Frailty is highly prevalent among institutionalized older adults and may exacerbate vulnerability to pressure injuries. Despite its clinical relevance, the prognostic value of frailty for pressure injuries risk in nursing home residents remains insufficiently characterized. To determine the relationship between the FI, measured by the Frailty Index (FI), and the risk of pressure injuries in a population of very complex older adults living in Caribbean nursing homes. Data are from the KASEHPAD (Karukera Study on Aging in Nursing Homes) study, a prospective, longitudinal study conducted in six nursing homes in Martinique and Guadeloupe. The FI was calculated at baseline using a 31-item deficit accumulation model (score range: 0-1). The association between FI and pressure injuries risk was examined using logistic regression models, with and without adjustment for age and sex. The study sample consisted of 332 individuals with a mean age of 81.3 years (standard deviation, SD, 10.1), of whom 50.6% were male. The mean FI score was 0.28 ± 0.14. Among the participants, 111 (33.4%) were identified as having a moderate to high risk of pressure ulcers. FI was strongly correlated with pressure ulcer risk (r = - 0·64; p < 0·001). Participants with an FI > 0·40 had markedly increased odds of pressure injuries risk (age- and sex-adjusted OR 24·1, 95% CI 11·7-52·7, p < 0.001). Frailty was independently and strongly associated with pressure injuries risk among nursing home residents. Routine assessment of frailty should be integrated into geriatric care to facilitate early identification of individuals at heightened risk and to inform preventive interventions. Such an approach could substantially reduce the clinical and economic burden of pressure injuries in this vulnerable population.

Optimizing wheelchair cushion design through pressure mapping analysis for pressure ulcer risk reduction

A fully integrative multimodal biosensing system for real-time assessment of hypoxic metabolism and pressure ulcers risk

Structural, process, and clinical factors associated with hospital-acquired conditions in older adults: A retrospective study.

Many people with long-term neurological conditions (e.g. multiple sclerosis, spina bifida) live independently and manage complex health needs, including mobility and sensory limitations which mean they have a high risk of pressure ulcer development. Despite their high risk, appropriate pressure ulcer prevention support and resources are often lacking. To develop a Theory of Change pathway, which will underpin future development of a multicomponent intervention package supporting pressure ulcer risk identification and management, in partnership with people with long-term neurological conditions who self-manage care and live at home, their informal carers and personal assistants. We used a partnership approach based in the participatory research paradigm, with extensive input from those whose lives are the focus of the research. The study comprised four interlinked work packages: Work package 1 - Development of two co-operative inquiry groups Work package 2 - Semistructured interviews and/or participation via a smartphone app Work package 3 - Professional and strategic stakeholder engagement Work package 4 - Systems mapping and Theory of Change pathway development Iterative, qualitative data analysis was undertaken with emerging findings from each work package informing subsequent elements of the study. Overall, 74 participants contributed across the 4 work packages. This incorporated 31 service users, 8 carers, 9 personal assistants and 26 professional stakeholders. The findings indicate the complexities of pressure ulcer prevention for this population, who are often fulfilling multiple roles in society (i.e. in their families, communities, work) alongside onerous self-care routines. Systemic and professional barriers were found to hamper people's ability to self-care, support others and seek help. Areas of learning were highlighted around developing safe routines, third sector and peer support, learning about pressure ulcer prevention, navigating complex systems, adapting and reacting to change, perceptions of risk, risk negotiation and the role of non-clinical carers. By collaboratively reflecting on these findings with key stakeholders (service users, carers, personal assistants, professional/strategic partners), we were able to identify points in the system amenable to change. This underpinned the development of a Theory of Change for a multicomponent intervention incorporating awareness raising, routine guidance, escalation guidance and communication components (supported by preconditions, contextual requirements, long-term outcomes, impacts and explanatory rationale). We acknowledge that despite our best efforts (incorporating targeted National Health Service and third-sector recruitment), the ethnic diversity of our research was not as representative as we had intended. We have included work to address this lack of diversity in our next study, including dedicated community workshops to explore the cultural relevance and appropriateness of our proposed intervention. The study highlights the significant impact and complexities of managing pressure ulcer prevention activities at home, for people with long-term neurological conditions, carers and personal assistants. By understanding these complexities from different perspectives, we were able to develop a systems map and Theory of Change pathway informing future intervention development and evaluation. Funding has been awarded for Pressure Ulcer Prevention at Home 2 (PUP@home2): Self-management intervention development and user testing for people with long-term neurological conditions (NIHR163165) to support pressure ulcer prevention and self-care, based on our learning from this study. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR134029.

Mobility is a key indicator of overall health and significantly influences outcomes among hospitalized patients. While the link between immobility and pressure ulcer development is well established, less is known about patients who are able to ambulate. Although mobility may reduce the risk of pressure ulcers, it may increase the likelihood of falls and related injuries. This study aimed to compare the incidence of falls with injury and hospital-acquired pressure ulcers in ambulatory patients. This retrospective cohort study included adults aged 18 to 89 years admitted to a rural tertiary care center in Southern West Virginia from January 1, 2021, to December 31, 2023. Patients with a history of lower extremity amputation, cerebral vascular accident and/or transient ischemic attack or an admitting diagnosis that included pressure ulcers were excluded. Out of 9693 patients who met the inclusion criteria, 100 (1.03%) experienced falls without injuries, 23 (0.24%) had falls with injuries, and 19 (0.20%) developed hospital-acquired pressure ulcers. Overall, 62.79% of all recorded falls were unassisted, 6.98% were assisted by nursing staff or physical therapists, and 30.23% were undocumented. Among those with pressure ulcers, 8 (42.11%) were ambulated by either nursing staff or physical therapists. This study is consistent with the possibility that increased mobility may not be associated with a higher risk of falls when appropriate supervision and safety protocols are in place. These findings are hypothesis-generating and suggest further investigation is needed to better understand how to balance fall prevention with mobility practices in hospital settings.

Aim: To estimate national incidence, temporal trends, and regional variability of hospital-acquired pressure ulcers in Italy from 2018 to 2024 using age-adjusted models and regional estimates. Design: Retrospective nationwide observational study using hospital administrative data. Methods: All Italian Hospital Discharge Records (SDOs) for adults aged ≥ 18 years with hospital stays ≥ 5 days between 2018 and 2024 were analysed. Records with pre-existing or principal diagnoses of pressure ulcer and excluded MDC/DRG categories were omitted according to adapted AHRQ PSI 03 specifications. The final dataset represented eligible hospitalizations considered at risk for hospital-acquired pressure ulcers. Crude and age-adjusted rates per 10,000 eligible discharges were estimated using logistic regression models. Results: Eligible discharges declined from approximately 1.7 million in 2018 to 1.4 million in 2020, increasing to 1.5 million in 2024. Within this population, coded hospital-acquired pressure ulcer events decreased from 3657 to 1888, then increased to 2728. Age-adjusted national rates ranged from 13.5 to 21.3 per 10,000 eligible discharges, showing temporal fluctuations during the study period, including a reduction during 2020–2021 followed by a gradual return toward pre-pandemic levels. Substantial regional variability was observed, with lower median annual adjusted rates in regions such as Friuli Venezia Giulia and Toscana and higher values in Lazio and Abruzzo. Conclusions: This nationwide analysis provides an initial descriptive overview of temporal and regional variability in coded hospital-acquired pressure ulcer events identified through an adapted PSI 03-based administrative indicator in Italy. The findings may contribute to future methodological discussion and exploratory development of nursing-sensitive indicators using national administrative healthcare databases. Implications for the profession and/or patient care: The integration of nursing-sensitive administrative indicators into national quality monitoring systems may represent an initial methodological area for future benchmarking activities, indicator validation processes, and descriptive evaluation of preventive care practices using national healthcare administrative databases. Impact (addressing): Problem: limited national evidence on hospital-acquired pressure ulcers and interregional variability in Italy. Main findings: temporal fluctuations in age-adjusted rates and persistent regional heterogeneity in coded pressure ulcer events. Impact: administrative data may represent a preliminary and exploratory source for the study of nursing-sensitive outcomes and patient safety indicators at national level.

In this study, we aimed to investigate the association between the presence of pressure ulcers and body composition parameters in older residents of long-term care facilities and identified the most relevant indicators. This cross-sectional observational study assessed 156 residents. Body composition was measured, including body mass index (BMI) and phase angle (PhA). Functional assessments included the Barthel index (BI), and Clinical Frailty Scale. The participants were classified into two groups based on the presence or absence of pressure ulcers. Group comparisons and receiver operating characteristic analyses were used to determine the area under the curve (AUC) and cutoff values. The diagnostic performance of the combined cutoff values was also examined. Binary logistic regression was used to evaluate the association between PhA and the presence of pressure ulcers. Twenty (12.8%) participants had pressure ulcers, 90% of which were mild-stage. PhA was lower in the pressure ulcer group (p < 0.001), with an optimal cutoff value of 3.1° (AUC 0.72). Using the cutoff values derived from each assessment, the combination of PhA with BI or BMI improved the AUC to a maximum of 0.78. Logistic regression demonstrated a significant association between PhA and the presence of pressure ulcers (p < 0.05). Phase angle may serve as a complementary biomarker for pressure ulcer risk assessment and may be more useful when combined with functional and nutritional indicators. The use of body composition parameters for noninvasive risk assessment could play an important role in future pressure ulcer prevention strategies.

ABSTRACTThis study evaluated the inter‐rater reliability and usability of the Swedish version of the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T) when used by both registered nurses and assistant nurses. Although previous validation studies involved only registered nurses, assistant nurses often perform these assessments in practice. The study was conducted in three acute care hospitals in Sweden between October 2022 and September 2023, involving 117 patients. In pairs, eight registered nurses and eight assistant nurses independently assessed patients using PURPOSE T in paper format. The percentage agreement between the registered nurses and assistant nurses was 86.6% (n = 97/112). The corresponding simple kappa statistic was 0.69 (95% CI 0.55–0.84); the PABAK kappa statistic was 0.73 (95% CI 0.61–0.86). Both registered nurses and assistant nurses found the tool generally easy to use, though some items in Step 2 were reported as challenging. While the study indicated good inter‐rater reliability and PURPOSE T was perceived as user‐friendly by both groups, education and training should be prioritised when implementing the instrument in routine care to optimise its use. A digital application may provide more effective facilitation and guidance during the assessment compared with a paper‐based version.

ABSTRACTObjective(s)Peristomal skin complications occur in up to 29% of pediatric tracheostomy patients. While foam dressings have demonstrated superiority over traditional gauze, comparative evidence regarding silver‐impregnated versus standard foam dressings remains limited. This study aimed to compare the effectiveness of standard foam versus silver‐impregnated foam dressing in preventing peristomal complications following pediatric tracheostomy.MethodsThis prospective randomized controlled trial enrolled 50 pediatric patients (aged 0–18 years) undergoing elective tracheostomy between March 2022 and July 2024. Patients were randomly assigned to receive either standard foam dressing (Group A, n = 25) or silver‐impregnated foam dressing (Group B, n = 25). All patients followed a standardized postoperative care protocol. The primary outcome was incidence of peristomal complications during the first postoperative month. Secondary outcomes included pressure ulcer risk assessment using the Braden Q Scale and wound staging according to the National Pressure Injury Advisory Panel (NPIAP) classification.ResultsThe complication rate was 12% (n = 3) in the foam dressing group and 8% (n = 2) in the silver‐impregnated foam dressing group, and no statistically significant difference was detected (risk difference: 4%, 95% CI: −0.114 to 0.194, p = 1.000). No significant differences were observed in Braden Q scores on postoperative days 1, 7, 14, and 21 (p > 0.05). NPIAP staging revealed comparable pressure ulcer severity between groups (p = 1.000).ConclusionNo statistically significant difference was detected between standard foam and silver‐impregnated foam dressing when combined with standardized care protocols. However, the small sample size limits statistical power to detect clinically meaningful differences, and as this study was not designed as a non‐inferiority trial, equivalence cannot be concluded. Larger trials are needed to confirm these findings. Standard foam dressing may be a lower‐cost option for routine postoperative wound management in pediatric tracheostomy patients.Level of Evidence2.Trial Registration: NCT07392294.

Feeling lonely defined as a subjective dissatisfaction with social relationships, is associated with an increased risk of functional and cognitive decline well-known factors for institutionalization. The objective was to evaluate the predictive role of feeling lonely on admission to nursing homes among elderly people hospitalized via emergency departments. This was an observational, longitudinal, prospective, multicenter study. Participants were recruited over a period of ten months. Patients were eligible if they were aged 75 years or older and hospitalized in a medical ward of the same hospital as the emergency department (ED) where they were initially admitted. The assessment included the collection of sociodemographic data-age, sex, level of education, available support (particularly the presence of a primary caregiver), number of children, and living arrangements (home or institutional setting)-as well as clinical variables, including presence of dementia or delirium, mood disorders, comorbidities, nutritional status, dependence in activities of daily living (ADL), mobility, risk of falls, and risk of pressure ulcers. The assessment included the collection of sociodemographic (age, sex, level of education, available support (in particular the presence of a primary caregiver), number of children, living conditions (e.g., at home or in an institution) Loneliness was assessed using item 14 of the CES-D (Center for Epidemiologic Studies Depression) scale. Univariate and multivariate analyses were performed using a Cox model that took death into account as a competing risk, using a Fine & Gray model. The mean age was 84.4 ± 5.9 years, and 55% were women. In this population, 40% reported feeling lonely, 41% were at risk of depression, 78% had at least one child, 67% had at least one family caregiver, and 79% (n = 833) lived alone. Over the 36-month follow-up period, 31.46% of patients entered nursing homes. Independent risk factors for institutionalization included social determinants specifically feeling lonely, which was independently associated with an increased risk of placement at 12, 24, and 36 months. Individuals reporting loneliness showed an increased risk of functional and cognitive decline. This study regarding hospitalized elderly after admission to an Emergency Department shows that feeling lonely is not merely a marker of social vulnerability but is independently associated with of nursing home admission.

Fragility fractures of the pelvis (FFPs) are increasingly recognized in older adults with osteoporosis; however, their long-term prognostic impact remains incompletely defined. This study evaluated the risks of mortality, hospital readmission, subsequent fractures, and immobility-related complications associated with FFP in osteoporotic older adults. We conducted a global, retrospective cohort study using the TriNetX Research Network. Patients aged 65years or older with osteoporosis were categorized into an FFP group and a non-FFP control group. Propensity score matching was performed in a 1:1 ratio to balance baseline covariates. Primary outcomes included mortality, hospital readmission, and subsequent fractures, assessed at 1-, 3-, and 5-year follow-up. Secondary outcomes comprised immobility-related complications. Age-stratified subgroup analyses were conducted to evaluate differential risk patterns. After matching, 76,556 patients (38,278 per group) were included. Over 5 years of follow-up, patients with FFP exhibited significantly higher risks of mortality (HR 1.59; 95% CI 1.54-1.64), hospital readmission (HR 1.98; 95% CI 1.93-2.03), and subsequent fractures (HR 2.86; 95% CI 2.76-2.96) compared with controls. FFP was also associated with increased risks of immobility-related complications, including infections, thromboembolic events, and pressure ulcers. Analyses stratifying patients aged 65-79years into three subgroups yielded consistent and highly elevated relative risks across all strata, whereas absolute event burdens were greatest among those aged 80years or older. FFPs are associated with substantially increased long-term mortality, morbidity, and healthcare utilization in older adults with osteoporosis. These findings establish FFP as a high-risk condition warranting proactive, age-tailored secondary prevention, functional rehabilitation, and long-term care strategies.

oropharyngeal dysphagia (OD) is highly prevalent and leads to severe complications. It requires screening (EAT-10) and confirmatory clinical tests (MECV-V), which frequently yield disparate results. to correlate the EAT-10 and the MECV-V in hospitalized patients at risk for dysphagia (EAT-10 ≥ 3), identify associated factors, and analyze predictors of survival. a cross-sectional study was conducted in Pulmonology and Gastroenterology units involving patients at risk for dysphagia (EAT-10 ≥ 3). All subjects were evaluated using the MECV-V. Various sociodemographic, clinical, and functional variables were collected, alongside alterations in safety and efficacy, and survival data. of the 315 patients included, 79 % (n = 249) were diagnosed with OD. The correlation between the total EAT-10 score and the diagnosis of OD was moderate (r = 0,33); notably, in patients with low scores (3-8 points), 50,8 % presented with objective OD. Patients with OD exhibited advanced age (p = 0,025), higher comorbidity (p = 0.024), poorer functional status (p < 0.0001), and an increased risk of pressure ulcers (p < 0.0001). Alterations in efficacy were more prevalent, and piecemeal deglutition was identified as the most robust predictor of OD. Pharyngeal residue and age were the variables with the greatest predictive capacity for survival. the EAT-10 tool is useful for identifying patients at risk, but its correlation with the MECV-V is moderate; therefore, it must be accompanied by an objective clinical evaluation. Piecemeal deglutition is a strong clinical predictor of OD. The presence of pharyngeal residues is associated with poorer survival outcomes.

Pressure injuries during the perioperative period can adversely affect postoperative outcomes and patient recovery. An essential component of prevention and patient care is systematic risk assessment. The Munro Pressure Ulcer Risk Assessment Scale is a perioperative-specific tool designed to evaluate patients' risk for pressure injuries, enabling early identification of high-risk individuals and facilitating timely preventive interventions by perioperative nurses. This methodological study aimed to evaluate the validity, reliability, and diagnostic Accuracy of the Munro Pressure Ulcer Risk Assessment Scale (Munro Scale) in adult patients undergoing surgery. This methodological study was conducted on a sample of 200 adult surgical patients from October 2024 to May 2025. Data were collected using the Munro Pressure Injury Risk Assessment Scale alongside a demographic questionnaire. The scale underwent a rigorous process of translation and cultural adaptation following established methodological standards. Psychometric testing encompasses evaluations of content validity, construct validity, and Cronbach's alpha coefficient. Out of 200 surgical patients, 37 (18.5%) developed pressure injuries, mostly classified as Stage I and Stage II. Confirmatory factor analysis (CFA) was conducted using AMOS to evaluate the construct validity of the scale, which included three latent factors: preoperative, intraoperative, and postoperative risk factors. Factor loadings for most items exceeded 0.4, indicating acceptable item relevance. Reliability analysis showed Cronbach's alpha values of 0.84, 0.62, and 0.83 for the preoperative, intraoperative, and postoperative factors, respectively. Composite reliability (CR) values were 0.83, 0.71, and 0.82, confirming acceptable internal consistency. The Munro Scale demonstrated acceptable reliability and validity, confirmatory factor analysis indicating a moderate or limited fit. This scale can be used to assess the risk of pressure injuries in perioperative patients.

Evaluating the effectiveness of care bundles on the development of pressure ulcers in surgical patients: a systematic review.

Pressure ulcer prevalence, risk, clinical features and outcomes: Evidence from a public tertiary hospital in Athens, Greece.

Comorbid risk of pressure ulcers in orthopedic surgery amongst patients with a preexisting chronic dermatological condition

This study aimed to assess the incidence of pressure ulcers (PUs) in two Italian emergency departments (EDs) in a cohort of patients cared for with a standardised preventive care bundle, and to identify risk factors associated with PU development during the ED stay. In the RUNTIME Study-a prospective observational cohort study-patients with any critical illness, ≥18 years of age and at risk of developing a PU were included. Those with a pre-existing PU and significant cognitive decline were excluded. Sociodemographic and clinical characteristics were collected at baseline and follow-up. PU risk was ascertained at admission with the Braden scale. Cumulative survival and risk factors associated with PU were estimated with Kaplan-Meier curves and Cox proportional regression. A total of 201 patients (mean age: 81±8.3 years; male: 53%) were included. After a mean of 84.7±46.6 hours, 12 patients developed a PU (incidence: 6%). Lesions were at the first stage and located at the sacrum. The probability of remaining free from PUs dropped from 98% at 24 hours to 80% at 168 hours. Risk of PU increased with age (hazard ratio (HR): 1.13; p=0.004) and decreased with longer ED stays (HR: 0.36; p<0.001). The findings of this study offer additional knowledge about PU incidence and risk factors in ED patients followed by a standardised preventive bundle. The low incidence and presence of risk factors suggests that a preventive protocol led by ED nurses trained in wound care can reduce the incidence and risk factors for PUs. However, the study included only 12 cases of PU development, which limits the robustness of the statistical conclusions. Therefore, the findings should be interpreted with caution and confirmed in studies with larger populations.

Pressure ulcers represent a significant healthcare challenge among respiratory patients. This study aimed to develop and validate a predictive nomogram based on machine learning algorithms to identify patients at high risk for pressure ulcer development. We conducted a retrospective analysis of 263 respiratory patients (166 with pressure ulcers). Patients were randomly divided into training and testing cohorts at a 7:3 ratio. Potential risk factors were identified through univariate logistic regression. Least absolute shrinkage and selection operator (LASSO) regression selected 17 significant predictors, from which 10 variables with optimal predictive values were incorporated into a nomogram model. Model performance was assessed using receiver operating characteristic (ROC) curves, calibration plots and decision curve analysis (DCA). The final nomogram incorporated 10 predictors: age, albumin, C-reactive protein, serum sodium, history of diabetes, chronic obstructive pulmonary disease, peripheral vascular disease, urinary incontinence, length of hospital stay and Braden sensory perception score. The model demonstrated excellent discriminative ability with AUCs of 0.865 (95% CI: 0.816-0.914) in the training cohort and 0.837 (95% CI: 0.783-0.891) in the testing cohort. Calibration curves showed good agreement between predicted and observed probabilities (Hosmer-Lemeshow test: training cohort χ2 = 4.257, P = 0.833; testing cohort χ2 = 12.350, P = 0.142). DCA confirmed the nomogram's superior clinical utility compared to individual predictors across a wide range of threshold probabilities. The machine learning-derived nomogram provides a practical, noninvasive tool for early identification of respiratory patients at risk for pressure ulcers. Implementation of this model could facilitate timely intervention strategies, potentially reducing the incidence of pressure ulcers and improving patient outcomes.

Objective: This study aimed to adapt the Gosnell Pressure Ulcer Risk Assessment Scale into Turkish and to evaluate its linguistic validity, content validity, inter-observer reliability, and construct validity through exploratory and confirmatory factor analyses. Methods: This methodological study was conducted with 150 patients treated in a palliative care unit over one year. The adaptation process consisted of two stages: linguistic validation and assessment of validity and reliability. Linguistic validity was assessed using the translation-back translation method and expert reviews. Content validity was evaluated using the Lawshe technique with input from five experts from the Department of Family Medicine. Reliability was assessed by measuring inter-observer agreement using the Kappa coefficient, Cramer’s V coefficient, and Spearman correlation analysis. To evaluate construct validity, Exploratory Factor Analysis (EFA) using Principal Component Analysis and Confirmatory Factor Analysis (CFA) using the Diagonally Weighted Least Squares (DWLS) estimation method were conducted. Results: A total of 150 participants were included, with a mean age of 74.74 years, and 58% were female. The Content Validity Ratio (CVR) for each item was calculated as 1. Regarding reliability, the Kappa coefficient for the Mental Status item was 0.903, and Cramer’s V coefficient was 0.896; for the Continence, Mobility, and Activity items, both the Kappa and Cramer’s V coefficients were 1. For the Nutrition item, the Kappa coefficient was 0.840, and Cramer’s V coefficient was 0.862. A significant and positive correlation was found between the total scores of the two observers (p