The reported period prevalence rate of STs in elderly persons residing in LTC in a region of southwestern Pennsylvania was 9%. This rate is lower than reported in 1 LTC in Canada (22%),6 a Western Australian hospital in 2008 (11%),17 an Australian VA home care (19.5%),18 and an Australian hospital in 2004 (11%)19; it is higher than in an acute medical ward in Singapore (6.2%),15 hospitalized cancer patients in Brazil (3.3%),16 and Western Australian hospital patients in 2007 (8%).17 The current study findings are clinically significant and suggest STs in elderly persons in LTC are a problem that requires more attention. The 6-facility individual reported point prevalence ranged from 3% to 16%. The reason for this difference is unclear and could be related to reporting or care practices. A larger, multisite prospective study of prevalence across different settings is needed to determine the true extent of STs.
This study suggests STs occur more frequently in women than men, a finding supported by Amaral et al,16 Chang et al,15 LeBlanc et al,6 and Malone et al,7 although a study by Carville and Smith18 reported more STs in men than women. The average age of LTC residents with STs in this study was high (83.5), similar to results from Carville and Smith,18 Chang et al,15 LeBlanc et al, 6 Malone et al,7 and McGough-Csarny and Kopac.21 In a 1998 prospective descriptive study (N = 154) of STs in institutionalized elderly, McGough-Csarny and Kopac21 reported 72 (81.8%) had functional impairment, which was also supported in findings reported by Chang et al,15 LeBlanc et al,6 and Malone et al,7 concurring with the current study findings. The current study reported more STs on the upper body, which also was demonstrated in studies by LeBlanc et al,6 Malone et al,7 McErlean et al,19 and McGough-Csarny and Kopac.21 In terms of recurrence, 12 patients in the current study had recurring STs; more research is needed in this area. McGough-Csarny and Kopac21 showed 79.2% of patients (N =154) had a previous ST. In their cross-sectional, quantitative study among LTC patients in Canada, Leblanc et al6 found ST prevalence was noted to be statistically significant (X2 = 3.98; P = .46) with correction of continuity, the Pearson chi-square, suggesting the possibility of a relationship between presence of and a clinical history of a ST.
LeBlanc et al6 reported banging into equipment as the most frequent cause of ST (36%), whereas Malone et al7 reported that bumping into object (12%) and wheelchair use (12%) contributed equally to STs. McGough-Csarny and Kopac21 cited wheelchairs (29.9%) as contributing most frequently to ST development, contradicting the current study findings that the most frequent cause of ST was falls. In their hospital audit to determine ST prevalence, McErlean et al19 found 25% of STs were caused by falls.
STs were more frequently recorded on the 7–3 and 3–11 shifts when peak activities of daily living are occurring. The role of preventive measures during these active shifts require further investigation.
Need for classification system use. One of the many difficulties encountered by wound care consultants is the absence of a universally accepted and used ST classification system, which has been hypothesized to result in better identification, tracking, and treatment.22 A ST classification system was not used in any of the LTC facilities in this study. Researchers are calling for a common validated ST classification system to be adopted — according to LeBlanc et al,22 acceptance and use of a common classification system are paramount to future research. According to expert opinion, STs can be incorrectly diagnosed as pressure ulcers; LeBlanc et al22 propose use of a ST classification system may reduce this error. Unidentified STs can lead to wounds that do not follow a normal healing trajectory, delay provision of preventive measures, and increase health care costs.
Although ST research groups are investigating the possibility, a ST risk assessment tool has not yet been developed. A 3-stage prospective study was conducted by Newall et al23 to develop a ST risk assessment tool, ensure tool reliability, and validate the instrument in a metropolitan tertiary hospital in Western Australia. This study determined that the study tool had inadequate predictive validity and required further investigation. More research is needed to identify at-risk patients and associated factors and to evaluate the economic impact of ST on health care facilities, best practices in identification, risk factors, prevention, and treatment of ST, as well as education of all health care providers who care for individuals who develop ST. So far, little research has been conducted in this area. No studies were found about the impact of an ST on patient quality of life, thus representing another area of research that needs to be explored. Developing evidence-based practices through research is essential to the understanding, prevention, and treatment of ST.