LETTER
Pressure Ulcers
Francesco Landi, MD;
Antonio Sgadari, MD; and
Roberto Bernabei, MD
1 September 1996 | Volume 125 Issue 5 | Page 422
TO THE EDITOR:
We read with interest Dr. Smith's article on the diagnosis and treatment of pressure ulcers in the nursing home [1]. We agree that pressure ulcers are a multidisciplinary care problem and that the nursing staff plays a major role in coordinating systematic preventive interventions. However, both students and professionals working in health care hold negative attitudes toward aging and show much lower motivation for treating elderly patients than for treating younger patients. These attitudes may in turn influence the quality of the care provided to elderly patients. It may be argued that poor motivation and negative attitudes toward aging arise from cultural background and academic education, which is focused principally on theory and acute care. Therefore, nursing homes are rapidly becoming an important health care setting and an essential resource for geriatric medical and nursing education.
It is important to provide nursing home staff with in-depth knowledge of the geriatric assessment process by teaching them about a comprehensive instrument [2]. We believe that the Minimum Data Set for Nursing Home Resident Assessment and Care Screening [3] is one of the best available multidimensional tools. In fact, its effect on nursing home care is already impressive, as shown by the decreased incidence of such common problems as pressure ulcers in nursing home residents [4]. We argue that such comprehensive instruments as Minimum Data Set assessment may improve strategies for preventing pressure ulcers better than other specific and standardized risk assessment instruments. We have also shown that the Minimum Data Set provides nursing home staff with good assessment skills and expertise in the decisional process, which are prerequisites for effective prevention of pressure ulcers and for quality improvement in the care of the elderly [5]. Eventually, data collected with the Minimum Data Set can be used in epidemiologic research to explore determinants of pressure ulcers and confounding factors, thus increasing our knowledge of this common and disabling condition.
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Author and Article Information
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Catholic University of Sacred Heart, Rome, Italy
1. Smith DM. Pressure ulcers in the nursing home. Ann Intern Med. 1995; 123:433-42.
2. Rubenstein LZ, Wieland D, Bernabei R, eds. Geriatric Assessment Technology: State of the Art. Milan: Kurtis; 1995.
3. Morris JN, Hawes C, Murphy K, Nonemaker S, Phillips C, Fries BE, et al. Resident Assessment Instrument Training Manual and Resource Guide. Natick, MA: Eliot Pr; 1991.
4. Mor V. Effects of the nursing home resident assessment on process and outcome quality. Third European Congress of Gerontology, Amsterdam; 1995.
5. Cipriani L, Landi F, Sgadari A, Zuccala G, Bernabei R. A gerontological continuing education programme: R.A.I. as a teaching tool for nursing home professionals. Educational Gerontology. 1995; 21:683-99.
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