Management of pressure ulcers in elderly patients

Pressure ulcers: Current understanding and newer modalities of treatment

Sometimes due to the elderly patient suffering from a type of dementia, their ability to communicate or remember life events deteriorates and therefore they cannot provide the professional assessing the ulcer with key medical information.

Incidence, Mortality, and Costs The incidence rates of pressure ulcers vary greatly with the health care settings.

Above are some examples of how the management of Pressure ulcers can become complex; there are more diseases such as terminal diseases and other medical conditions that need to be taken into consideration when planning the care or prevention of a pressure ulcer.

The overall patient assessment will directly impact decisions on the frequency of positioning for the patient and the suitability of the support surface on which the patient is sitting or lying Benbow, This is usually either surgery which directly closes the wound or flap reconstruction.

There are clear guidelines on managing pressure ulcers by NICE; however, further research needs to be done to optimize the management of pressure ulcers in elderly patients Cullum, Darkly pigmented skin may not have visible blanching; its colour may differ from the surrounding area.

It is important to assess an elderly patient's current health status and not just the status of their health as documented previously on records or on admittance to see a professional, as a variety of factors can affect the development of a pressure ulcer - some factors more rapidly than others.

Pressure, in combination with shear when layers of skin are forced to slide which integrates elements of frictional forces deformation of tissuesparticularly near a bony prominence is believed to cause pressure ulceration6.

Management of pressure ulcers

Risk Factors More than risk factors of pressure ulcers have been identified in the literature. There are clear guidelines on managing pressure ulcers by NICE; however, further research needs to be done to optimize the management of pressure ulcers in elderly patients Cullum, Also, some patients may be in trauma or are not conscious; this, again, makes the information gathering stage of the patient's current health status difficult for the assessing professional.

This too can compound the tissue damage. Fast Facts and Practice Questions. In the indirect sense, friction is necessary to generate the shearing forces.

The Management Of Pressure Ulcers In Elderly Patients

Preventing pressure ulcers has been a nursing concern for many years. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated. The scores on this scale range from 6 high risk to 23 low riskwith 18 being the cut score for onset of pressure ulcer risk.

Studies by Bergstrom and Braden 4243 found that in a skilled nursing facility, 80 percent of pressure ulcers develop within 2 weeks of admission and 96 percent develop within 3 weeks of admission.

Specialised mattresses can also reduce pressure in comparison to standard mattresses. Charts were evaluated for the presence of six recommended pressure ulcer prevention processes of care.

Full thickness skin loss Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. However, some specialists advise that air, water or foam filled support devices are better than traditional cushions Benbow, Complaints of pain from the patient should be considered in the skin assessment, followed by a categorization of the ulcer as a stage 1,2,3 or 4 Pressure ulcer NICE, These beds are electric and contain silicone-coated beads.

Debridement methods vary depending on the clinical situation. Mechanical Loading One of the most important preventive measures is decreasing mechanical load. Table 1 presents the NPUAP definition, and Table 2 illustrates the differences between the old and new pressure ulcer staging systems.

Research has shown that hospital nurses could accurately determine pressure ulcer risk Retrieved Jan 4th from http: This may result in patients being in the same position for long periods of time, which may then put pressure on that area of the body, putting them at greater risk of developing a pressure ulcer.

A physiotherapist can often advise on repositioning that will be safe and that will also allow pressure release. Pain management is difficult in Pressure ulcer management if the elderly individual has an altered perception of pain due to a spinal cord injury or other related nerve damage injuries.

The Management Of Pressure Ulcers In Elderly Patients

Musculoskeletal disease such as osteoarthritis is usually diagnosed in elderly individuals and it can limit the mobility of the patient or their ability to do specific activities NHS, In one prospective study, high-risk patients who were undernourished on admission to the hospital were twice as likely to develop pressure ulcers as adequately nourished patients 17 percent and 9 percent, respectively.

Given the similar clinical effectiveness, cost should be considered in determining the support surface. Erythema subsides as soon as tissues are restored to their resting state. This is not only to manage the Pressure ulcer but also to be aware of those individuals who may have difficulty, as mentioned above, in detecting changes in their skin or possibly even possess a disability.

Retrieved 2nd Jan from http: Pressure ulcer prevalence, incidence, risk factors, and impact. This includes frequent turning and repositioning of patients. The overall patient assessment will directly impact decisions on the frequency of positioning for the patient and the suitability of the support surface on which the patient is sitting or lying Benbow, What causes bed sores?.

Management of pressure ulcers

In addition, patients with lower extremity edema or patients who have had a pressure ulcer in the past are high risk. Therefore, regardless of their Braden score, these patients need a higher level of preventive care: support surface use, dietary consults, and more frequent skin assessments.

This article summarizes the current and evolving knowledge related to pressure ulcers and discusses an algorithm recently developed to assist in clinical management decisions related to patients with pressure ulcers, with emphasis on appropriate utilization of Negative Pressure Wound Therapy delivered by V.A.C.(R) Therapy (KCI USA, Inc.) in.

Read more about how critically ill patients have factors that put them at risk for developing pressure ulcers despite implementation of pressure ulcer prevention bundles: Shanks HT, Kleinhelter P, Baker J. Skin failure: a retrospective review of patients with hospital-acquired pressure ulcers.

Pressure ulcers are an injury that damages skin and the layer(s) of tissue beneath, which have been exposed to pressure (NHS, ). They can occur in patients of varied ages; however, the most vulnerable age group who are at risk of developing pressure ulcers.

Chapter 12 Pressure Ulcers: A Patient Safety Issue. Courtney H. Lyder new data suggest that 15 percent of elderly patients will develop pressure ulcers within the first week of hospitalization. 12 For those elderly The use of adjunctive therapies is the fastest growing area in pressure ulcer management.

Adjunctive therapies include. The focus of this paper will be elderly patients and the following topics will be discussed; risk assessment, patient assessment, pressure recognition and removal, non-surgical treatments/advice, complications of pressure ulcers and surgery.

Management of pressure ulcers in elderly patients
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Management of pressure ulcers | Nursing in Practice