An overview of co-morbidities and the development of pressure ulcers among older adults

Abstract

BackgroundThe prevalence of pressure ulcers particularly in the frail older adult population continues to be high and very costly especially in those suffering from chronic diseases and has brought a higher awareness to comprehensive, preventive and therapeutic measures for treatment of pressure ulcers. Internal risk factors highlighted by comorbidities play a crucial role in the pathogenesis of pressure ulcers.Main bodyFocusing on the impact of common chronic diseases (comorbidities) in aging on pressure ulcers (e.g., cardiovascular diseases, diabetes, chronic pulmonary diseases, renal diseases and neurodegenerative disorders) and the significant complicating conditions e.g., anemia, infectious diseases, malnutrition, hospitalization, incontinence and polypharmacy, frailty and disability becomes important in developing a more complete, inclusive and multidisciplinary approach to prevention of PU in older patients.ObjectiveTo describe chronic and acute conditions which are risk factors in elderly patients for developing PU.MethodsWe present an overview of comorbidities seen with PU in three diverse patient locations.The inclusion criteria are sites (community, acute hospital and long term facilities), older patients, chronic diseases and pressure ulcers grade 2 and over.Using a recently developed conceptual framework accepted by European and National Pressure Ulcer Advisory Panels, we examined chronic diseases to identify the risk factors of chronic conditions and complicating conditions which potentially influence risk for PU development.ConclusionMultiple chronic diseases and complicating factors which associated with immobility, tissue ischemia, and undernutrition are caused to PU in community settings, hospitals, and nursing facilities.

An Unorthodox Skin Traction Technique for the Initial Management of Distal Femur Fractures in a High-volume Trauma Centre: A Technical Review

“…Another issue associated with increased morbidity in the elderly is the heightened risk of pressure sores associated with this type of fracture. Elderly patients presenting with these types of fractures typically have a reduced physiological reserve [6]. Sarcopenia and frailty result in biological and physiological changes characterised by reduced muscle strength and functional dependence [6].…”

“…Elderly patients presenting with these types of fractures typically have a reduced physiological reserve [6]. Sarcopenia and frailty result in biological and physiological changes characterised by reduced muscle strength and functional dependence [6]. Distal femur fractures may result in long periods of immobilisation, which can lead to weight loss, loss of mobility and declined physiological reserve [6].…”

“…Sarcopenia and frailty result in biological and physiological changes characterised by reduced muscle strength and functional dependence [6]. Distal femur fractures may result in long periods of immobilisation, which can lead to weight loss, loss of mobility and declined physiological reserve [6]. Sweating in the typical traction kit may produce moisture, which, when combined with prolonged immobilisation, will hasten the risk of developing a pressure sore.…”

Clinical and Economic Value of Nutrition in Healthcare: A Nurse's Perspective

“…Along with longer lengths of stay and increased risk of 30‐day readmission, patients with malnutrition are more likely to experience impeded wound healing, infections, and pressure injuries . An ongoing 1‐day annual audit of energy intake and nutrition risk on healthcare‐associated infections (HAIs) by Thibault et al noted a significant association between documented 1‐day energy consumption and hospital‐acquired infections (HAIs) .…”

Hospital Nutrition Care Betters Patient Clinical Outcomes and Reduces Costs: The Malnutrition Quality Improvement Initiative Story

“…[7][8][9][10] The consequences of malnutrition in hospitalized patients are serious. Malnutrition increases risks for complications including impaired wound healing, 11 infections, 12 and pressure ulcers 13 ; leads to longer hospital length of stay and hospital readmissions 14 ; and is associated with increased risk of mortality. 14,15 Older adults are particularly vulnerable because of their higher likelihood of having multiple chronic conditions or diseases along with acute illness or need for surgery, impaired functional or cognitive status, or limited food access.…”