Dr. Nancy Bergstrom, Director of the Center
on Aging and the Theodore J. & Mary E. Trumble
Professor of Aging Research, received a $2.5 million research grant funded by the National Institute of Nursing Research to conduct a research study on preventing pressure ulcers for residents at nursing facilities. Pressure ulcers are generally viewed as a preventable nursing error. The Centers for Medicare and Medicaid Services (CMS) and the US Department of Health and Human Services (DHHS) put pressure ulcer prevention as a national priority. Current rates for all health care settings are nearly three times higher than the target rate set by the DHHS. According to data posted on the Nursing Home Compare national database (www.medicare.gov/NHCompare), 13% of residents who are immobile, malnourished or in a coma and 2% of residents without these conditions have pressure ulcers (or bedsores). If treatment of this sore requires hospitalization, the cost can exceed $10,000 dollars per patient.

Pressure ulcers are most likely develop over bony prominences such as the hips, heels and tailbone, or places were the skin is most prone to pressure. In general, the harder the surface exerting the pressure,the quicker the sore may develop. Wetness from urine or friction of the skin against the bed linens as well as being in poor health also increases the risk. Dr. Bergstrom previously developed, with Dr. Barbara Braden, an instrument that permits identifying patients at risk of developing ulcers. Using this instrument, Braden Scale for Pressure Sore Risk®, preventative measures can be taken that will reduce the risk. Traditionally, based on studies done nearly 40 years ago, nurses

-Mary Pat Rapp, Ph.D., RN
and Nancy Bergstrom, Ph.D., RN,
UT SON Center on Aging-

reposition, or turn, patients at least every two hours. More recently, nurses are placing at risk residents on high density foam mattresses that reduces the pressure against the tissues. These residents are also turned every two hours. Both approaches add to the cost of care. Repositioning patients every two hours takes people, who are often needed elsewhere, and time. It also disrupts the residents rest and presents a safety concern for both the fragile elderly and the health care worker. Dr. Bergstrom’s research will look at improving the quality of life and safety of the patient. Her team, using a randomized controlled trial to determine if there is a significant difference, will
examine the following”
.......1. the rate of pressure ulcers among nursing facility residents who are at moderate risk and repositioned every 2, 3, or 4 hours
.......2. the rate of pressure ulcers among nursing facility residents who are at high risk and repositioned every 2 or 3 hours.
.......3. other resident characteristics such as movement during the day and night,ness
and the care given by the nursing staff.

Nursing facility residents participating in the study will be placed on pressure reducing mattresses and randomly assigned to the 2, 3, or 4-hour repositioning schedule for three weeks. During that time, their nursing assistants will look carefully at the skin for any evidence of a pressure ulcer each time they reposition the resident or provide personal care. Additionally, a registered nurse (RN) will examine the residents weekly to determine if a pressure ulcer has occurred. The prediction is that by first identifying at risk residents using the Braden Scale, and then employing preventive measures, will reduce the rate of pressure ulcers and permit better resource allocation. The goal of this innovative study is to shape nursing facility policy concerning pressure ulcer prevention.

Dr. Bergstrom will collaborate with a leading expert in the study of illness severity; Dr. Susan Horn of the International Severity Information Systems and Institute for Clinical Outcomes Research. Dr. Mary Pat Rapp will direct the project, and consultants include Rita Frantz PhD, RN, Professor and Area Chair for Systems and Practice at the University of Iowa College of Nursing, Francine Nelson PhD, RN adjunct faculty at UTHSC-Houston School of Nursing, Thomas Krouskop PhD a retired biomedical engineer formerly of the Department of Physical Medicine and Rehabilitation at Baylor College of Medicine, and Joseph Ouslander MD, Professor of Medicine and Nursing and Director of the Division of Geriatric Medicine and Gerontology and Director for Health in Aging at Emory University. A 5-member Data Safety and Monitoring Board will follow the progress of the study to ensure resident safety. St. James House located in Baytown, Texas will be the first site to implement the study.

Research study funded by:
National Institutes of Health-National Institute for
Nursing Research / National Institute on Aging: “Preventing
Pressure Ulcers: A Multi-Site Randomized
Controlled Trial in Nursing Facilities.”

Dental Video Educates on Oral Care for Elders
 

Administration on Aging Joins Launch of Aging with Dignity 500,000 Wishes National Call to Action Campaign
 

Five Wishes is a planning tool that helps individuals express how they want to be treated if they become seriously ill and unable to speak for themselves. To help further the use of advance directives such as Aging with Dignity’s Five Wishes by individuals of
diverse cultures, ethnicities and incomes, U.S. Assistant Secretary for Aging, Josefina G. Carbonell, joined the launch of the 500,000 Wishes Campaign on June 7.

Information on ordering Five Wishes planning tool can be found at the Adminstration on Aging web site ww.aoa.gov. You can also call the Center on Aging at 713-500-9921 for assistance with obtaining order forms.

Director's Corner
 

Dear Friends of the Center on Aging,

Another new year has begun and the Center on Aging is off to an excellent beginning. Three fairly new sources of funding are enabling the Center on Aging to meet our goals of research, education and community service. The study, “Preventing Pressure Ulcers: A Multi-Site Randomized Control Trial in Nursing Facilities,” is launching data collection in Baytown. This study is described in the lead article. We will provide ongoing updates.

The Houston Geriatric Education Center, co-directed by Dr. Carmel Dyer (School of Medicine) and Dr. Sharon Ostwald, is in the process of developing training programs that will provide practicing professionals, service agencies and students with opportunities to increase their ability to care for vulnerable elderly by recognizing and preventing elder abuse and neglect.

The Isla Carroll Turner Foundation, a wonderful friend of the Center on Aging, awarded $110,000 to continue the community and outreach activities that provide support for frail elders and their caregivers. One of the projects recently completed, the Oral Hygiene and Caregiver Training DVD, provides an opportunity for community and family caregivers to learn how to assist family members. Information on the DVD is also included in this issue.

The annual Valley Conference is in the planning stages. It is not too soon to start thinking about nominating individuals for the Valley Professional of the Year and the Community Advocate of the Year. Please visit our website to see the criteria for this award.

We are grateful to have the resources to address our mission and goals. We will report our progress to you during this year.

Happy New Year and Graceful Aging to ALL,

Nancy Bergstrom, PhD
Director, Center on Aging

6901 Bertner, 6th Floor
Houston, TX 77030
www.uthcoa.org
Phone 713.500.9921