Original report
The Incidence and Prevalence of Pressure Ulcers among Elderly Patients in General Medical Practice

https://doi.org/10.1016/S1047-2797(01)00255-1Get rights and content

Abstract

PURPOSE: The objective of this study was to estimate the period prevalence and incidence of pressure ulcer among those 65 years of age and older.

METHODS: We used a patient-record database called the General Practice Research Database (GPRD). Subjects were 65 years of age and older and cases were ascertained based on strict inclusion and exclusion criteria. The accuracy of the ascertainment strategy was estimated using mailed physician-answered questionnaires. Annual period prevalence and age-specific incidence were estimated per 100 person-years with exact 95% confidence intervals (CI).

RESULTS: The accuracy of our ascertainment strategy was excellent, with a positive predictive value of 100% (95% CI: 92%,100%) and negative predictive value of 95% (85%, 95%). Over 200,000 person-years of data were analyzed. The annual period prevalence of pressure ulcer among those 65 years of age and older varied from 0.31% to 0.70%. The incidence varied significantly with advancing patient age from 0.18 to 3.36 per 100-person years (p < 0.001) but was not associated with gender (p = 0.95).

CONCLUSIONS: Pressure ulcers are seen in the general practice setting. They are most likely to occur in those over 85 years of age. Preventative strategies within the general practice setting should concentrate on the oldest of the elderly.

Introduction

Pressure ulcers are wounds that occur as localized areas of necrosis of skin and deeper soft tissues. These wounds tend to occur in areas of bony prominence and primarily in individuals who are immobile 1, 2. These chronic wounds are thought to account for over one billion dollars in health care costs per year, and primarily occur near the end of a person's life 3, 4. Pressure ulcers, like other chronic wounds, can result in diminished quality of life, longer hospitalizations, and increased morbidity and mortality 3, 5, 6, 7, 8, 9, 10.

Most previous studies have estimated the incidence and prevalence of pressure ulcers in acute care, home care, or long term care settings. Among the elderly, about 10% of patients in an acute care setting can be expected to develop a pressure ulcer during a hospitalization 11, 12, 13, 14, 15. A patient's likelihood of developing a pressure ulcer increases with length of stay, increasing age, immobility, and certain medical or surgical procedures 11, 14, 15, 16, 17. The point prevalence of pressure ulcers in the home care population is 3% to 10% and seen in about 2% to 4% of those over 55 years of age 10, 12, 18, 19, 20, 21, 22. However, estimates of the frequency of pressure ulcers among patients seen in general medical practice (i.e., those not in the hospital, those recently discharged from the hospital, and those unable to care for themselves at home) are not available.

Our objective was to estimate the period prevalence and incidence of pressure ulcers among the elderly patients seen by general practitioners. Estimates were derived from data in the General Practice Research Database (GPRD), a large electronic medical record database that contains information on patients seen by general practitioners (GPs) in the UK National Health Service 23, 24, 25, 26. In addition, we estimated the accuracy of our method of pressure ulcer ascertainment.

Section snippets

Study Design and Population

This was a retrospective cohort study using a large medical record and administrative database from the UK. In the UK, all patients who are cared for under the National Health Service are registered with a GP. The GPRD currently receives data from 1562 GPs representing 542 practices in England and Wales, which represents about 6% of the total population and about one million individuals 65 years of age or older. Access to the GPRD was granted through a vendor called Epidemiology and

Accuracy

For the pressure ulcer group, all 65 of the questionnaires were returned. However, 18 (28%) of the questionnaires were returned without answers because the GP no longer had the patient's records, due to the patient transferring out of the physician's practice (n = 7), or due to death (n = 11). For the no ulcer group, eight (12%) of the questionnaires could not be evaluated because the GP did not respond or GP did not currently have the patient's medical record.

Sensitivity, specificity, and

Discussion

Our study showed that it was possible to accurately determine whether or not an elderly patient in the GPRD has a pressure ulcer. This method for ascertaining patients with a pressure ulcer was then used to estimate the period prevalence and incidence of pressure ulcers in the elderly who are cared for by a GP. It is likely that since elderly patients with pressure ulcers are more likely to have co-morbid illnesses that may contribute to their death within 12 months of developing a pressure

Acknowledgements

Grants R01 AR44695 and K08 AG00715 from the National Institutes of Health supported this work. The authors would like to thank Ms. Sandra Masiak for her secretarial assistance.

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