co-morbidities (renal failure and stroke) and living in nursing homes where there were no nurses but more nursing assistants, were at higher risk for pressure ulcer development.


Evidence-based interventions should be adopted to minimize the possible problems of pressure, malnutrition, friction and shear force, and the decreased pain perception of bedfast or chairfast residents in nursing homes, especially those with renal failure or stroke.

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