The Association between Malnutrition and Pressure Ulcers in Elderly in Long-Term Care Facility

Lenche Neloska, Katerina Damevska, Andjelka Nikolchev, Lidija Pavleska, Biljana Petreska-Zovic, Milenko Kostov, Lenche Neloska, Katerina Damevska, Andjelka Nikolchev, Lidija Pavleska, Biljana Petreska-Zovic, Milenko Kostov

Abstract

Background: Malnutrition is common in elderly and is a risk factor for pressure ulcers.

Aim: The aim of the present study was to determine the prevalence of malnutrition in geriatric and palliative patients hospitalised in long-term care facility, and to examine the influence of nutritional status on the prevalence of pressure ulcers (PU).

Material and methods: Descriptive, observational and cross-sectional study including 2099 patients admitted to the Hospital during a 24 month period (January 2013 to December 2014). We recorded: demographic data, body mass index (BMI), Braden score, laboratory parameters of interest (albumin, total protein, RBC count, haemoglobin and iron levels) and presence or absence of malnutrition and pressure ulcers.

Results: The pressure ulcer prevalence was 12.9% (256 out of 2099). Based on the BMI classification, 61.7% of patients had a good nutritional status, 27.4% were undernourished, and 2.1% were considered malnourished. Nutritional status was statistically significantly different between patients with and without PU (p < 0.0001). This study also showed that hypoproteinemia, hypoalbuminemia, low RBC was positively associated with PU prevalence.

Conclusion: The results highlight the impact of nutritional status on the prevalence of pressure ulcers in hospitalised geriatric and palliative population. It is of paramount importance to correctly evaluate the presence of malnutrition in patients at risk of pressure ulcers.

Keywords: geriatric patients; long-term care facility; malnutrition; palliative patients; pressure ulcers.

Figures

Figure 1
Figure 1
Percentage of patients with altered nutrition-related lab values

References

    1. European Pressure Ulcer Advisory Panel, National Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Washington, DC: National Pressure Ulcer Advisory Panel; 2009.
    1. Allman RM. Pressure ulcer prevalence, incidence, risk factors, and impact. Clin Geriatr Med. 1997;13(3):421–36. PMid:9227937.
    1. Horn SD, Bender SA, Ferguson ML, Smout RJ, Bergstrom N, Taler G, Cook AS, Sharkey SS, Voss AC. The National Pressure Ulcer Long-Term Care Study: pressure ulcer development in long-term care residents. J Am Geriatr Soc. 2004;52(3):359–67. . PMid:14962149.
    1. Donini LM, De Felice MR, Tagliaccica A, De Bernardini L, Cannella C. Comorbidity, frailty, and evolution of pressure ulcers in geriatrics. Med Sci Monit. 2005;11(7):CR326–36. PMid:15990690.
    1. Lahmann NA, Halfens RJ, Dassen T. Pressure ulcers in German nursing homes and acute care hospitals: prevalence, frequency, and ulcer characteristics. Ostomy Wound Manage. 2006;52(2):20–33. PMid:16464992.
    1. Neloska L, Damevska K, Nikolchev A, Pavleska L, Petreska-Zovic B, Kostov M. The influence of comorbidity on the prevalence of pressure ulcers in geriatric patients. Glob Dermatol. 2016;3(3):319–322. .
    1. Barker LA, Gout BS, Crowe TC. Hospital malnutrition: Prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011;8(2):514–527. . PMid:21556200 PMCid: PMC3084475.
    1. Braunschweig C, Gomez S, Sheean PM. Impact of declines in nutritional status on outcomes in adult patients hospitalized for more than 7 days. J Am Diet Assoc. 2000;100(11):1316–22. .
    1. Pezzana A, Cereda E, Avagnina P, Malfi G, Paiola E, Frighi Z, Capizzi I, Sgnaolin E, Amerio ML. Nutritional Care Needs in Elderly Residents of Long-Term Care Institutions: Potential Implications for Policies. J Nutr Health Aging. 2015;19(9):947–54. . PMid:26482698.
    1. Lelovics Z. [Nutritional status and nutritional rehabilitation of elderly people living in long-term care institutions] Orv Hetil. 2009;150(44):2028–36. . PMid:19861289.
    1. Lou MF, Dai YT, Huang GS, Yu PJ. Nutritional status and health outcomes for older people with dementia living in institutions. J Adv Nurs. 2007;60(5):470–7. . PMid:17973710.
    1. Gielen E, Verschueren S, O’Neill TW, Pye SR, O’Connell MD, Lee DM, et al. Musculoskeletal frailty: a geriatric syndrome at the core of fracture occurrence in older age. Calcif Tissue Int. 2012;91(3):161–77. . PMid:22797855.
    1. Bergstrom N, Braden B, Kemp M, Champage M, Ruby E. Predicting pressure ulcer risk: a multisite study of the predictive validity of the Braden Scale. Nurs Res. 1998;47:261–9. . PMid:9766454.
    1. Abbasi AA, Rudman D. Observations on the prevalence of protein-calorie undernutrition in VA nursing homes. J Am Geriatr Soc. 1993;41(2):117–21. .
    1. Saunders J, Smith T. Malnutrition: causes and consequences. Clin Med (Lond) 2010;10(6):624–7. .
    1. Brownie S. Why are elderly individuals at risk of nutritional deficiency? Int J Nurs Pract. 2006;12(2):110–8. . PMid:16529597.
    1. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27(1):5–15. . PMid:18061312.
    1. Donini LM, Savina C, Cannella C. Eating habits and appetite control in the elderly: the anorexia of aging. Int Psychogeriatr. 2003;15(1):73–87. . PMid:12834202.
    1. Harris CL, Fraser C. Malnutrition in the institutionalized elderly: the effects on wound healing. Ostomy Wound Manage. 2004;50(10):54–63. PMid:15509882.
    1. Todorovic V. Food and wounds: nutritional factors in wound formation and healing. Br J Community Nurs. 2002;43-4:46. 48 passim. . PMid:12362158.
    1. Smoliner C, Norman K, Scheufele R, Hartig W, Pirlich M, Lochs H. Effects of food fortification on nutritional and functional status in frail elderly nursing home residents at risk of malnutrition. Nutrition. 2008;24(11-12):1139–44. . PMid:18789649.
    1. Günes ÜY, Efteli E. Predictive validity and reliability of the Turkish version of the risk assessment pressure sore scale in intensive care patients: results of a prospective study. Ostomy Wound Manage. 2015;61(4):58–62. PMid:25853378.
    1. Fossum M, Ehnfors M, Svensson E, Hansen LM, Ehrenberg A. Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: an intervention study. Int J Med Inform. 2013;82(10):911–21. . PMid:23827767.
    1. Park KH. A retrospective study using the pressure ulcer scale for healing (PUSH) tool to examine factors affecting stage II pressure ulcer healing in a Korean acute care hospital. Ostomy Wound Manage. 2014;60(9):40–51. PMid:25211606.
    1. Russell L. The importance of patient’s nutritional status in wound healing. B J Nurs. 2001;10(6S):S42–49. . PMid:12070399.
    1. James J. Optimal wound healing: a comprehensive approach through metabolic, anabolic and nutritional interventions. Involuntary weight loss and its effect on the body to heal. WOUNDS. 2002;14(9):4–8.
    1. Mathus-Vliegen EM. Old age, malnutrition, and pressure sores: an ill-fated alliance. J Gerontol A Biol Sci Med Sci. 2004;59(4):355–60. . PMid:15071079.
    1. Balcombe NR, Ferry PG, Saweirs WM. Nutritional status and well being. Is there a relationship between body mass index and the well-being of older people? Curr Med Res Opin. 2001;17:1–7. . PMid:11464440.
    1. Posthauer ME, Banks M, Dorner B, Schols JM. The role of nutrition for pressure ulcer management: national pressure ulcer advisory panel, European pressure ulcer advisory panel, and pan pacific pressure injury alliance white paper. Adv Skin Wound Care. 2015;28(4):175–88. . PMid:25775201.
    1. Elia M, editor. Development and use of the ‘Malnutrition Universal Screening Tool’ (‘MUST’) for Adults. BAPEN; 2003. Screening for Malnutrition: A Multidisciplinary Responsibility.
    1. Milne AC, Potter J, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD003288. Review. Update in: Cochrane Database Syst Rev 2009;(2): CD003288. PMid:19370584.
    1. Kirkland LL, Kashiwagi DT, Brantley S, Scheurer D, Varkey P. Nutrition in the hospitalized patient. J Hosp Med. 2013;8(1):52–58. . PMid:23065968.
    1. Tappenden KA, Quatrara B, Parkhurst ML, Malone AM, Fanjiang G, Ziegler TR. Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. J Parenter Enteral Nutr. 2013;37(4):482–97. . PMid:23736864.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner