Risk Factors of Pressure UIcers in Hospitalized Elderly

Abstract

This study is a hospital based concurrent cohort study with the objectives of investigating the risk factors and the predictive level of the risk factors of pressure ulcers in hospitalized elderly The study was conducted between January 9th and March 12th 2002, in the medical, surgical, and orthopedic wards of Pranangklao Hospital, a 430-bed tertiary hospitsl under the Ministry of Public Health in Nonthaburi Province. The participants in this study were 117 hospitalized elderly patients who were 60 years or older, did not have pressure ulcers on admission, and were hospitalized for at least four days. Data were collected by the researcher and the research assistant who achieved an inter-rater reliability for pressure ulcer risk assessment and skin assessment on the research instrument of 0.905 and 0.954 resprctively. Pressure ulcer risk assessment and skin assessment were conducted daily by utilizing the Braden pressure ulcer risk assessment scale and the Bergstrom's skin assessment scale throughout the study period. Logistic regression analysis was employrd to analyze the data. The results of the study revealed the greatest frequency of pressure ulcers was found in those aged 70 to 79 years old (41%) and had neurological or spinal problems (30.8%). The assessment of elderly patients' risk of pressure ulcers on admission correctly predicted 71.8% of pressure ulces. Of the elderly patients who were predicted to have pressure ulcers, 28.2% developed this complication during the hospitalization period. Most pressure ulcers occurred on the second day after admission. Of the elderly who were predicted not to develop this complication, 93.6% were free from pressure ulcers. An increase in friction and shearing (OR=4.592, 95% CI=1.531-13.770) was the risk factor that had the most influence among the participants, where the second most important risk factor was an increase in core temperature (OR=2.760, 95%CI=1.105-6.891). This study indicates the need for pressure ulcer risk assessment at the time of admission and a need for a pressure ulcer education program for the elderly or their caregivers and for all health care providers. In addition, this study also reveals the need for proper management of these elderly patients who are prone to develop pressure ulcers at the time of admission, especially among those who have increases in friction and shearing forces and an increase in core temperature.