Impaired mobility and pressure ulcer development in older adults: Excess movement and too little movement—Two sides of the one coin?

Abstract

Aim: To identify how activity and mobility lead to pressure ulcer development, using two objective assessments, one for mobility and one for early pressure ulcer detection.Methods: 150 older persons from long-term settings were followed up for 20 days, using an observational, quantitative, prospective study design. The study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. Visual skin assessment and sub-epidermal moisture assessments were undertaken daily. Activity was measured using the Braden subscale.Further, a mobility profile of the participants was identified using a piezoelectric motion sensor which provided a "movement score" (mean number of movements/hour).Movement scores from 22 healthy participants were also measured to better understand the mobility profile in a healthy population.Results: Pressure ulcer incidence using visual skin assessment was 12.7% (low movers = 6.7%; high movers = 6%) and 78.7% using sub-epidermal moisture assessment (low movers = 40.0%; high movers = 38.7%). Sub-epidermal moisture assessment detected pressure ulcers on average 8.2 days before they appeared visually on the skin's surface. Pressure ulcer detection was 25 times greater using sub-epidermal moisture compared to visual skin assessment. Considering the results of the "movement level" assessment using the motion sensor technology, of all those who were determined to be immobile by Braden, 18.8% were assessed as high movers.Discussion & Conclusion: Pressure ulcers occurred both in low and high movers, which was unexpected as a similar finding has not been previously reported in the literature.

Developing Algorithm Based on Activity and Mobility for Pressure Ulcer Risk Among Older Adult Residents: Implications for Evidence‐Based Practice

“…Moda Vitoriano Budri et al (2020). A relatively similar number of participants developed a VSA-PU or an SEM-PU regardless of whether they were high or low movers.…”

“…In the same study, of the 118 SEM‐PU observed, 51% ( n = 60) occurred among those classified as being low movers, and 49% ( n = 58) occurred among those classified as being high movers. It is somewhat surprising that an equal number of individuals (low and high movers) developed a VSA‐PU or an SEM‐PU (Moda Vitoriano Budri et al, 2020). The findings from the current study corroborate those of Moda Vitoriano Budri et al (2020).…”

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“…16,17 Dynamic conditions like repositioning and patient transfers may drag the skin over bony prominences, increasing both the friction and shearing forces. 18,19 This increases the risk of superficial tissue injury including skin tears and blister formation particularly in older adults given their skin atrophy, reduced collagen, and loss of elastin. 19 These movements may also make the skin tissue more vulnerable to deeper PIs.…”

“…18,19 This increases the risk of superficial tissue injury including skin tears and blister formation particularly in older adults given their skin atrophy, reduced collagen, and loss of elastin. 19 These movements may also make the skin tissue more vulnerable to deeper PIs.…”

Sub‐epidermal moisture measurement: an evidence‐based approach to the assessment for early evidence of pressure ulcer presence

“…A recent study 67 in the older population, also using this device among 150 participants cared for in long‐term settings, undertook SEM assessment and VSA to identify how activity and mobility lead to pressure ulceration. The authors, using an observational design, followed the participants up for 20 days and assessed mobility using a piezoelectric movement sensor and the activity subscale of the Braden scale.…”