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  1. Okuwa, Mayumi MSN, RN
  2. Sanada, Hiromi PhD, RN, WOCN
  3. Sugama, Junko PhD, RN
  4. Inagaki, Michiko PhD, RN
  5. Konya, Chizuko PhD, RN, WOCN
  6. Kitagawa, Atsuko PhD, RN
  7. Tabata, Keiko RN


OBJECTIVE: To estimate the incidence and identify risk factors for lower-extremity pressure ulcers in bedfast older adult patients.


DESIGN: Prospective cohort study.


SETTING: A 500-bed long-term-care facility in Japan.


PATIENTS: A total of 259 patients who were aged 65 years or older, confined to bed, and without lower-extremity pressure ulcers at enrollment participated in the study.


MAIN OUTCOME MEASURES: Incidence of occurrence, wound characteristics, and risk factors for lower-extremity pressure ulcers. The incidence of lower-extremity pressure ulcers per 100 person-years was 16.8 (n = 33). The most common sites of lesions were the toes and heels. Cox regression analysis indicated that 3 factors were independently related to new lower-extremity pressure ulcer risk: low ankle-brachial index value (hazards ratio 0.075; 95% confidence interval [CI], 0.023-0.242), length of bedfast period (hazards ratio 1.010; 95% CI, 1.004-1.015), and male gender (hazards ratio 2.951; 95% CI, 1.450-6.009). Receiver operating characteristic curve analysis showed the area under the curve was 0.760 (95% CI, 0.675-0.844) for the ankle-brachial index. Therefore, an ankle-brachial index cutoff level of 0.8 provided high sensitivity and adequate specificity.


CONCLUSION: Lower-extremity pressure ulcers are a significant problem in bedfast older adult patients aged 65 years or older. Bedfast older adult patients who developed lower-extremity pressure ulcers in this study were believed to have arteriosclerosis; the patients' ulcers exhibited features of ischemic ulcers. The findings of the present study suggest that bedfast older adult patients with a low ankle-brachial index value, a long bedfast period, or male gender should be closely monitored for lower-extremity pressure ulcer development on admission to long-term-care facilities. In particular, the ankle-brachial index is recommended as a screening tool in this practice setting.