NURSING INTERVENTION FOR ELDERLY HIGH-RISK PATIENTS WITH DIABETIC FOOT ULCERATION

Abstract

Foot ulcerations is one of the most severe complications of older patients with diabetes. The incidence rate is as high as 62% and up to 10 % of those patients have an amputation within three years. Patient education comprising instruction on foot care and self-monitoring has been suggested as pivotal part of treatment. An RCT evaluating the effectiveness of a nurse-led intervention for patients with existing diabetic foot ulceration and/or amputation was conducted. In addition to dressing and wound inspection (usual care), the patients in the intervention group received eight individualized, face-to-face counselling sessions at patients’ homes over five weeks and two telephone follow-ups. From 254 identified high risk patients, 118 could be enrolled (age M=64.2/±11.5 years). During the 12 months follow-up, overall hospital or ER admission was significantly lower in the IG compared to the CG (40.0% vs. 62.5%, RR=0.67, p=.029). Hospital/ER admission specific due to foot ulceration was lower (18% vs 31.3%, ns), but not statistically significant, as were new wounds (42.6% vs. 56.1%, n.s.). Survival time in overall hospital admission was significantly longer in the IG compared to the CG (M=280 days/CI: 240, 321 vs. M=206 days/CI: 164, 249, p=.021). Although the study did not show significant effects on wounds or hospital admission specific due to foot ulceration, the nurse-led intervention showed preventive effects in this high risk population of older patients with diabetes. Therefore, further full-powered research investigating patient-directed, and more individually tailored interventions should be conducted in this high risk patients.