Main Article Content
Purpose: To determine predicting factors of pressure ulcerdevelopment in elderly stroke patients.
Design: A predictive study design.
Methods: The 107 elderly stroke patients from urbancommunities in 3 districts; Bangkok Noi, Thonburi andPasicharoen; were recruited for this study. Data were collected byusing the demographic questionnaire, the skin Assessment tool,and the Braden risk assessment scale for each patient. The resultswere analyzed using descriptive statistics, chi-square test, andlogistic regression analysis.
Main findings: The results revealed that sensory perception(χ2 = 12.4, p = .002) mobility (χ2 = 34.5, p < .001) activity (χ2 = 33.9, p < .001) moisture (χ2 = 41.0, p < .001) friction and shearing(χ2 = 53.7, p < .001) and nutrition (χ2 = 32.3, p < .001) weresignificantly associated with pressure ulcers. Multiple LogisticRegression analysis was applied to calculate the odds ratio. Threerisk factors were statistically significant in predicting pressureulcer. There were moisture (OR = 2.2, 95%CI = 1.12 - 4.12, p <.05) friction and shearing (OR = 11.2, 95%CI = 2.61 - 47.91, p =.001) and nutrition (OR = 2.8, 95%CI = 1.36 - 5.85, p < .01).Pseudo R2 indicated that 75.2 % of the variation in pressure ulcerdevelopment was explained by the binary logistic regressionmodel. Overall, the correct prediction rate was 86%.
Conclusion and recommendations: Health care providersshould develop a clinical practice guidelines for prevention andrisk factors management of pressure ulcer development, especiallymoisture, friction, shearing, and nutrition to reduce the incidencerate of pressure ulcers in elderly stroke patients.
Copyright Notice: Nursing Science Journal of Thailand has exclusive rights to publish and distribute the manuscript and all contents therein. Without the journal’s permission, the dissemination of the manuscript in another journal or online, and the reproduction of the manuscript for non-educational purpose are prohibited.
Disclaimer: The opinion expressed and figures provided in this journal, NSJT, are the sole responsibility of the authors. The editorial board bears no responsibility in this regard.
Sackley C, Brittle N, Patel S, Ellins J, Scott M, Wright C, et al. The prevalence of joint contractures, pressure sores, painful shoulder, other pain, falls, and depression in the year after a severely disabling stroke. Stroke. 2008;39(12):3329-34.
Franzen-Dahlin A, Billing E, Nasman P, Martensson B, Wredling R, Murray V. Poststroke depression-effect on the life situation of the significant other. Scand J Caring Sci.
Hanger HC, Wilkinson TJ, Mears A. Stroke discharge from a rehabilitation unit: 1-year and 5-year domicile outcomes. Function is important. Internal Med J. 2010;40:45-51.
Landi F, Onder G, Russo A, Bernabei R. Pressure ulcer and mortality in frail elderly people living in community. Arch Gerontol Geriatr Suppl. 2007;1:217-23.
Soppi E. Pressure ulcer--occurrence, pathophysiology and prevention. Duodecim. 2010;126(3):261-8.
Bergquist S. Pressure ulcer prediction in older adults receiving home health care: Implications for use with the OASIS. Adv Skin Wound Care. 2003;16:132-9.
Suttipong C, Sindhu S, Utriyaprasit K, Saneha J, Nilanont Y. Factors Associated with Severity of Pressor Ulcers in Patients with Stoke. The Thai Journal of Nursing
Council. 2006;21(4):56-67. (in Thai).
Bergstrom N, Horn SD, Smout RJ, Bender SA, Ferguson ML, Taler G, et al. The National Pressure Ulcer Long-Term Care Study: outcomes of pressure ulcer treatments in
long-term care. J Am Geriatr Soc. 2005;53(10):1721-9.
Redelings MD, Lee NE, Sorvillo F. Pressure ulcers: more lethal than we thought? Adv Skin Wound Care. 2005;18(7):367-72.
Sae-Sia W, Wipke-Tevis DD, Williams DA. Elevated sacral skin temperature (T(s)): a risk factor for pressure ulcer development in hospitalized neurologically impaired Thai patients. Appl Nurs Res. 2005;18(1):29-35.
Brem H, Maggi J, Nierman D, Rolnitzky L, Bell D, Rennert R, et al. High cost of stage IV pressure ulcers. Am J Surg. 2010;200 (4):473-7.
Kerstein MD, Gemmen E, Rijswijk LV, Lyder CH, Phillips T, Xakellis G, et al. Cost and cost effectiveness of venous and pressure ulcer protocols of care. Dis Manage Health Outcomes. 2001;9:651-63.
Capitano B, Leshem OA, Nightingale CH, Nicolau DP. Cost effect of managing methicillin-resistant Staphylococcus aureus in a long-term care facility. J Am Geriatr Soc. 2003;51(1):10-6.
Ostwald SK, Swank PR, Khan MM. Predictors of functional independence and stress level of stroke survivors at discharge from inpatient rehabilitation. J Cardiovasc Nurs. 2008;23(4):371-7.
Kwong EW, Pang SM, Aboo GH, Law SS. Pressure ulcer development in older residents in nursing homes: influencing factors. J Adv Nurs. 2009;65(12):2608-20.
Ngamprasert M. Risk factors of pressure ulcers in the hospitalized elderly.(Thesis). Bangkok, Mahidol University; 2002.
Buranakul A. Pressure ulcer risk factors among hospitalized neurological patients.(Thesis). Bangkok, Mahidol University; 2002.
Braden B, Bergstrom N. A Conceptual schema for the study of the etiology of pressure sores. Rehabil Nurs. 2000;25(3):105-9.
Bluestein D, Javaheri A. Pressure ulcers: prevention, evaluation, and management. Am Fam Physician. 2008;78(10):1186-94.
Westergren A, Karlsson S, Andersson P, Ohlsson O, Hallberg IR. Eating difficulties, need for assisted eating, nutritional status and pressure ulcers in patients admitted for stroke rehabilitation. J Clin Nurs.2001;10(2):257-69.
Lizaka S, Okuwa M, Sugama J, Sanada H. The impact of malnutrition and nutritionrelated factors on the development and severity of pressure ulcers in older patients receiving home care. Clin Nutr. 2009;29(1):
Lindgren M, Unosson M, Krantz A-M, Ek A-C. Pressure ulcer risk factors in patients undergoing surgery. J Adv Nurs. 2005;50(6): 605-12.
Lohachiwa S. Relationships among hope, social support and quality of life of the elderly with stroke. (Thesis). Bangkok, Mahidol University; 2005.
Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 8 ed. Philadelphia:Lippincott;2008.
Khawanmuang R. Pressure ulcer risk assessment in patients with limited activity. (Thesis). Bangkok, Mahidol University; 2001.
Lin LY, Lee CH, Yu CC, Tsai CT, Lai LP, Hwang JJ, et al. Risk factors and incidence of ischemic stroke in Taiwanese with nonvalvular atrialfibrillation- a nation wide database analysis. Atherosclerosis. 2011;217(1):292-5.
Nonnemacher M, Stausberg J, Bartoszek G, Lottko B, Neuhaeuser M, Maier I. Predicting pressure ulcer risk: a multifactorial approach to assess risk factors in a large university hospital population. J Clin Nurs. 2009;18(1):
Phantusena C, Khupantavee N. The principle of nursing for immobilized patients. Adult nursing 1 (surgery). 2nd ed. Songkhla: Chanmuang Publication; 1999. (in Thai).
Ounnapiruk, L. Pathophysiology for Nursing. 4th ed. Bangkok: Boonsiri Publication; 2003. (in Thai).