When one's 85-year-old aunt's dementia worsens to the point that nursing home admission is necessary, it's hoped that the color of her skin won't determine whether a pressure ulcer develops. Unfortunately, findings of a new study indicate that black nursing home residents are significantly more likely to develop pressure ulcers than white residents are.

Baumgarten and colleagues used data from 59 randomly chosen Maryland nursing homes with residents already enrolled in an earlier study (in which it was found that nonwhite residents were more likely to have dementia) to examine the effect of race on the risk of developing pressure ulcers. The authors had access to more than 3,200 residents at least 65 years old who were admitted to the nursing homes between 1992 and 1995, and to their family members, the nursing home staff, and the residents' medical records. A total of 1,938 patients (301 black and 1,637 white) participated.

A comparison of patients along racial lines revealed a 66% greater likelihood that black residents would develop a stage 2 (or worse) pressure ulcer. When a secondary analysis considered eight patient characteristics (age; sex; the need for assistance with activities of daily living [ADLs]; and whether the patient was bedfast, had had a pressure ulcer on admission, was incontinent, had dementia, or received Medicaid), black residents were still 35% more likely than whites to develop a pressure ulcer. When authors also controlled for facility characteristics (the number of beds, nonprofit status, and urban versus nonurban location) the percentage was reduced to 31%, but the difference was still statistically significant.

The authors point out that they adjusted for known risk factors for pressure ulcers (a greater need for help in performing ADLs, a pressure ulcer on admission, fecal incontinence or both fecal and urinary incontinence, dementia, and Medicaid coverage, among others); they concluded that the greater number of these among the black residents probably accounted for the higher incidence of pressure ulcers among blacks. They also write that caregivers may have a harder time detecting early-stage pressure ulcers on dark skin and that because the study included only data on pressure ulcers at stage 2 or worse, underdetection of stage 1 ulcers could have resulted in a greater number of ulcers progressing to stage 2 in those residents.-Doug Brandt

Baumgarten M, et al. J Am Geriatr Soc 2004;52(8):1293-8.