Pressure Ulcers Among Terminally Ill Nursing Home Residents

Abstract

The purpose of this prospective, anthropological study was to describe and analyze the experiences and care of terminally ill nursing home residents who were admitted with or acquired pressure ulcers (PUs) after admission. Data were collected in two proprietary nursing homes. Participant observation, in-depth interviews, event analysis, and chart review were used to obtain data. A total of 64 (54.7%) of the 117 terminally ill residents in the study had PUs; 52 (81.3%) of whom died with PUs. The findings disclosed that the absence of family advocacy, inability to speak English, and inadequate staffing and lack of supervision, along with other previously reported risk factors, contributed to the development of PUs. Specifically, inadequate staffing and lack of supervision led to inadequate assistance at mealtime, infrequent repositioning, and inadequate continence care, which in turn led to weight loss, unrelieved pressure on bony prominences, and moist, irritated skin. The outcome was a high rate of residents dying with PUs. Knowledge of and attention to these risk factors can guide nurses in the prevention and management of PUs.

Pressure ulcers in patients receiving palliative care: A systematic review

“… EPUAP: European Pressure Ulcer Advisory Panel. Pressure ulcer location was documented in five articles; the sacrum was the commonest site (range 38%–78.4%), followed by buttock, hip and heel. 15,18,19,22,24 …”

“…Hanson et al 19 found that 62% of pressure ulcers developed within 2 weeks of death despite ulcers forming any time between 1 and 139 days from admission. Hendrichova et al 20 found that 53.5% of new ulcers developed within 6 days of death, whereas Kayser-Jones et al 22 identified a mean of 66.8 days from pressure ulcer formation to death. Henoch and Gustafsson 21 also recorded data on time from ulcer formation to death but used median (12 days, range 1–59 days) rather than mean making it difficult to draw direct comparisons between articles.…”

“…2 As patients approach the end of life, appetite and thirst often reduce, nutrition becomes less of a priority as comfort becomes the focus of care and the underlying physiology switches to a catabolic state. Kayser-Jones et al 22 found weight loss to be a statistically significant risk factor for pressure ulcer formation. Although there was no significant difference between patients with and without ulcers at entry to the study or at time of death, those with pressure ulcers had a mean weight loss of 30 lb compared with patients without pressure ulcers losing a mean of 6.9 lb.…”

Pressure Injury Progression and Factors Associated With Different End-Points in a Home Palliative Care Setting: A Retrospective Chart Review Study

“…6,10,11 Immobility, skin moisture, and poor nutritional status are among the most relevant risk factors for pressure injuries in patients with advanced illnesses, 4,12 who are the population showing the highest prevalence for developing them. 3,10,13 Furthermore, although pressure injury prevention represents a crucial goal, wound care specialists unanimously suggest that not all injuries are avoidable 2,5,6,14,15 mainly because of the extremely frail conditions of patients approaching death. 13,16,17 In palliative care settings, the management of pressure injuries requires a holistic and integrated approach.…”

Everyday Excellence

“…Job turnover among RN staff is associated with worsening of quality of care measures for residents (Castle & Engberg, 2005). Without the leadership of professional nurses, people living in nursing homes suffer many negative consequences, such as pressure ulcers (Hickey et al, 2005; Kayser-Jones et al, 2008), unexpected weight loss (Bostick, Rantz, Flesner, & Riggs, 2006), increased urinary catheterization, and a decline their ability to complete activities of daily living (Horn, Buerhaus, Bergstrom, & Smout, 2005). …”