Pressure Ulcers In Elderly Patients Research Articles

Repair of pressure ulcers in the elderly using autologous microskin implantation and negative pressure wound therapy: A retrospective study.

Pressure ulcers remain a worldwide problem. To introduce an intermittent and feasible wound treatment method for the treatment of pressure ulcers in elderly patients. This surgical procedure was performed on eight elderly patients suffering from pressure ulcers. Microskin measuring 0.1 × 0.1 centimeters was cut from a small amount of thin skin and then grafted onto the wound surface in conjunction with closed negative pressure therapy. Seven patients had their wounds closed after a single surgery, while one patient required two surgeries to close the wound. Autologous microskin implantation for the treatment of pressure ulcers in the elderly is an effective method to close the wound, which can prevent the elderly from living with wounds in their later years and is a viable treatment option.

Decreased proteasome function increases oxidative stress in the early stage of pressure ulcer development

The aging process in the elderly results in heightened skin fragility associated with various disorders, including pressure ulcers (PUs). Despite the high incidence of PUs in the elderly population, there is a limited body of research specifically examining the impact of aging on the development of pressure ulcers. Therefore, investigating age-related physiological abnormalities is essential to elucidate the pathogenesis of PUs. Ischemia-reperfusion (I/R) injury and the subsequent oxidative stress caused by reactive oxygen species (ROS) play essential roles in the early stage of PUs. In this study, we used a mouse model of proteasomal dysfunction with an age-related phenotype to examine the role of proteasome activity in cutaneous I/R injury in vivo. Decreased proteasome function did not affect the expression of inflammatory cytokines and adhesion molecules in the I/R area in transgenic mice; however, proteasome inhibition increased oxidative stress that was not attenuated by activation of the oxidative stress response mediated by NF-E2-related factor 2 (Nrf2). In dermal fibroblasts (FCs) subjected to hypoxia-reoxygenation (H/R), proteasome inhibition induced oxidative stress and ROS production, and Nrf2 activation did not adequately upregulate antioxidant enzyme expression, possibly leading to antioxidant/oxidant imbalance. The free radical scavenger edaravone had protective effects against I/R injury in vivo and decreased oxidative stress in FCs treated with a proteasome inhibitor and subjected to H/R in vitro. The results suggest that the age-related decline in proteasome activity promotes cutaneous I/R injury-induced oxidative stress, and free radical scavengers may exert protective effects by preventing oxidative stress in the early stage of PUs.

A Comparative Study on Platelet-Rich Plasma From Elderly Individuals and Young Adults to Treat Pressure Ulcers in Mice

ObjectiveThe aim of the present study was to compare the therapeutic effects of activated platelet-rich plasma (PRP) prepared from elderly individuals and young adults to treat pressure ulcers (PUs), and to accumulate a theoretical basis for allogeneic PRP treatment of PUs in elderly patients. Materials and methodsWhole blood was extracted from elderly individuals aged >65 y and young adult volunteers for PRP preparation, and platelet concentrations in whole blood and PRP were compared. Growth factors released from activated PRP were assayed using the enzyme-linked immunosorbent assay. C57BL/6 mice were divided into three groups: the control saline, elderly-PRP (Group A), and young adult-PRP (Group B). Ischemia-reperfusion injury-induced PUs were established on the backs of mice. PUs were photographed on days 0, 5, and 10 to assess their sizes. Specimens were collected on day 10 and subjected to hematoxylin and eosin and Masson's staining. Immunohistochemical staining for CD31 was conducted to evaluate vascular formation, and cell invasion was assessed using a Transwell assay. The action of PRP on transforming growth factor-beta (TGF-β)-dependent fibroblast activity and epithelial-mesenchymal transition was analyzed using immunofluorescence and Western blotting in vitro. ResultsThe platelet concentrations in whole blood and PRP of young adults were significantly higher than that in elderly individuals. The two PRP treatment groups had similar platelet enrichment coefficients of PRP. After activation, PRP from young adults produced significantly higher levels of platelet-derived growth factor, TGF-β, and vascular endothelial growth factor than PRP from elderly individuals (P < 0.05). The concentrations of platelet-derived growth factor, TGF-β, and vascular endothelial growth factor were positively correlated with the platelet concentrations in whole blood and PRP. The effects of PRP in regulating the expressions of TGF-β, α-smooth muscle actin, vimentin, and E-cadherin were observed in vivo and in vitro. The two PRP treatment groups exhibited better wound healing than the control group, as evidenced by more re-epithelialization, higher collagen content, skin fibrosis, and more blood vessel formation over time. Group B exhibited better wound healing than Group A (P < 0.05). ConclusionPRP exhibits potent wound healing ability in PU therapy, and PRP from young adults is seemingly superior to that from elderly individuals because of a higher concentration of platelets and increased production of growth factors.

Risk factors of Pressure Ulcers in hospitalized elderly Egyptian people

Background: Pressure ulcers affect a large scale of elderly people. Despite advances in technology, the rate continues to increase. This increases morbidity, health care costs and mortality. Aim: searching for risk factors of pressure ulcers in elderly patients admitted to acute geriatric care units. Methods: A case control study was conducted recruiting100 elderly male and female patients above the age of six ty. History and physical examination were done, as well as nutritional and functional assessment. Nursing care was assessed using a checklist and Braden scale was done as a risk assessment scale for pressure ulcers. Blood samples were collected for laboratory measures. Results: pressure ulcers result from contribution of many factors as cardiovascular and cerebrovascular diseases, urinary incontinence, poor nutrition, immobility. Patients free from pressure ulcers had better nursing care with more frequent repositioning and use of air mattress (in more than 80%, compared use of air mattress in about 40% only of patients acquiring pressure ulcers). Braden scale was highly sensitive for the occurrence of pressure ulcers (cutoff point ≤ 17) with 77.4% positive predictive value and 97.3% negative predictive value. Conclusion: Pressure ulcers are multifactorial in origin. Nursing care is of utmost importance for their prevention. Braden scale should be applied to elderly pa tients upon admission to hospitals

IOT Medical Device-Assisted Foam Dressing in the Prevention of Pressure Sore during Operation

With the development of the times, people’s living standards are constantly improving, but the medical pressure brought by the aging population is also increasing, and pressure ulcers in elderly patients during hospitalization are also constantly occurring. Of course, the relevant medical equipment is also progressing, especially the emergence of medical-assistant foam dressing on the Internet of Things, which makes people cope with pressure ulcers more handily. In order to test the role of IOT medical devices, especially the application of foam dressings in the prevention of pressure ulcers, this article has carried out a survey of patients in a city hospital, investigated relevant literature, interviewed professionals, collected relevant information, designed experiments, and obtained relevant research data. Research shows that IOT medical devices can improve the efficiency of hospital treatment and improve the efficiency by about 12%; pressure ulcer incidence in different age groups of people is different, and the probability of occurrence in the elderly population is far higher than that of young people; foam dressing has obvious effect on the prevention of pressure sore, and the probability of pressure sore after using foam dressing is lower than that of unused 35%. It indicates that foam dressing can play a key role in the prevention of pressure sore.

Time-to-treatment is a risk factor for the development of pressure ulcers in elderly patients with fractures of the pelvis and acetabulum

IntroductionFractures of the pelvis and acetabulum are associated with pain and immobilization and, hence, pose the risk of developing a pressure ulcer - especially in elderly patients. In the literature, information on risk factors for the occurrence of pressure ulcers related to geriatric pelvic or acetabulum fractures is missing. MethodsConsecutive in-hospital patients aged 55 years or older treated for closed pelvis and/or acetabulum fractures between 2013 and 2017 were retrospectively identified from an institutional prospective database. Epidemiologic characteristics and patient specifics with special focus on the time from admission to treatment, duration of hospitalization and comorbidities were retrospectively assessed by chart review. ResultsDuring the evaluated interval, 407 patients with isolated fractures of the pelvis or acetabulum (mean age 78 years, range 55 to 101 years, 69,3% female) were treated. A new pressure ulcer that developed during the hospitalization was observed in 46/407 patients (11.3%). This included pressure ulcers of stage 1 in 18/46 cases (39%), stage 2 in 24/46 cases (52%), and stage 3 in 4/46 cases (9%). No stage 4 ulcers were seen in this cohort. The mean duration of hospitalization was longer in patients with a pressure ulcer (25 days, SD 17) than in patients with no ulcers (12 days, SD 9; p < .001). Patients who developed a pressure ulcer, had waited significantly longer for treatment of their pelvis/acetabulum fracture when compared to patients without an ulcer (5 days, SD 5 vs. 3 days SD 4, p = =.001). A logistic regression analysis confirmed “time to treatment” as an independent risk factor for the occurrence of a pressure ulcer during hospitalization. In an analysis adjusted for the confounders age, male gender, diabetes and malignancy, the odds ratio to develop a pressure ulcer remained 1.10 (CI 1.03 to 1.19; c-value = 0.774, p = .008) for each day of waiting treatment. Conclusion“Time to treatment” is an independent risk factor for the occurrence of a pressure ulcer during hospitalization after a pelvis/acetabulum fracture in elderly patients. Each day of waiting treatment increases the risk of developing a pressure ulcer by 10%.

Application of bundled nursing strategies in the management of pressure ulcers in elderly patients in operating rooms and its influence on nursing quality

Objective To explore the application effect of clustering nursing strategies and the impact on nursing quality in the management of pressure sores in elderly patients with operating room. Methods A total of 1 560 cases of elderly patients in the operating room who were admitted to this hospital from July 2015 to March 2017 were selected and randomly divided into control group and experimental group, 780 cases of each group.The patients in the control group were given routine nursing interventions, and the patients in the experimental group performed bundled nursing interventions on the basis of routine care.After two weeks of intervention, the incidence, occurrence time, quality of life, and quality of care were compared between the two groups. Results The incidence of pressure sores in the experimental group was 1.28% (10/780), lower than that in the control group 10.26% (80/780). The time of occurrence (9.20±2.10) days was later than that of the control group (5.06±2.12) days, and the difference was statistically significant (P 0.05). After two weeks of intervention, SF-36 score in both groups increased, and the increase in the study group was even greater, and the difference was statistically significant (P<0.05). The nursing quality of the experimental group was higher than that of the control group, and the difference was statistically significant (P<0.05). Conclusion The application of clustering nursing in pressure ulcer treatment in elderly patients in operating room can effectively reduce the incidence of pressure sores, delay the occurrence of pressure sores, improve the quality of care and quality of life of patients, and it is worthy of clinical application. Key words: Operating room; Pressure sore care management; Bundled care; Quality of care; Quality of life

Therapeutic effects of dermlin and the combination of dermlin and pressure dressing on pressure ulcers in elderly patients

Objective To explore the therapeutic effect of dermlin and the combination of dermlin and pressure dressing in elderly patients with pressure ulcer. Methods From January 2011 to August 2016, a total of 120 hospitalized elderly patients with pressure ulcers in First Affiliated Hospital of PLA General Hosptial were chosen as research objects. Patients with blister diameter less than 5 mm were defined as small blister group, and patients with blister diameter equal to or more than 5 mm were defined as big blister group. Each group containing 60 patients was divided into the observation group and the control group. In the small blister group, there were 30 cases in the control group with 41 blisters and 30 cases in the observation group with 37 blisters. Blisters in small blister groups were not pumped, of which the control group was treated by iodine while the observation group was treated by dermlin. In the big blister group, there were 30 cases in the control group with 42 blisters and 30 cases in the observation group with 41 blisters. Blisters in big blister groups were pumped, of which the control group was firstly treated by iodine and then applied with pressure dressing, while the observation group was firstly treated by dermlin and then applied with pressure dressing. The evaluation standard of therapeutic effect contained recovery, efficiency, improvement and non-effect. All the groups' healing situations were observed and recorded within 7 days. Results In the small blister group, the effective rates were 100.0% in the observation group and 97.6% in the control group. The therapeutic effects in the observation group were statistically significant better than the control group (Z=-2.347, P=0.019) . The therapeutic time in the observation group was significantly shorter than the control group (P<0.01) . In the big blister group, the effective rates were 97.5% in the observation group and 92.9% in the control group. The therapeutic effects in the observation group were statistically significant better than the control group (Z=-3.495, P<0.001) . The therapeutic time in the observation group was significantly shorter than the control group (P<0.01) . Conclusions Both dermlin and the combination of dermlin and pressure dressing could significantly enhance the healing of elderly patients' pressure ulcers and reduce the healing time. Key words: Aged; Pressure ulcer; Dermlin; Pressure dressing

Prevalence and incidence density of unavoidable pressure ulcers in elderly patients admitted to medical units

To describe the prevalence and incidence density of hospital-acquired unavoidable pressure sores among patients aged ≥65 years admitted to acute medical units. A secondary analysis of longitudinal study data collected in 2012 and 2013 from 12 acute medical units located in 12 Italian hospitals was performed. Unavoidable pressure ulcers were defined as those that occurred in haemodynamically unstable patients, suffering from cachexia and/or terminally ill and were acquired after hospital admission. Data at patient and at pressure ulcer levels were collected on a daily basis at the bedside by trained researchers. A total of 1464 patients out of 2080 eligible (70.4%) were included. Among these, 96 patients (6.5%) hospital-acquired a pressure ulcer and, among 19 (19.7%) were judged as unavoidable. The incidence of unavoidable pressure ulcer was 8.5/100 in hospital-patient days. No statistically significant differences at patient and pressure ulcers levels have emerged between those patients that acquired unavoidable and avoidable pressure sores. Although limited, evidence on unavoidable pressure ulcer is increasing. More research in the field is recommended to support clinicians, managers and policymakers in the several implications of unavoidable pressure ulcers both at the patient and at the system levels.

Application of quality control circle in reducing incidence rate of pressure ulcers in elderly patients whose Braden scale ≤16

Objective To explore the application and effect of quality control circle in reducing incidence rate of pressure ulcers in elderly patients whose Braden scale ≤16. Methods The actual reasons in elderly patients with pressure ulcers were found through the application of quality control circle method, which included the following six aspects: single prevention equipment of pressure ulcers; imperfect execution path of prevention measures of pressure ulcers; imperfect prevention process of special patients with pressure ulcers; not improve the risk assessment content of pressure ulcers in time; no educational manual of pressure ulcers prevention with pictures; new progress in pressure ulcer prevention knowledge training of not reach the designated position. According to the true cause, countermeasures were made and standardized management was implementation, and quality improvement was continued. According to the true cause, corresponding measures were formulated and implemented, and the standardized management system was maintained. Results After the implementation of quality control circle, the incidence rate of elderly patients with pressure ulcers whose Braden scale ≤16 points was decreased from 6.06% to 2.19% after the implementation of quality control circle. Conclusions The application of quality control circle method in security management of elderly patients whose Braden score ≤ 16 points, can reduce the incidence rate of pressure ulcers in elderly patients whose Braden scale ≤ 16, and also can improve the quality of nursing, circle member work enthusiasm, creative thinking, responsibility and honor, QCC technique application and team spirit. Key words: Elderly patients; Pressure ulcers; Quality control circle; Braden score

Effects of MEBO on promoting healing of pressure ulcers in elderly patients in community

Objective To explore the effects of moist exposed burn ointment (MEBO) and in situ skin regeneration technology in the treatment of pressure ulcers in elderly patients in community. Methods A total of 31 elderly patients with pressure ulcers in community were treated with MEBO and in situ skin regeneration technology. The amount of wound exudate, histological types and area change were observed dynamically to evaluate the condition of wound healing. Results There were 14 elderly patients with StageⅠ-Ⅱ pressure ulcers healed within two weeks after treatment, and other 17 patients were healed without skin-grafting within 120 days. Conclusions The application of MEBO and in situ skin regeneration technology can effectively promote healing of pressure ulcers in elderly patients in community and is worthy of clinical promotion and application. Key words: Community health center; Geriatric nursing; Pressure ulcer; In situ skin regeneration technology; Moist exposed burn ointment

Predicting the risk of pressure ulcers in elderly patients in the postoperative period

1Faculty of Medicine, Ovidius University, Dept of Anaesthesiology & Intensive Care, Constanta, Romania, 2Faculty of Medicine, Ovidius University, Dept of Surgery, Constanta, Romania

Hard to heal pressure ulcers (stage III–IV): Efficacy of injected activated macrophage suspension (AMS) as compared with standard of care (SOC) treatment controlled trial

The objective of this study was to compare local injections of AMS with SOC treatments for stage III and IV pressure ulcers in elderly patients. It was designed as historically prospective 2-arms non-parallel open controlled trial, and conducted in a department of geriatric medicine and rehabilitation of a university affiliated tertiary hospital. We studied 100 consecutive elderly patients with a total of 216 stage III or IV pressure ulcers, 66 patients were assigned to the AMS group and had their wounds injected, while 38 patients were assigned to the SOC group. Primary outcome was rate of complete wound closure. Time to complete wound closure and 1-year mortality served as secondary outcomes. Statistical analyses were performed at both patient and wound levels. Percentage of completely closed wounds (wound level and patient level) were significantly better ( p < 0.001/ p < 0.001, respectively) in all patients in favor of AMS, as well as in the subset of diabetic patients ( p < 0.001/ p < 0.001). Similarly, AMS proved significantly better for the subset of those with leg ulcers and with baseline wounds ≤15 cm 2, compared with SOC. There were no statistically significant differences with regard to time to complete closure or 1-year mortality rates in the two groups. It is concluded that there is a significant difference in favor of stage III and IV wound closure rates by AMS, as compared with SOC treatments.

Efficacy and safety of ornithine alpha-ketoglutarate in heel pressure ulcers in elderly patients: Results of a randomized controlled trial

ObjectivePressure ulcers affect predominantly the elderly and nutritional status is a known risk factor. Guidelines on pressure ulcers provide recommendation on nutritional management. Ornithine alpha-ketoglutarate (OKG) is an adjuvant treatment in undernourished elderly patients or in patients with hypercatabolism states. It is a precursor of different amino-acids which play a role in the process of healing. The objective of the study is to determine the efficacy of OKG on pressure ulcer area reduction after six weeks of treatment. DesignMulti-centre, international, randomized, comparative, double blind, parallel groups, placebo-controlled study. Participants160 patients (ITT population) aged over 60 years with a heel pressure ulcer at stage II or III. InterventionPatients received OKG (n=85) or placebo (n=75) once a day for 6 weeks. MeasurementsUlcer area was measured each week, using a tracer. The primary endpoint was the percentage reduction of the surface at the final visit: [(Wound areatn — Wound areat0)/(Wound areat0)]. ResultsAt inclusion, ulcer area distribution deviated from normal distribution (median ulcer area OKG 6.6cm2, placebo 3.9 cm2, p=0.044, Mann-Whitney test). As healing is strongly related to baseline ulcer area, the abnormal distribution was a major bias. Therefore it was decided to perform the analysis on 2 sub-groups of patients according to the mean ulcer area, i.e. above or below 8cm2. The mean wound area reduction for baseline area ≤ 8 cm2 are −59. 5 ± 71.4% and −54.0 ± 69.0% for the OKG group and placebo groups respectively (p=0.477, Mann-Whitney test). In the group with baseline pressure ulcer area > 8 cm2 no between group differences on either parameter was detected. When closure rate is considered, a significant difference in favor of OKG group is observed (− 0.07 cm2/day in the OKG group and − 0.04 cm2/day in the placebo groups respectively p=0.007, Mann-Whitney test). Thirty serious adverse events were reported in 28 patients (15 allocated to OKG and 13 to placebo). None of them was considered treatment related. ConclusionThis clinical trial supports a potential benefit of OKG 10g daily in the subgroup of patients with pressure ulcers ≤ 8 cm2 surface area in elderly population when associated with debridement together with wound management according to pressure ulcer guidelines. However this study highlights methodological difficulties to perform clinical trials in old-old patients that may affect the robustness of the results for this type of study.

Pressure Ulcers in Elderly Patients with Hip Fracture Across the Continuum of Care

To identify care settings associated with greater pressure ulcer risk in elderly patients with hip fracture in the postfracture period. Prospective cohort study. Nine hospitals that participate in the Baltimore Hip Studies network and 105 postacute facilities to which patients from these hospitals were discharged. Hip fracture patients aged 65 and older who underwent surgery for hip fracture. A full-body skin examination was conducted at baseline (as soon as possible after hospital admission) and repeated on alternating days for 21 days. Patients were deemed to have an acquired pressure ulcer (APU) if they developed one or more new stage 2 or higher pressure ulcers after hospital admission. In 658 study participants, the APU cumulative incidence at 32 days after initial hospital admission was 36.1% (standard error 2.5%). The adjusted APU incidence rate was highest during the initial acute hospital stay (relative risk (RR)=2.2, 95% confidence interval (CI)=1.3-3.7) and during re-admission to the acute hospital (RR=2.2, 95% CI=1.1-4.2). The relative risks in rehabilitation and nursing home settings were 1.4 (95% CI=0.8-2.3) and 1.3 (95% CI=0.8-2.1), respectively. Approximately one-third of hip fracture patients developed an APU during the study period. The rate was highest in the acute setting, a finding that is significant in light of Medicare's policy of not reimbursing hospitals for the treatment of hospital-APUs. Hip fracture patients constitute an important group to target for pressure ulcer prevention in hospitals.

Monochromatic phototherapy: effective treatment for grade II chronic pressure ulcers in elderly patients

Monochromatic pulsating light may have effects on wound healing. In an earlier study of grade II ulcers, there was a tendency toward better healing in the phototherapy group (p=0.06). The present study on patients with grade II ulcers was performed to verify these findings. Data from this study were pooled with data from the earlier study. Ninety-four patients were offered participation in the new study and 76 patients were evaluated. They were pooled with 87 patients from the earlier study, bringing the total to 163. All patients were treated with monochromatic pulsating light or placebo over the ulcerated area, according to a specified program up to 12 weeks. The mean normalized reduction in pressure ulcer size at week 12 was 0.79 for the phototherapy group and 0.50 for the placebo group (95% confidence interval 0.01-0.53; p=0.039). No serious side-effects were noted. Monochromatic pulsating light accelerates healing in grade II pressure ulcers in elderly patients.

The role of support surfaces and patient attributes in preventing pressure ulcers in elderly patients

Nurses caring for elderly patients often need to select support surfaces that reduce the likelihood of pressure ulcers, but there is little information about the effectiveness of different support surfaces. This randomized trial compared two support surfaces and investigated patient attributes related to the risk of developing a pressure ulcer. Eighty-four elderly patients were nursed on a convoluted or solid foam overlay and assessed three times a week for pressure ulcers. Stepwise Cox proportional hazards regression revealed a statistically significant relationship between the risk of developing a pressure ulcer and the variables mobility and type of support surface.