Pressure Ulcers in Older Adults

2 Objectives Identify how to calculate the incidence and prevalence of pressure ulcers Perform a risk assessment for pressure ulcers, using validated risk assessment scale Define pressure ulcer, including staging Plan care for prevention of pressure ulcers Plan care to include debridement, cleansing, dressing, and pressure relief

3 Prevalence

4 Incidence 23.9%

5 Healthy People 2010 “Reduce the proportion of nursing home residents with a diagnosis of pressure ulcers to 8 diagnoses per 1,000 residents.”

6 Risk Assessment: Braden Scale 1. Sensory Perception 2. Skin Moisture 3. Activity 4. Mobility 5. Nutrition 6. Friction / Shear Braden Scale Try This Assessment Series available on Hartford Institute website at

7 Risk Assessment: Norton Scale

8 Pressure Ulcer defined Any lesion, caused by unrelieved pressure resulting in damage of underlying tissue.

9 Staging Source: National Pressure Ulcer Advisory Panel, 1989

10 Factors to consider… Nutritional deficiencies / weight Aging Lowered mental status Immunosuppressant drugs Infection Continence

11 Stage I Observable pressure-related alteration of intact skin. Indicators Skin temperature Tissue consistency Sensation

12 Stage II Involves partial thickness skin loss involving epidermis, dermis, or both The ulcer is superficial Clinical presentation: abrasion, blister, or shallow crater

13 Stage III Full thickness skin loss; damage or necrosis of subcutaneous tissue to underlying fascia. Clinical presentation: deep crater with or without undermining of adjacent tissue

14 Stage IV Full thickness skin loss: 1. Extensive destruction 2. Tissue necrosis; sinus tracts 3. Damage to muscle, bone or supporting structures

15 Key Staging Points Only stage once Stage to maximum anatomic depth of tissue involved Do not Reverse Stage

16 Limitations of staging system Difficult to evaluate darkly pigmented skin Use natural or halogen light, NOT FLOURESCENT Cannot be staged if with eschar

17 Prevention: Risk Assessment Bed-or chair-bound persons at risk Use Braden Scale Identify ALL risk factors Assess on admission and regularly

18 Prevention: Skin Care and Early Treatment Inspect skin daily Individualize bathing frequency Assess / treat incontinence Use moisturizers; avoid massaging bony prominences Proper positioning Dry lubricants Correct nutritional deficiencies

19 Prevention: Mechanical Loading and Support Surfaces Reposition bed-bound persons every 2 hours Consider postural alignment Teach chair-bound persons to shift their weight every 15 minutes Use lifting devices Use pillows or foam wedges Elevate HOB as little as possible Use repositioning schedule

20 Prevention: Education Implement educational programs Include etiology, risk assessment, skin assessment, support surfaces, individualized programs of skin care, demonstration of positioning Accurate documentation Mechanism to evaluate

21 Management of Pressure Ulcers AHRQ Guidelines Algorithm

22 Nutritional Assessment AHRQ Guidelines Algorithm

23 Management of Tissue Loads AHRQ Guidelines Algorithm

24 Ulcer Care AHRQ Guidelines Algorithm

25 Managing Bacterial Colonization and Infection AHRQ Guidelines Algorithm

26 Questions?