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The prevention and management of pressure ulcers

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  01 November 2007

David R Thomas
David R Thomas*
Affiliation:
Saint Louis University Health Sciences Center, Saint Louis, MO, USA
*
Address for correspondence: DR Thomas, St. Louis University Health Sciences Center, Dept. of Geriatric Medicine, 1402 South Grand Blvd. M23, St. Louis, MO 63104 63104, USA.
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Extract

Pressure ulcers are the visible evidence of pathological changes in the blood supply to dermal tissues. Pressure ulcers are rare, affecting only about 0.5% of the total population. The distribution is clustered into two groups, peaking once in younger, mostly neurologically impaired persons and again in older persons. The cluster in the geriatric population accounts for about 70% of all pressure ulcers.

Type
Biological gerontology
Information
Reviews in Clinical Gerontology , Volume 17 , Issue 4 , November 2007 , pp. 241 - 257
Copyright
Copyright © Cambridge University Press 2008

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References

1Whittington, K, Patrick, M, Roberts, JL. A national study of pressure ulcer prevalence and incidence in acute care hospitals. J Wound Ostomy Continence Nurs 2000; 27:209–15.Google ScholarPubMed
2Seiler, WO, Stahelin, HB. Skin oxygen tension as a function of imposed skin pressure: implication for decubitus ulcer formation. J Am Geriatr Soc 1979; 27:298–301.CrossRefGoogle ScholarPubMed
3Vasconez, LO, Schneider, WJ, Jurkiewicz, MJ. Pressure sores. Curr Probl Surg 1977; 14:1–62.CrossRefGoogle ScholarPubMed
4Meehan, M. National pressure ulcer prevalence survey. Adv Wound Care 1994; 7:27–30, 34, 36–8.Google ScholarPubMed
5Barbenel, J. The prevalence of pressure sores. National Symposium on the Care, Treatment, and Prevention of Decubitus Ulcers. Conference proceedings 1984: 1–9.Google Scholar
6Sanada, H, Nagakawa, T, Yamamoto, M, Higashidani, K, Tsuru, H, Sugama, J. The role of skin blood flow in pressure ulcer development during surgery. Adv Wound Care 1997; 10:29–34.Google ScholarPubMed
7Mayrovitz, HN, Sims, N, Taylor, MC. Sacral skin blood perfusion: a factor in pressure ulcers? Ostomy Wound Manage 2002; 48:34–8, 40–2.Google ScholarPubMed
8Van Marum, RJ, Meijer, JH, Ribbe, MW. The relationship between pressure ulcers and skin blood flow response after local cold provocation. Arch Phys Med Rehabil 2002; 83:40–3.CrossRefGoogle ScholarPubMed
9Thomas, DR. Are all pressure ulcers avoidable? J Am Med Dir Assoc 2001; 2:297–301.CrossRefGoogle ScholarPubMed
10Scott, JR, Gibran, NS, Engrav, LH, Mack, CD, Rivara, FP. Incidence and characteristics of hospitalized patients with pressure ulcers: State of Washington, 1987 to 2000. Plast Reconstr Surg 2006; 117:630–34.CrossRefGoogle ScholarPubMed
11Gunningberg, L. EPUAP pressure ulcer prevalence survey in Sweden: a two-year follow-up of quality indicators. J Wound Ostomy Continence Nurs 2006; 33:258–66.CrossRefGoogle ScholarPubMed
12Pancorbo-Hidalgo, PL, Garcia-Fernandez, FP, Lopez-Medine, IM, Alvariex-Nieto, C. Risk assessment scales for pressure ulcer prevention: a systematic review. J Adv Nurs 2006; 54:94–110.CrossRefGoogle ScholarPubMed
13Cullum, N, Deeks, J, Fletcher, A et al. The prevention and treatment of pressure sores: how useful are the measures for scoring people's risk of developing a pressure sore? Eff Health Care 1995; 2:1–18.Google Scholar
14McGough, A. A systematic review of the effectiveness of risk assessment scales used in the prevention and management of pressure sores. In: Rycroft-Malone, J, McInnes, E eds. Pressure ulcer risk assessment and prevention, technical report. London: Royal College of Nursing, 2000: 84–99.Google Scholar
15Vanderwee, K, Grypdonck, M, Defloor, T. Non-blanchable erythema as an indicator for the need for pressure ulcer prevention: a randomized-controlled trial. J Clin Nurs 2007; 16:325–35.CrossRefGoogle ScholarPubMed
16Kenedi, RM, Cowden, JM, Scales, JT eds. Bedsore biomechanics. Baltimore: University Park Press, 1976.Google Scholar
17Knox, DM, Anderson, TM, Anderson, PS. Effects of different turn intervals on skin of healthy older adults. Adv Wound Care 1994; 7:48–52, 54–56.Google ScholarPubMed
18Bliss, MR, McLaren, R. Preventing pressure sores in geriatric patients. Nurs Mirror Midwives' J 1967; 123:434–37, passim.Google ScholarPubMed
19Clark, M. Repositioning to prevent pressure sores–what is the evidence? Nurs Stand 1998; 13:58–60, 62, 64.CrossRefGoogle ScholarPubMed
20Cullum, N, McInnes, E, Bell-Syer, SEM, Legood, R. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev 2004 (3): CD001735.Google ScholarPubMed
21Maklebust, J, Mondoux, L, Sieggreen, M. Pressure relief characteristics of various support surfaces used in prevention and treatment of pressure ulcers. J Enterostomal Ther 1986; 13:85–89.Google ScholarPubMed
22Krouskop, TA, Williams, R, Krebs, M et al. Effectiveness of mattress overlays in reducing interface pressures during recumbency. J Rehabil Res Dev 1985; 22:7–10.CrossRefGoogle ScholarPubMed
23Guin, P, Hudson, A, Gallo, J. The efficacy of six heel pressure-reducing devices. Decubitus 1991; 4:15–16, 18, 20, passim.Google ScholarPubMed
24Mulder, GD, LaPan, M. Decubitus ulcers: update on new approaches to treatment. Geriatrics 1988; 43:37–39, 44–45, 49–50.Google ScholarPubMed
25Defloor, T, De Bacquer, D, Grypdonck, MH. The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers. Int J Nurs Stud 2005; 42:37–46.CrossRefGoogle ScholarPubMed
26Defloor, T. Less frequent turning intervals and yet less pressure ulcers. Tijdschr Gerontol Geriatr 2001; 32:174–77.Google ScholarPubMed
27Vanderwee, K, Grypdonck, MH, De Bacquer, D, Defloor, T. Effectiveness of turning with unequal time intervals of the incidence of pressure ulcer lesions. J Adv Nurs 2007; 57:59–68.CrossRefGoogle ScholarPubMed
28Vanderwee, K, Grypdonck, MH, Defloor, T. Effectiveness of alternating pressure air mattresses for the prevention of pressure ulcers. Age Ageing 2005; 34:261–7.CrossRefGoogle ScholarPubMed
29Stapleton, M. Preventing pressure sores – an evaluation of three products. Geriatr Nurs (Lond) 1986; 6:23–5.Google ScholarPubMed
30Gebhardt, KS, Bliss, MR, Winwright, PL, Thomas, J. Pressure-relieving supports in an ICU. J Wound Care 1996; 5:116–21.CrossRefGoogle Scholar
31Reddy, M, Gill, SS, Bouchon, PA. Preventing pressure ulcers: a systematic review. JAMA 2006; 296:974–84.CrossRefGoogle ScholarPubMed
32Thomas, DR. The role of nutrition in prevention and healing of pressure ulcers. Clin Geriatr Med 1997: 13:497–511.CrossRefGoogle ScholarPubMed
33Takeda, T, Koyama, T, Izawa, Y et al. Effects of malnutrition on development of experimental pressure sores. J Dermatol 1992; 19:602–09.CrossRefGoogle ScholarPubMed
34Thomas, DR, Goode, PS, Tarquine, PH, Allman, R. Hospital-acquired pressure ulcers and risk of death. J Am Geriatr Soc 1996; 44:1435–40.CrossRefGoogle ScholarPubMed
35Pinchcofsky-Devin, GD, Kaminski, MV Jr. Correlation of pressure sores and nutritional status. J Am Geriatr Soc 1986; 34:435–40.CrossRefGoogle ScholarPubMed
36Thomas, DR. Distinguishing starvation from cachexia. Clin Geriatr Med 2002; 188:83–91.Google Scholar
37Thomas, DR. Loss of skeletal muscle mass in aging: examining the relationship of starvation, sarcopenia and cachexia. Clin Nutr 2007; 26:389–99.CrossRefGoogle ScholarPubMed
38Langer, G, Schloemer, G, Knerr, A, Kuss, O, Behrens, J. Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database Syst Rev 2003; (4): CD003216CrossRefGoogle Scholar
39Bourdel-Marchasson, I, Barateau, M, Rondeau, V et al. A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients. GAGE Group. Groupe Aquitain Geriatrique d'Evaluation. Nutrition 2000; 16:1–5.CrossRefGoogle ScholarPubMed
40Langer, G, Schloemer, G, Knerr, A, Kuss, O, Behrens, J. Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database Syst Rev 2003; (4) CD003216.CrossRefGoogle Scholar
41Audit Commission. The virtue of patients: making the best use of ward nurse resources. The Audit Commission for Local Authorities and the National Health Service in England and Wales, London, 1991.Google Scholar
42Thomas, DR, Osterweil, D. Is a pressure ulcer a marker for quality of care? J Am Med Dir Assoc 2005; 6:228–30.CrossRefGoogle ScholarPubMed
43Lyder, CH, Preston, J, Grady, JN et al. Quality of care for hospitalized medicare patients at risk for pressure ulcers. Arch Intern Med 2001; 161:1549–54.CrossRefGoogle ScholarPubMed
44Bates-Jensen, BM, Cadogan, M, Osterweil, D et al. The Minimum Data Set pressure ulcer indicator: does it reflect differences in care processes related to pressure ulcer prevention and treatment in nursing homes? J Am Geriatr Soc 2003; 51:1203–12.CrossRefGoogle ScholarPubMed
45Abel, RL, Warren, K, Bean, G et al. Quality improvement in nursing homes in Texas: results from a pressure-ulcer prevention project. J Am Med Dir Assoc 2005; 6:181–88.CrossRefGoogle ScholarPubMed
46Lynn, J, West, J, Hausmann, S, Gifford, D et al. Collaborative clinical quality improvement for pressure ulcers in nursing homes. J Am Geriatr Soc 2007; 55:1663–69.CrossRefGoogle ScholarPubMed
47Berlowitz, DR, Bezerra, HQ, Brandeis, GH, Kader, B, Anderson, JJ. Are we improving the quality of nursing home care: the case of pressure ulcers. J Am Geriatr Soc 2000; 48:59–62.CrossRefGoogle ScholarPubMed
48Hopkins, B, Hanlon, M, Yauk, S, Sykes, S, Rose, T, Cleary, A. Reducing nosocomial pressure ulcers in an acute care facility. J Nurs Care Qual 2000; 14:28–36.CrossRefGoogle Scholar
49Richardson, GM, Gardner, S, Frantz, RA. Nursing assessment: impact on type and cost of interventions to prevent pressure ulcers. J Wound Ostomy Continence Nurs 1998; 25:273–80.Google ScholarPubMed
50Hagisawa, S, Barbenel, J. The limits of pressure-sore prevention. J R Soc Med 1999; 92:576–78.CrossRefGoogle ScholarPubMed
51Seiler, WO, Stahelin, HB, Zolliker, R et al. Impaired migration of epidermal cells from decubitus ulcers in cell culture: a cause of protracted wound healing? Am J Clin Pathol 1989; 92:430–34.CrossRefGoogle ScholarPubMed
52Ferrell, BA, Osterweil, D, Christenson, P: A randomized trial of low-air-loss beds for treatment of pressure ulcers. JAMA 1993; 269:494–97.CrossRefGoogle ScholarPubMed
53Brandeis, GH, Morris, JN, Nash, DJ et al. : The epidemiology and natural history of pressure ulcers in elderly nursing-home residents. JAMA 1990; 264:2905–09.CrossRefGoogle ScholarPubMed
54Cullum, N, Deeks, J, Sheldon, TA, Song, F, Fletcher, AW. Beds, mattresses and cushions for pressure sore prevention and treatment. Nurs Times 2001; 97:41.Google ScholarPubMed
55Ferrell, BA, Josephson, K, Norvid, P, Alcorn, H. Pressure ulcers among patients admitted to home care. J Am Geriatr Soc 2000; 48:1165–66.CrossRefGoogle ScholarPubMed
56Eaglstein, WH, Mertz, PM. New method for assessing epidermal wound healing. The effects of triamcinolone acetonide and polyethylene film occlusion. J Invest Derm 1978; 71:382–84.CrossRefGoogle ScholarPubMed
57Bolton, L, Johnson, C, van Rijswijk, L. Occlusive dressings: therapeutic agents and effects on drug delivery. Clin Dermatol 1991; 9:573–83.CrossRefGoogle ScholarPubMed
58Thomas, DR. Issues and dilemmas in managing pressure ulcers. J Gerontol Med Sci 2001; 56:M238–M340.CrossRefGoogle Scholar
59Bradley, M, Cullum, N, Nelson, E A, Petticrew, M, Sheldon, T, Torgerson, D. Systematic reviews of wound care management: dressings and topical agents used in the healing of chronic wounds. Health Technol Assess 1999; 3:1–135.CrossRefGoogle ScholarPubMed
60Graumlich, JF, Blough, LS, McLaughlin, RG et al. Healing pressure ulcers with collagen or hydrocolloid: a randomized, controlled trial. J Am Geriatr Soc 2003; 51:147–54.CrossRefGoogle ScholarPubMed
61Bouza, C, Saz, Z, Munoz, A, Amate, J. Efficacy of advanced dressings in the treatment of pressure ulcers: a systematic review. J Wound Care 2005; 14:193–99.CrossRefGoogle ScholarPubMed
62Thomas, DR. Age-related changes in wound healing. Drugs Aging 2001; 18:607–20.CrossRefGoogle ScholarPubMed
63Robson, MC, Phillips, LG, Thomason, A et al. Recombinant human platelet-derived growth factor-BB for the treatment of chronic pressure ulcers. Ann Plast Surg 1992; 29:193–201.CrossRefGoogle ScholarPubMed
64Robson, MC, Phillips, LG, Thomason, A et al. Platelet-derived growth factor BB for the treatment of chronic pressure ulcers. Lancet 1992; 339 (8784): 23–25.CrossRefGoogle ScholarPubMed
65Robson, MC, Phillips, LG, Lawrence, WT et al. The safety and effect of topically applied recombinant basic fibroblast growth factor on the healing of chronic pressure sores. Ann Surg 1992; 216:401–06; discussion 406–08.CrossRefGoogle ScholarPubMed
66Landi, F, Aloe, L, Russo, A et al. Topical treatment with nerve growth factor for pressure ulcers: A randomized controlled trial. Ann Intern Med 2003; 139:635–41.CrossRefGoogle Scholar
67Thomas, DR. The promise of topical nerve growth factors in the healing of pressure ulcers. Ann Intern Med 2003; 139:694–95.CrossRefGoogle ScholarPubMed
68Ford, CN, Reinhard, ER, Yeh, D et al. Interim analysis of a prospective, randomized trial of vacuum-assisted closure versus the healthpoint system in the management of pressure ulcers. Ann Plast Surg 2002; 49:55–61.CrossRefGoogle ScholarPubMed
69Wanner, MB, Schwarzl, F, Strub, B, Zaech, GA, Pierer, G. Vacuum-assisted wound closure for cheaper and more comfortable healing of pressure sores: a prospective study. Scand Plast Reconstr Surg Hand Surg J 2003; 37:28–33.CrossRefGoogle ScholarPubMed
70Jones, KR and Fennie, K. Factors influencing pressure ulcer healing in adults over 50: an exploratory study. J Am Med Dir Assoc 2007; 8:378–87.CrossRefGoogle ScholarPubMed
71Thomas, DR. Managing pressure ulcers: learning to give up cherished dogma. J Am Med Dir Assoc 2007; 8:347–48.CrossRefGoogle ScholarPubMed
72Thomas, DR. Improving the outcome of pressure ulcers with nutritional intervention: review of the evidence. Nutrition 2001; 17:121–25.CrossRefGoogle ScholarPubMed
73Gersovitz, M, Motil, K, Munro, HN et al. Human protein requirements: assessment of the adequacy of the current Recommended Dietary Allowance for dietary protein in elderly men and women. Am J Clin Nutr 1982; 35:6–14.CrossRefGoogle ScholarPubMed
74Long, CL, Nelson, KM, Akin, JM Jr. et al. (A physiologic bases for the provision of fuel mixtures in normal and stressed patients. J Trauma 1990; 30:1077–85.CrossRefGoogle Scholar
75Vilter, RW: Nutritional aspects of ascorbic acid: Uses and abuses. West J Med 1980; 133:485–92.Google Scholar
76ter Riet, G, Kessels, AG, Knipschild, PG. Randomized clinical trial of ascorbic acid in the treatment of pressure ulcers. J Clin Epidemiol 1995; 48:1453–60.CrossRefGoogle ScholarPubMed
77Sandstead, HH, Henriksen, LK, Greger, JL et al. Zinc nutrition in the elderly in relation to taste acuity, immune response, and wound healing. Am J Clin Nutr 1982; 36 (5 suppl): 1046–59.CrossRefGoogle ScholarPubMed
78Henderson, CT, Trumbore, LS, Mobarhan, S et al. Prolonged tube-feeding in long-term care: nutritional status and clinical outcomes. J Am Coll Nutr 1992; 11:309–25.CrossRefGoogle ScholarPubMed
79Mitchell, SL, Kiely, DK, Lipsitz, LA. The risk factors and impact on survival of feeding-tube placement in nursing-home residents with severe cognitive impairment. Arch Intern Med 1997; 157:327–32.CrossRefGoogle ScholarPubMed
80Constantine, BE, Bolton, LL. A wound model for ischemic ulcers in the guinea pig. Arch Dermatol Res 1986; 278:429–31.CrossRefGoogle ScholarPubMed
81Bradley, M, Cullum, N, Sheldon, T. The debridement of chronic wounds: a systematic review. Health Technol Assess 1999; 3:1–78.CrossRefGoogle ScholarPubMed
82Alvarez, OM, Fenandez-Obregon, A, Rogers, RS, Bergamo, L, Masso, J, Black, M. Chemical debridement of pressure ulcers: a prospective, randomized, comparative trial of collagenase and papain/urea formulations. Wounds 2000; 12:15–25.Google Scholar
83Meaume, S, Vallet, D, Morere, MN, Teot, L. Evaluation of a silver-releasing hydroalginate dressing in chronic wounds with signs of local infection. J Wound Care 2005; 14:411–19.CrossRefGoogle ScholarPubMed