A Multi-site Study to Characterize Pressure Ulcers in Long-term Care under Best Practices

Pressure ulcers may occur under circumstances ranging from excellent care to severe neglect. At present the medical and criminal justice fields are guided by a combination of common sense, anecdotal evidence, and clinical experience to determine when a pressure ulcer is a forensic marker of neglect. Scientific evidence is needed to better understand when they are truly markers of neglect. In order to understand this, this project proposes that the field must first understand the characteristics of an ulcer that occurs under circumstances of good care. The hypothesis being explored by this study states that long-term care residents may develop advanced stage pressure ulcers despite good care; that these pressure ulcers will be noticed prior to becoming a stage 3 or 4; and these ulcers share some common characteristics that have forensic value. The setting for the proposed research will include long-term care facilities throughout the United States that are implementing best practices for elder care. The study sample will include residents of long-term care facilities who are age 65 or over, exhibit one or more pressure ulcers stage 3 or greater that developed at the facility, and are the recipients of high quality individual care. A panel of elder abuse experts will review the medical information and rate the quality of care the resident has received on a 1 to 5 point Likert scale with 5 being the best care possible. Only those residents who are judged to have received a 4 or 5 will be included in the study. Descriptive analysis will be performed to examine pressure ulcer characteristics that occur in a setting of good care including documenting and analyzing the number, severity, and location of the ulcers. The research team will also specifically determine if an advanced stage ulcer can develop without a prior documentation of a lower grade ulcer.
ca/ncf