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BACKGROUND: Pressure sores are a serious complication of multimorbidity and lack of mobility. Decubitus ulcers have become rarer among bed-ridden patients because of the conscientious use of pressure-reducing measures and increased mobilization. Nonetheless, not all decubitus ulcers can be considered preventable or potentially curable, because poor circulation makes some patients more susceptible to them, and because cognitive impairment can make prophylactic measures difficult to apply. METHODS: A systematic literature search was performed in 2004 and 2005 in the setting of a health technology assessment, and a selective literature search was performed in 2009 for papers on the prevention of decubitus ulcers. RESULTS: Elderly, multimorbid patients with the immobility syndrome are at high risk for the development of decubitus ulcers, as are paraplegic patients. The most beneficial way to prevent decubitus ulcers, and to treat them once they are present, is to avoid excessive pressure by encouraging movement. At the same time, the risk factors that promote the development of decubitus ulcers should be minimized as far as possible. CONCLUSIONS: Malnutrition, poor circulation (hypoperfusion), and underlying diseases that impair mobility should be recognized if present and then treated, and accompanying manifestations, such as pain, should be treated symptomatically. Over the patient's further course, the feasibility, implementation, and efficacy of ulcer-preventing measures should be repeatedly re-assessed and documented, so that any necessary changes can be made. Risk factors for the development of decubitus ulcers should be assessed at the time of the physician's first contact with an immobile patient, or as soon as the patient's condition deteriorates; this is a prerequisite for timely prevention. Once the risks have been assessed, therapeutic measures should be undertaken on the basis of the patient's individual risk profile, with an emphasis on active encouragement of movement and passive relief of pressure through frequent changes of position. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this work was to characterise and distinguish persons without (fit), with earliest signs (pre-frail) or accelerated functional decline (frail) during self-referral (geriatric centre) or preventive home visits., Methods: After screening independently living older people in an urban longitudinal cohort (n = 1,995) using a self-administered questionnaire, they were functionally classified as fit, pre-frail or frail. In 10% randomly selected samples of these cohort parts a comprehensive extended gerontological-geriatric assessment (EGGA) was administered., Results: Fit, pre-frail and frail samples are significantly different regarding comorbidity, medication, mobility, fall risk, instrumental activities of daily living and use of social support but not nutrition. The best indicator to discriminate fit versus frail was exhaustion (mobility tiredness)., Conclusion: Competence is essential regarding health in old age. Identification of resources and risks by comprehensive assessment is useful before planning interventions to prevent frailty or its progression.

Background: The interactions between rising life expectancy, morbidity and development of disability warrant interdisciplinary research on functional disability, health promotion and prevention as well as healthcare provision for older people. Therefore, the interdisciplinary LUCAS (Longitudinal Urban Cohort Ageing Study) research consortium of university and non-university institutions was established and is coordinated by the research department of the Albertinen-Haus at the University of Hamburg. The aim is to study particular aspects of functional competence, the changes with ageing, to detect pre-clinical signs of functional decline and to address questions on how to maintain functional competence and to prevent adverse outcomes. The research questions have their origin in problems of practical healthcare provision in the different settings of communities, hospitals and nursing homes. The articles of LUCAS subprojects report selected results from the first project phase (2007-2010) which was funded by the German Federal Ministry of Education and Research (BMBF) (Research program"Health in the elderly").)., Methods: The LUCAS subprojects 1-7 applied a true cohort study design with embedded randomized controlled intervention studies and cross-sectional studies for comparative purposes and to prepare intervention studies to be performed in the second project phase., Conclusions: Results from the first project phase provided new instruments to screen and to assess functional competence in older people (population-based screening). In the second project phase these will be evaluated according to practicability and usefulness. Furthermore, parts of the results will be used by the health reporting system in Hamburg and for intervention studies performed by LUCAS subprojects during the second project phase (LUCAS II).

In Germany a minimal quota of 50% professionally qualified nursing personnel is statutory for the care of nursing home inhabitants. The influence of this quota on the quality outcome of nursing care is controversially discussed. The study investigated the question, whether there is an association between the proportion of qualified personnel and the incidence of pressure ulcers in nursing homes. A historical cohort study was performed. Incidence data were taken from a routine survey on pressure ulcers. Nursing homes participating in this survey were asked for information about their proportion of qualified personnel and some additional factors that could possibly influence the incidence of bedsores. Included nursing home inhabitants (n = 2813) were divided into three groups according to whether they have been cared for with a low (< 50%), medium (50-60%) or high (> or = 60%) proportion of qualified personnel. Multivariate logistic regression models were calculated. Comparing medium to low proportion of qualified personnel, an odds ratio of 1.5 (p = 0.455), comparing high to low proportion, an odds ratio of 0.8 (p = 0.703) and comparing high to medium proportion, an odds ratio of 0.54 (p = 0,09) was calculated. The study question can not be answered by the contradictory results.