With the growing number of elderly long-term care residents in the United States, pressure ulcers (PU) represent a significant healthcare problem. The National Pressure Ulcer Advisory Panel (NPUAP) reported in 2001 that the incidence rates of PU in long-term care residents ranged from 2.2% to 23.9% and the prevalence from 2.3% to 28%. Multiple risk factors for the development of PU have been suggested, and can be divided into extrinsic factors and intrinsic factors. The aims of this study were to: (1) conduct a focused literature review of intrinsic and extrinsic factors related to PU development in elderly long-term care residents; (2) conduct a secondary analysis of demographic and clinical data from Randomized Clinical Trial on Preventing Pressure Ulcers with Seat Cushions (RCT-SC), to identify risk factors associated with acquiring/not acquiring a PU in elderly long-term care residents. Three different methods were used to analyze the data: (a) stepwise logistic regression, (b) odds ratios, and (c) Exhaustive Chi-Square Automatic Interaction Detection (CHAID); and generate a decision-making tree for the prescription of wheelchairs and seat cushions by rehabilitation practitioners for elderly long-term care wheelchair users. Inter-rater and intra-rater reliability of the rehabilitation team decisions were also established. As a result of this study it was concluded that:(a) the focused literature review provided useful information about intrinsic, extrinsic and combinations of these risk factors in PU acquisition,(b) the stepwise logistic regression, odds ratios, and CHAID analyses confirmed known risk factors and added new risk factors that predict PU development,(c) the decision-making tree can be a starting point for rehabilitation practitioners that are new to the field of seating and mobility, and (d) the decision making tree showed that the use of a pressure mapping system is a good tool if used in combination with clinical judgment.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-06182008-153223 |
| Date | 08 September 2008 |
| Creators | Allegretti, Ana Luiza Caltabiano |
| Contributors | David M. Brienza, Mark R. Schmeler, Joan C. Rogers, Jules Rosen, Margo B. Holm |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-06182008-153223/ |
| Rights | restricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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