NURSING ASSESSMENT OF PRESSURE SORE RISK IN THE ELDERLY

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The long-term objectives of this project are to develop and test nursing interventions aimed at reducing nutritional and other risk factors and to prevent pressure sores in specific at-risk patients. The specific aim of this study is to improve nursing assessment of elderly nursing home residents by determining what nutritional and other risk factors are most highly predictive of the development of pressure sores in this population. Subjects will be: (a) over 65 years of age; (b) admitted to a long-term care facility for at least 21-28 days; (c) at risk for the development of pressure sores as defined by a score of less than 2/3 of the possible points on the Braden Scale for prediction of risk of developing pressure sores; and (d) free of pressure sores at the outset of the study. A prospective study is proposed. Subjects will be studied at the following time intervals: (1) admission to the study; (2) weekly for one month (days 7, 14, 21, 28); (3) biweekly for two months (days 42, 56, 70, 84); (4) at the first report of erythema over a bony prominence (if this occurs); and (5) one week following skin breakdown. At each time interval the subjects: (a) will be assessed for risk of skin breakdown; (b) will be observed for 24-hour diet intake; (c) will have a blood sample withdrawn; and (d) will have physical status information recorded from the records. Dietary intake will be analyzed for the following nutrients: calories, protein, carbohydrate, fat, calcium, phosphorus, iron, vitamins A, D, C, thiamine, riboflavin, niacin, cholesterol, sodium, and water. Blood samples will be analyzed for CBC, serum albumin, total serum protein, vitamin C, total iron, and total iron binding capacity. Clinical data about dietary and plasma zinc may also be obtained.