Pressure sores are a serious and common problem for bedridden, elderly patients. They are associated with prolonged and expensive hospitalizations and increased death rates. Little work has been done to identify the factors that increase the risk of pressure sores independent of being bedridden. As an extension of our previous work, we propose & 4-year prospective study of 1,300 bedridden patients 65 years or older in the University of Alabama Hospital. The major objective of this study is to define the demographic, medical and the nutritional factors that increase the risk of developing a pressure sore among bedridden patients. Secondary objectives include comparing the mortality, lengths of stay and re-hospitalization rates of patients who develop pressure sores with those who do not. At baseline, data will be collected from physical examination, medical record review, attending physician and nursing assessments, selected laboratory studies and assays of nutritional factors. We will reexamine patients each week to monitor for pressure sores. Sore severity will be assessed from photographs by an investigator masked to risk factor status and timing of the photographs. Other complications that may impact length of stay and mortality will be monitored. Patients who develop pressure sores and control patients who do not will be followed up by phone calls at 3, 6, 9 and 12 months after discharge to determine subsequent mortality and re-hospitalizations. Baseline factors that we hypothesize to increase risk for pressure sore development will be studied using multiple logistic regression to determine which factors are independently associated with pressure sore development. Mortality, length of stay and rehospitalization rates of patients who develop sores and those who do not will be compared and adjustments will be made for severity of disease, co-morbidity and hospital complications using multivariate techniques. This study should facilitate prevention trials in the future by allowing us to reliably identify high-risk patients and by defining potentially modifiable risk factors that could be studied in such trials.
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