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Pressure Injury in the Critically Ill Elderly Patient

  • Surgical Care (F Luchette and R Gonzalez, Section Editors)
  • Published:
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Abstract

Purpose of Review

Pressure injuries are a major problem for all people, but they are especially problematic in the elderly patient. The goal of this review is to provide strategies for reducing the incidence of these problem wounds in the geriatric population. The review asks: what are the risk factors for developing pressure injuries? And how are these risks magnified in the elderly population?

Recent Findings

There are several wound healing organizations that have developed definitions and strategies for dealing with pressure injuries. Risks can be divided into “intrinsic” and “extrinsic” factors. “Intrinsic” risk factors include limited mobility, malnutrition, comorbidities, and aging. “Aging” leads to inexorable body and skin changes. There are “intrinsic” skin alterations—wrinkling, thinning, sagging, increased fragility—that occur in everyone as they age. One can accelerate age-related changes in the skin with “extrinsic” factors—exposure to ultraviolet light, smoking, and other stresses. All of these “intrinsic” risks interact with “extrinsic” risk factors that are the forces that cause the actual injury. “Extrinsic” risk factors include pressure from a firm surface, friction, and moisture.

Summary

By addressing the specific risk factors that predispose the elderly to pressure injuries, any clinician can reduce the incidence of these problematic wounds.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Ratliff CR, Droste LR, Bonham P, Crestodina L, Johnson JJ, Kelechi T. Varnado, and the Wound Ostomy and Continence Nurses Society – Wound Guidelines Task Force. WOCN 2016 guideline for prevention and management of pressure injuries (ulcers). J Wound Ostomy Continence Nurs. 2017;44:241–6 This paper is an excellent review of the basic concepts of preventing pressure injuries.

    Article  Google Scholar 

  2. •• Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M. Revised National Ulcer Advisory Panel pressure injury staging system. J Wound Ostomy Continence Nurs. 2016;43:241–6 This task force has created new definitions of the stages of pressure injuries that clarify many of past problems.

    Article  Google Scholar 

  3. Bluestein D, Javaheri A. Pressure ulcers: prevention, evaluation, and management. Am Fam Physician. 2008;78:1186–94.

    PubMed  Google Scholar 

  4. Greenhalgh DG. Wound healing and diabetes mellitus. Clin Plast Surg. 2003;30:37–45.

    Article  PubMed  Google Scholar 

  5. Greenhalgh DG. Management of the skin and soft tissue in the geriatric surgical patient. In Caring for the Geriatric Surgical Patient. Luchette FA, editor, in Surgical Clinics of North America, Martin RF consulting editor; Surg Clin N Am. 2015;95:103–114.

  6. Ahmed T, Haboubi N. Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging. 2010;5:207–16.

    PubMed  PubMed Central  Google Scholar 

  7. • Krutmann J, Bouloc A, Sore G, Bernard BA, Passeron T. The skin aging exposome. J Dermatological Sci. 2017;85:152–61 This is a recent discussion that describes the outside factors, described as the “exposome” that accelerate the changes in the skin as one ages.

    Article  Google Scholar 

  8. Braden BJ, Bergstrom NA. Clinical utility of the Braden Scale for predicting pressure sore risk. Decubitus. 1989;2:44–51.

    CAS  PubMed  Google Scholar 

  9. Haesler E, Kottner J, Cuddigan J. 2014 International Guideline Development Group. The 2014 international pressure ulcer guideline: methods and development. J Adv Nurs. 2017;73:1515–30.

    Article  PubMed  Google Scholar 

  10. •• Whitney J, Phillips L, Aslam R, Barbul A, Gottrup F, Gould L, et al. Guidelines for the treatment of pressure ulcers. Wound Repair Regen. 2006;14:663–79 This is a detailed consensus guideline on the prevention and treatment of pressure ulcers from the Wound Healing Society.

    Article  PubMed  Google Scholar 

  11. • Gould L, Stuntz M, Giovannelli M, Ahmad A, Aslam R, Mullen-Fortino M, et al. Wound Healing Society 2015 update on guidelines for pressure ulcers. Wound Repair Regen. 2016;24:145–62 This is the update on the Wound Healing Societies’ guidelines.

    Article  PubMed  Google Scholar 

  12. • Mervis JS, Phillips TJ. Pressure ulcers: prevention and management. J Am Acad Dermatol. 2019;70:789–99. https://doi.org/10.1016/j.jaad.2018.12.068 This is a publication that is the most up-to-date review.

    Article  Google Scholar 

  13. McInnes E, Jammali-Blasi A, Bell-Syer SE, Leung V. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev. 2018;10:CD009490. https://doi.org/10.1002/14651858.CD009490.pub2.

    Article  PubMed  Google Scholar 

  14. McInnes E, Jammali-Blasi A, Bell-Syer SE, Dumville JC, Middleton V, Cullum N. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev. 2015;3(9):CD001735. https://doi.org/10.1002/14651858.CD001735.pub5.

    Article  Google Scholar 

  15. Torra i Bou JE, Segovia Gomez T, Verdu Soriano J, Nolasco Bonmati A, Rueda Lopez J, Arboix i Perenamo M. The effectiveness of a hyperoxygenated fatty acid compound preventing pressure ulcers. J Wound Care. 2005;14:117–21.

    Article  PubMed  Google Scholar 

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Correspondence to David G. Greenhalgh.

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David G. Greenhalgh declares that he has no conflict of interest.

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Greenhalgh, D.G. Pressure Injury in the Critically Ill Elderly Patient. Curr Geri Rep 8, 167–172 (2019). https://doi.org/10.1007/s13670-019-00289-3

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