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Predictors for Development of Pressure Ulcer in End-of-Life Care: A National Quality Register Study.

BACKGROUND
The scientific knowledge about pressure ulcers (PUs) is growing, but there is a shortage of studies of PUs at end of life. The recommendations regarding PU prevention in palliative care (PC) are based on consensus documents.


AIM
To use data from a national register to identify predictors for development of PUs at the end of life.


DESIGN
A retrospective, descriptive, and comparative study design was used.


SETTING/PARTICIPANTS
All deceased patients over 17 years old (n = 60,319) and registered in the Swedish Register of Palliative Care (SRPC) during 2014 were included.


STATISTICAL ANALYSIS
Logistic regression.


RESULTS
In the full model, all health units except general palliative home care had a significantly higher incidence of PUs than did the nursing homes. The well-known predictors of PUs in general, diabetes, postfracture state, infections, and multiple sicknesses, are predictors even in dying patients. Dementia was significantly associated with lower likelihood of PUs, while pain was associated with more PUs. Intravenous drip or enteral feeding was associated with a significantly decreased likelihood of developing PUs.


CONCLUSIONS
The SRPC could be a unique resource for quality improvement and research. The present study cannot prove causation, but it can report correlations between background variables and PU prevalence. More studies, with different designs, are warranted to establish the roles of risk factors for PU in end-of-life care.