Pressure ulcers in elderly individuals can cause significant morbidity and mortality and are a major economic burden to the health care system.

The braden Scale is the most widely used tool for the assessment of the risk of developing pressure ulcers.

 

Prevention should be the ultimate objective of pressure ulcer care, and it requires an understanding of the pathophysiology leading to pressure ulcers and the means of reducing both intrinsic and extrinsic risk factors.

 

Clinical manifestations may be minor in the early stages, and early recognition requires a low threshold of suspicion.

Clinical examination often under­estimates the degree of deep-tissue involvement, and its findings are inadequate for the detection of associated osteomyelitis.

 

Microbiological data, if obtained from deep-tissue biopsy, are useful for directing antimicrobial therapy, but they are insuf­ficient as the sole criterion for the diagnosis of infection.

Imaging studies, such as computed tomography and magnetic resonance imaging, are useful, but bone biopsy and histopathological evaluation remain the “gold standard” for the detection of osteomyelitis.

The goals of treatment of pressure ulcers should be resolution of infection, promotion of wound healing, and establishment of effective infection control

Pressure ulcers have important consequences both for patients and for the health care system. They can lead to severe or intolerable pain, are prone to infection, and are associated with high mortality rates (Allman RM, 1997).

They also inflict a considerable economic burden on the health care system (Xakellis GC, 1996).

 

Prevention

The keys to prevention are identifying patients at risk, improving general health, minimizing external forces, and promoting educational programs about pressure ulcers to caregivers.

In this regard, the importance of quality nursing care in the prevention of pressure ulcers cannot be overemphasized.

The incidence of pressure ulcers in a long-term care facility is often a direct measure of the quality of nursing care provided, particularly in the meticulous attention paid to careful positioning and frequent turning of the bedridden patient.

 

Various risk pre­diction scales (such as the Braden scale) have been developed to aid in patient assessment and to identify patients for whom early treatment or prevention of pressure ulcers should be considered (Perneger TV, 1998).

 

Ability to minimize the 4 ex­trinsic risk factors (pressure, friction, shear stress, and moisture) is crucial to this preventive strategy. Pressure can be reduced through careful positioning and turning.

Friction and shear stress can be avoided by not pulling patients over their beds and by paying attention to their positioning.

Moisture usually is the result of incontinence; incontinence should be treated, if possible, or its effects should be reduced by the use of ab­sorbent pads.

 

There also is strong evidence that educational programs can lead to a reduction in the incidence of pressure ulcers (Moody BL, 1988).

A multitude of devices and different dressings and topical agents that have been proposed for the treatment or prevention of pressure ulcers.

The Pressure Ulcer Scale for healing (PUSH) tool is useful for monitoring the progress healing of pressure ulcers over time.