Characteristics of pressure injuries among geriatric patients at an Indonesian tertiary hospital: a cross-sectional study
BACKGROUND Pressure injury develops due to sustained pressure at the bony prominence of the skin and tissues. Geriatric patients often have multiple comorbidities, predisposing them to pressure injury. Data on the characteristics of the geriatric with pressure injuries are still limited. This study aimed to report the characteristics of geriatric patients with pressure injuries admitted at a tertiary hospital in Indonesia.
METHODS This cross-sectional study used medical records of geriatric patients admitted with all stages of pressure injuries consulted to the Department of Dermatology and Venereology at a tertiary hospital in Indonesia between January 2017 and April 2021. Pressure injuries were classified based on the 2019 National Pressure Injury Advisory Panel guideline.
RESULTS 39 patients presented with varied pressure injury characteristics. The sacral region was the most reported site (36%), with stage 2 pressure injury being the most commonly found stage in the patients (74%). Interestingly, 22% of the patients had pressure injuries found on the atypical sites due to prolonged surgery or the pressure of medical devices. More than half of the patients used conventional dressings (51.3%). Immobility was found in 35.9% of the patients due to being bedridden.
CONCLUSIONS No characteristics were found as a significant risk factor for pressure injury formation during or outside the admission period. However, a history of surgery might be related to pressure injury formation during admission.
Díaz-Caro I, García Gómez-Heras S. Incidence of hospital-acquired pressure ulcers in patients with "minimal risk" according to the "Norton-MI" scale. PLoS One. 2020;15(1):e0227052. https://doi.org/10.1371/journal.pone.0227052
Kottner J, Balzer K, Dassen T, Heinze S. Pressure ulcers: a critical review of definitions and classifications. Ostomy Wound Manage. 2009;55(9):22-9.
Mervis JS, Phillips TJ. Pressure ulcers: pathophysiology, epidemiology, risk factors, and presentation. J Am Acad Dermatol. 2019;81(4):881-90. https://doi.org/10.1016/j.jaad.2018.12.069
Reddy M. Pressure ulcers. BMJ Clin Evid. 2011;2011:1901.
Amir Y, Halfens RJ, Lohrmann C, Schols JM. Pressure ulcer prevalence and quality of care in stroke patients in an Indonesian hospital. J Wound Care. 2013;22(5):254-60. https://doi.org/10.12968/jowc.2013.22.5.254
Li Z, Lin F, Thalib L, Chaboyer W. Global prevalence and incidence of pressure injuries in hospitalised adult patients: a systematic review and meta-analysis. Int J Nurs Stud. 2020;105:103546. https://doi.org/10.1016/j.ijnurstu.2020.103546
Amir Y, Lohrmann C, Halfens RJ, Schols JM. Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer characteristics, prevention and treatment. Int Wound J. 2017;14(1):184-93. https://doi.org/10.1111/iwj.12580
Greenhalgh DG. Pressure injury in the critically ill elderly patient. Curr Geriatr Rep. 2019;8:167-72. https://doi.org/10.1007/s13670-019-00289-3
Bhattacharya S, Mishra RK. Pressure ulcers: current understanding and newer modalities of treatment. Indian J Plast Surg. 2015;48(1):4-16. https://doi.org/10.4103/0970-0358.155260
Jackson D, Sarki AM, Betteridge R, Brooke J. Medical device-related pressure ulcers: a systematic review and meta-analysis. Int J Nurs Stud. 2019;92:109-20. https://doi.org/10.1016/j.ijnurstu.2019.02.006
Kim JY, Lee YJ; Korean Association of Wound Ostomy Continence Nurses. Medical device-related pressure ulcer (MDRPU) in acute care hospitals and its perceived importance and prevention performance by clinical nurses. Int Wound J. 2019;16 Suppl 1(Suppl 1):51-61. https://doi.org/10.1111/iwj.13023
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: quick reference guide. Emily Haesler, editor. EPUAP/NPIAP/PPPIA; 2019.
Hernández-Martínez-Esparza E, Santesmases-Masana R, Román E, Abades Porcel M, Torner Busquet A, Berenguer Pérez M, et al. Prevalence and characteristics of older people with pressure ulcers and legs ulcers, in nursing homes in Barcelona. J Tissue Viability. 2021;30(1):108-15. https://doi.org/10.1016/j.jtv.2021.01.003
Hossain B, Mamun AA, Razi HA, Raisul NI. Evaluation of pressure ulcer among the critically ill patients admitted in a tertiary hospital. J Bangladesh Coll Phys Surg. 2022;40(1):23-30. https://doi.org/10.3329/jbcps.v40i1.57054
Ke YT, Peng AC, Shu YM, Chung MH, Tsai KT, Chen PJ, et al. Prevalence of geriatric syndromes and the need for hospice care in older patients of the Emergency Department: a study in an Asian Medical Center. Emerg Med Int. 2020;2020:7174695. https://doi.org/10.1155/2020/7174695
Kim MJ, Jeong YS, Kim HJ, Hahn HM, Thai DQ, Lee IJ. Effect of a team approach to pressure injury management over 5 years in a tertiary hospital. Adv Skin Wound Care. 2023;36(1):1-7. https://doi.org/10.1097/01.ASW.0000902488.10296.9b
Hartung B. Pressure injury prevention in a geriatric post- acute care setting: a quality improvement study. Practice Improvement Projects. 2019;40(4):12-6.
Santaeugènia SJ, Mas MÀ, Tarazona-Santabalbina FJ, Alventosa AM, García M, Monterde A, et al. Does the presence of pressure ulcers entail "high risk of negative outcomes" in geriatric rehabilitation? Results from a retrospective cohort study. Nutr Hosp. 2017;34(5):1305-10. https://doi.org/10.20960/nh.1065
Yusharyahya SN, Lestarini D, Mutmainnah E, Legiawati L, Astriningrum R, Kusumahapsari RW. Dermatological emergency cases in geriatric patients: a 3-year multicenter study of three national referral hospitals in Indonesia. Open Access Maced J Med Sci. 2022;10(B):1774-8. https://doi.org/10.3889/oamjms.2022.9324
Chen J, Wang X, Qian H, Ye J, Qian J, Hua J. Correlation between common postoperative complications of prolonged bed rest and quality of life in hospitalized elderly hip fracture patients. Ann Palliat Med. 2020;9(3):1125-33. https://doi.org/10.21037/apm-20-891
Ahmedov A, Ahmedov Y. Follow-up of geriatric patients with pressure ulcers by plastic, reconstructive and aesthetic surgery in intensive care conditions. Clin Exp Health Sci. 2022;12(1):107-12. https://doi.org/10.33808/clinexphealthsci.831458
Galivanche AR, Kebaish KJ, Adrados M, Ottesen TD, Varthi AG, Rubin LE, et al. Postoperative pressure ulcers after geriatric hip fracture surgery are predicted by defined preoperative comorbidities and postoperative complications. J Am Acad Orthop Surg. 2020;28(8):342-51. https://doi.org/10.5435/JAAOS-D-19-00104
Hyun S, Moffatt-Bruce S, Newton C, Hixon B. Hospital-acquired pressure injury: clinical characteristics and outcomes in critical care. Int J Adv Cult Technol. 2019;7(2):28-33. https://doi.org/10.2196/13785
Simões JL, Sa-Couto P, Voegeli D. Factors predicting pressure injury incidence in older adults following elective total hip arthroplasty: a longitudinal study. Adv Skin Wound Care. 2022;35(1):48-55. https://doi.org/10.1097/01.ASW.0000801540.04621.57
Aygör HE, Sahin S, Sözen E, Baydal B, Aykar FS, Akçiçek F. Features of pressure ulcers in hospitalized older adults. Adv Skin Wound Care. 2014;27(3):122-6. https://doi.org/10.1097/01.ASW.0000442874.86708.5e
Hu Y, Wang L, Cao ZD, Wang Y. The incidence of pressure ulcer in the elderly in China between 2009 and 2019: a meta-analysis. Med Data Min. 2020;3(3):110-8. https://doi.org/10.53388/MDM2020093002
Primiano M, Friend M, McClure C, Nardi S, Fix L, Schafer M, et al. Pressure ulcer prevalence and risk factors during prolonged surgical procedures. AORN J. 2011;94(6):555-66. https://doi.org/10.1016/j.aorn.2011.03.014
Abed Elahad J, McCarthy MW, Goverman J, Kaafarani HM. An overview of sacral decubitus ulcer. Curr Trauma Rep. 2018;4:263-72. https://doi.org/10.1007/s40719-018-0152-0
Wong D, Holtom P, Spellberg B. Osteomyelitis complicating sacral pressure ulcers: whether or not to treat with antibiotic therapy. Clin Infect Dis. 2019;68(2):338-42. https://doi.org/10.1093/cid/ciy559
Polancich S, Hall AG, Miltner R, Poe T, Enogela EM, Montgomery AP, et al. Learning during crisis: the impact of COVID-19 on hospital-acquired pressure injury incidence. J Healthc Qual. 2021;43(3):137-44. https://doi.org/10.1097/JHQ.0000000000000301
Varga E, Kay SI, Zbeidy RA, Souki FG. Facial pressure ulcers: unsightly complication of prone positioning. Anesthesiology. 2022;136(5):827-8. https://doi.org/10.1097/ALN.0000000000004188
Oomens CW, Broek M, Hemmes B, Bader DL. How does lateral tilting affect the internal strains in the sacral region of bed ridden patients? - A contribution to pressure ulcer prevention. Clin Biomech (Bristol, Avon). 2016;35:7-13. https://doi.org/10.1016/j.clinbiomech.2016.03.009
Karacabay K, Savci A, Dalkılıç M, Kabu Hergül F. Determining the incidence and risk factors of medical device-related pressure injury in intensive care patients. J Tissue Viability. 2023:S0965-206X(23)00097-9. https://doi.org/10.1016/j.jtv.2023.08.002
Su S, Ding X, Zou H, Lin Y, Huang J, Xiong D, et al. Wound management of multi-site pressure ulcer at different stages in elderly patients. Clin Cosmet Investig Dermatol. 2021;14:747-51. https://doi.org/10.2147/CCID.S316694
Kohara HT, Ikeda M, Okawa M. Relationship between pressure ulcers in elderly people and physiological indices of the skin. Acta Med Okayama. 2021;75(5):557-65.
Okamoto S, Ogai K, Mukai K, Sugama J. Association of skin microbiome with the onset and recurrence of pressure injury in bedridden elderly people. Microorganisms. 2021;9(8):1603. https://doi.org/10.3390/microorganisms9081603
Broussard KC, Powers JG. Wound dressings: selecting the most appropriate type. Am J Clin Dermatol. 2013;14(6):449-59. https://doi.org/10.1007/s40257-013-0046-4
Zhao N, Tian Z, Li Y, Yu H, Yang Y. Virtual reality-based analysis of pressure ulcer care information related to medical equipment for the prevention of pressure ulcer skin foam dressings in the elderly. J Healthc Eng. 2021;2021:6389001. https://doi.org/10.1155/2021/6389001
Jeong HS. Non-surgical treatment for pressure ulcer. J Korean Med Assoc. 2021;64(1):26-33. https://doi.org/10.5124/jkma.2021.64.1.26
Shao R, Du T, Zhang Y, Li Y, Zhang Q. The effectiveness of drugs combined with individualized management for elderly patients with stage III pressure ulcers. J Cosmet Dermatol. 2022;21(11):5984-9. https://doi.org/10.1111/jocd.15312
Lovegrove J, Fulbrook P, Miles S, Steele M. Effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings: a systematic review and meta-analysis of randomised controlled trials. Aust Crit Care. 2022;35(2):186-203. https://doi.org/10.1016/j.aucc.2021.04.007
Dhivya S, Padma VV, Santhini E. Wound dressings - a review. Biomedicine (Taipei). 2015;5(4):22. https://doi.org/10.7603/s40681-015-0022-9
Deutsch CJ, Edwards DM, Myers S. Wound dressings. Br J Hosp Med (Lond). 2017;78(7):C103-9. https://doi.org/10.12968/hmed.2017.78.7.C103
Norman G, Dumville JC, Moore ZE, Tanner J, Christie J, Goto S. Antibiotics and antiseptics for pressure ulcers. Cochrane Database Syst Rev. 2016;4(4):CD011586. https://doi.org/10.1002/14651858.CD011586
Jaul E, Factor H, Karni S, Schiffmiller T, Meiron O. Spasticity and dementia increase the risk of pressure ulcers. Int Wound J. 2019;16(3):847-51. https://doi.org/10.1111/iwj.13110
Schultz A, Bien M, Dumond K, Brown K, Myers A. Etiology and incidence of pressure ulcers in surgical patients. AORN J. 1999;70(3):434, 437-40, 443-9. https://doi.org/10.1016/S0001-2092(06)62325-9
Rondinelli J, Zuniga S, Kipnis P, Kawar LN, Liu V, Escobar GJ. Hospital-acquired pressure injury: risk-adjusted comparisons in an integrated healthcare delivery system. Nurs Res. 2018;67(1):16-25. https://doi.org/10.1097/NNR.0000000000000258
He M, Tang A, Ge X, Zheng J. Pressure ulcers in the intensive care unit: an analysis of skin barrier risk factors. Adv Skin Wound Care. 2016;29(11):493-8. https://doi.org/10.1097/01.ASW.0000494779.66288.c9
Padula WV, Delarmente BA. The national cost of hospital-acquired pressure injuries in the United States. Int Wound J. 2019;16(3):634-40. https://doi.org/10.1111/iwj.13071
Robineau S, Nicolas B, Mathieu L, Duruflé A, Leblong E, Fraudet B, et al. Assessing the impact of a patient education programme on pressure ulcer prevention in patients with spinal cord injuries. J Tissue Viability. 2019;28(4):167-72. https://doi.org/10.1016/j.jtv.2019.06.001
Song YP, Shen HW, Cai JY, Zha ML, Chen HL. The relationship between pressure injury complication and mortality risk of older patients in follow-up: a systematic review and meta-analysis. Int Wound J. 2019;16(6):1533-44. https://doi.org/10.1111/iwj.13243
Gaspar S, Peralta M, Marques A, Budri A, Gaspar de Matos M. Effectiveness on hospital-acquired pressure ulcers prevention: a systematic review. Int Wound J. 2019;16(5):1087-102. https://doi.org/10.1111/iwj.13147
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