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Alito A, Portaro S, Leonardi G, Ventimiglia C, Bonanno F, Fenga D, Sconza C, Tisano A. Pressure Ulcers-A Longstanding Problem: A 7-Year Neurorehabilitation Unit Experience of Management, Care, and Clinical Outcomes. Diagnostics (Basel) 2023; 13:3213. [PMID: 37892035 PMCID: PMC10605717 DOI: 10.3390/diagnostics13203213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/19/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Neurological disease patients present an increased risk of developing pressure ulcers. The primary aim of this study is to evaluate the incidence and prevalence of pressure ulcers and their impact on length of stay and functional recovery. METHODS A retrospective study was conducted in a neurorehabilitation unit over a seven-year period. Data collected include demographic data, length of stay, functional evaluation, risk of pressure ulcers development, nutritional status, and skin. Pressure ulcers were classified according to the European Pressure Ulcer Advisory Panel System. RESULTS Data from 816 patients were analyzed. On admission, the authors found 236 pressure ulcers in 131 patients (about 16%), divided into stage I (25%), stage II (50%), and stage III-IV (25%). The most common sites were the heel (36%) and sacrum (29%). Among the risk factors for the development of pressure ulcers, malnutrition played a significant role, with approximately 76% of patients with pressure ulcers having mild to moderate malnutrition. CONCLUSION The presence of pressure ulcers seems to have a negative impact on the functional recovery of patients, as shown by the outcome scales and the average length of stay: 51 days versus 36 days (p < 0.01).
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Affiliation(s)
- Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy
| | - Simona Portaro
- Physical Rehabilitation Medicine Department, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Giulia Leonardi
- Physical Rehabilitation Medicine Department, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Carlotta Ventimiglia
- Department of Adult and Developmental Human Pathology, University of Messina, 98125 Messina, Italy;
| | - Francesco Bonanno
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.T.); (F.B.)
| | - Domenico Fenga
- Department of Orthopaedics and Traumatology, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Cristiano Sconza
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Adriana Tisano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.T.); (F.B.)
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Sefcik JS, McLaurin EJ, Bass EJ, DiMaria-Ghalili RA. Chronic wounds in persons living with dementia: An integrative review. Int J Older People Nurs 2022; 17:e12447. [PMID: 35043568 PMCID: PMC9186127 DOI: 10.1111/opn.12447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/20/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persons living with dementia (PLWD) are at risk for chronic wounds; however, they are rarely included in research. OBJECTIVES To inform practice and research directions, the aim of this integrative review was to identify and synthesise previous knowledge about the characteristics of chronic wounds in PLWD, in terms of chronic wound types, prevalence, setting and interventions. DESIGN A literature search was conducted for publications in English using PubMed, Web of Science and CINAHL. The minimum information required for inclusion was how many PLWD enrolled in the study had wounds. METHODS This integrative review followed the Whittemore and Knafl methodology. Data extraction and synthesis were guided by a directed content analysis, with a coding structure based on an initial review of the literature. RESULTS Thirty-six articles met the inclusion criteria. The majority were missing characteristics of PLWD including severity of dementia and race/ethnicity/nationality, and none mentioned skin tone. Most focused on pressure injuries in the nursing home and acute care setting. Few included information on interventions. Only one discussed challenges of wound care for a PLWD exhibiting aggression. CONCLUSION There is a gap in the literature regarding PLWD and chronic wounds other than pressure injuries that are common in older adults (e.g. diabetic foot ulcers, venous leg ulcers). Research is warranted among those PLWD who live alone and those who receive wound care from family caregivers to understand experiences. Knowledge can inform the development of future novel interventions for wound healing. Future research is needed regarding chronic wounds in those who exhibit behavioural and psychological symptoms of dementia. RELEVANCE TO CLINICAL PRACTICE Nurses that care for chronic wounds in PLWD can contribute their knowledge to include information in guidelines on best care practices and contribute their perspective to research teams for future research.
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Affiliation(s)
- Justine S Sefcik
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Elease J McLaurin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ellen J Bass
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA.,College of Computing & Informatics, Drexel University, Philadelphia, Pennsylvania, USA
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Tuz MA, Mitchell A. The influence of anaemia on pressure ulcer healing in elderly patients. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:S32-S38. [PMID: 34379458 DOI: 10.12968/bjon.2021.30.15.s32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Anaemia is a common and multifactorial blood disorder in elderly individuals. This condition may be a significant barrier to pressure ulcers healing as it is associated with a decreased level of oxygen being supplied to body tissues. Some nutritional deficiencies such as iron, vitamin B12 and folate may also cause anaemia and have a negative impact on pressure ulcer healing. An increased iron demand in hard-to-heal pressure ulcers is a significant factor associated with the risk of anaemia of chronic disease in elderly patients. Anaemia screening and correction may need to be considered as well as iron supplementation if required in pressure ulcer prevention and management.
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Affiliation(s)
| | - Aby Mitchell
- Senior Lecturer, Adult Nursing, University of West London
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Gupta AD, Addison S. Healing hand ulcers caused by focal spasticity. Int Wound J 2020; 17:774-780. [PMID: 32135027 DOI: 10.1111/iwj.13335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/20/2020] [Indexed: 11/28/2022] Open
Abstract
Spasticity is a common manifestation of many upper motor neuron lesions such as stroke, traumatic brain injury, and multiple sclerosis. In some cases, spastic fingers in the hand press hard into the palm, resulting in skin breakdown and atypical pressure ulcerations. We treated 10 such patients living in the nursing homes with long-standing treatment-resistant hand ulcers in our spasticity clinic first, with Botulinum toxin A (BoNTA) injection into the spastic muscles followed by dressing, splinting, and hand therapy. These ulcers failed to respond to standard treatment, causing significant pain, offensive smell, increased carer burden, and difficulty in maintaining hygiene as hands could barely be opened for dressing and therapy. We noted complete healing of ulcers with significant improvement in the following outcome measures-Modified Ashworth Scale for spasticity, Visual Analog Scale for pain, pressure ulcer grading for the ulcers, Fingertip to Palm distance for hand opening, Carer Burden Scale, and in the Goal Attainment Scale pre, 4 weeks, and 3 months postinjection with P values of .003, .003, .004, .005, .004, and .004, respectively. Reducing spasticity with BoNTA should be the first step in treating hand ulcerations caused by focal spasticity, followed by dressing, splinting, and hand therapy.
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Affiliation(s)
- Anupam D Gupta
- Department of Rehabilitation Medicine, The Queen Elizabeth Hospital, University of Adelaide, Woodville South, South Australia, Australia
| | - Samantha Addison
- Department of Rehabilitation Medicine, The Queen Elizabeth Hospital, University of Adelaide, Woodville South, South Australia, Australia
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Gill CE, Hacker ML, Meystedt J, Turchan M, Schnelle JF, Simmons SF, Habermann R, Phibbs FT, Charles D. Prevalence of Spasticity in Nursing Home Residents. J Am Med Dir Assoc 2020; 21:1157-1160. [PMID: 32085950 DOI: 10.1016/j.jamda.2020.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the prevalence, rate of underdiagnosis and undertreatment, and association with activities of daily living dependency of spasticity in a nursing home setting. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS This study is an analysis of a deidentified data set generated by a prior quality improvement project at a 240-bed nursing home for residents receiving long-term care or skilled nursing care services. METHODS Each resident was examined by a movement disorders specialist neurologist to determine whether spasticity was present and, if so, the total number of spastic postures present in upper and lower limbs was recorded. Medical records, including the Minimum Data Set, were reviewed for neurologic diagnoses associated with spasticity, activities of daily living (ADL) dependency, and prior documentation of diagnosis and past or current treatments. Ordinary least squares linear regression models were used to evaluate the association between spasticity and ADL dependency. RESULTS Two hundred nine residents (154 women, 81.9 ± 10.9 years) were included in this analysis. Spasticity was present in 22% (45/209) of residents examined by the neurologist. Only 11% of residents (5/45) had a prior diagnosis of spasticity and were receiving treatment. Presence of spasticity was associated with greater ADL dependency (χ2 = 51.72, P < .001), which was driven by lower limb spasticity (χ2 = 14.56, P = .006). CONCLUSIONS AND IMPLICATIONS These results suggest that spasticity (1) is common in nursing homes (1 of 5 residents), (2) is often not diagnosed or adequately treated, and (3) is associated with worse ADL dependency. Further research is needed to enhance the rates of diagnosis and treatment of spasticity in long-term care facilities.
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Affiliation(s)
- Chandler E Gill
- Department of Neurology, Rush University Medical Center, Chicago, IL
| | - Mallory L Hacker
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN
| | - Jacqueline Meystedt
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Maxim Turchan
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - John F Schnelle
- Department of Medicine, Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN
| | - Sandra F Simmons
- Department of Medicine, Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN; Geriatric Research Education & Clinical Center, Tennessee Valley VA Healthcare System, Nashville, TN
| | - Ralf Habermann
- Geriatric Research Education & Clinical Center, Tennessee Valley VA Healthcare System, Nashville, TN
| | - Fenna T Phibbs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - David Charles
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN.
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Marcusso RMN, Van Weyenbergh J, de Moura JVL, Dahy FE, de Moura Brasil Matos A, Haziot MEJ, Vidal JE, Fonseca LAM, Smid J, Assone T, Casseb J, de Oliveira ACP. Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil. Pathogens 2019; 9:pathogens9010025. [PMID: 31888093 PMCID: PMC7168659 DOI: 10.3390/pathogens9010025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/30/2019] [Accepted: 12/24/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Despite its relatively low incidence of associated diseases, Human T-cell Leukemia Virus-1 (HTLV-1) infection was reported to carry a significant risk of mortality in several endemic areas. HTLV-1-associated diseases, adult T-cell leukemia/lymphoma (ATLL) and HTLV-1-associated myelopathy/tropical spastic paraperesis (HAM/TSP), as well as frequent coinfections with human immunodeficiency virus (HIV), hepatitis C virus (HCV), and Strongyloides stercoralis were associated to increased morbidity and mortality of HTLV-1 infection. Objective: To determine the mortality rate and its associated variables from an open cohort started in July 1997 at the HTLV Clinic, Emilio Ribas Institute (IIER), a major infectious disease hospital in São Paulo, Brazil. Methods: Since inception up to September 2018, we admitted 727 HTLV-1-infected individuals, with a rate of 30–50 new admissions per year. All patient data, including clinical and laboratory data, were regularly updated throughout the 21-year period, using a dedicated REDCap database. The Ethical Board of IIER approved the protocol. Results: During 21 years of clinical care to people living with HTLV-1 in the São Paulo region, we recruited 479 asymptomatic HTLV-1-infected individuals and 248 HAM/TSP patients, of which 632 remained under active follow-up. During a total of 3800 person-years of follow-up (maximum follow-up 21.5 years, mean follow-up 6.0 years), 27 individuals died (median age of 51.5 years), of which 12 were asymptomatic, one ATLL patient and 14 HAM/TSP patients. HAM/TSP diagnosis (but neither age nor gender) was a significant predictor of increased mortality by univariate and multivariate (hazard ratio (HR) 5.03, 95% CI [1.96–12.91], p = 0.001) Cox regression models. Coinfection with HIV/HCV was an independent predictor of increased mortality (HR 15.08; 95% CI [5.50–41.32]; p < 0.001), with AIDS-related infections as a more frequent cause of death in asymptomatics (6/13; p = 0.033). HIV/HCV-negative fatal HAM/TSP cases were all female, with urinary tract infection and decubitus ulcer-associated sepsis as the main cause of death (8/14, p = 0.002). Conclusions: All-cause mortality among people living with HTLV-1 in São Paulo differs between asymptomatic (2.9%) and HAM/TSP patients (7.3%), independent of age and gender. We observe a dichotomy in fatal cases, with HAM/TSP and HIV/HCV coinfection as independent risk factors for death. Our findings reveal an urgent need for public health actions, as the major causes of death, infections secondary to decubitus ulcers, and immune deficiency syndrome (AIDS)-related infections, can be targeted by preventive measures.
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Affiliation(s)
- Rosa Maria N. Marcusso
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
- Correspondence: (R.M.N.M.); (A.C.P.d.O.)
| | - Johan Van Weyenbergh
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium;
| | - João Victor Luisi de Moura
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
| | - Flávia Esper Dahy
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
| | | | - Michel E. J. Haziot
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
| | - Jose E. Vidal
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
- Institute of Tropical Medicine of São Paulo, São Paulo 05403-000, Brazil; (A.d.M.B.M.); (L.A.M.F.); (J.C.)
| | - Luiz Augusto M. Fonseca
- Institute of Tropical Medicine of São Paulo, São Paulo 05403-000, Brazil; (A.d.M.B.M.); (L.A.M.F.); (J.C.)
| | - Jerusa Smid
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
| | - Tatiane Assone
- Institute of Tropical Medicine of São Paulo, São Paulo 05403-000, Brazil; (A.d.M.B.M.); (L.A.M.F.); (J.C.)
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, Medical School, University of São Paulo Brazil, São Paulo 05403-000, Brazil
| | - Jorge Casseb
- Institute of Tropical Medicine of São Paulo, São Paulo 05403-000, Brazil; (A.d.M.B.M.); (L.A.M.F.); (J.C.)
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, Medical School, University of São Paulo Brazil, São Paulo 05403-000, Brazil
| | - Augusto César Penalva de Oliveira
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
- Correspondence: (R.M.N.M.); (A.C.P.d.O.)
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Jaul E, Factor H, Karni S, Schiffmiller T, Meiron O. Spasticity and dementia increase the risk of pressure ulcers. Int Wound J 2019; 16:847-851. [PMID: 30895715 DOI: 10.1111/iwj.13110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 02/20/2019] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to identify and characterise the association between the prevalence of pressure ulcers, spasticity levels, and advanced dementia in disable elderly patients. Data were obtained from the patient medical files. Patients were hospitalised in the geriatric skilled nursing department. A total of 40 frail elderly patients, bedbound and suffering from advanced chronic diseases, advanced dementia, and high-grade pressure ulcers, were examined. Pressure ulcer grades and spasticity in advanced dementia versus non-dementia patients were evaluated. Logistic regression indicated that only advanced dementia and spasticity were significantly associated with the development of pressure ulcers versus those without dementia or without spasticity. Patients with advanced dementia displayed a significantly higher prevalence of severe spasticity. In multivariate logistic regression analyses, spasticity was significantly associated with pressure ulcers. The strong association of spasticity with the onset of pressure ulcers in advanced dementia should encourage clinicians to implement preventative measures to delay the onset of pressure ulcers.
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Affiliation(s)
- Efraim Jaul
- Geriatric Skilled Nursing Department, Herzog Medical Center, Hebrew University, Jerusalem, Israel
| | - Hagai Factor
- Electrophysiology and Neurocognition Lab, Clinical Research Center for Brain Sciences, Herzog Medical Center, Jerusalem, Israel
| | - Sharon Karni
- Occupational Therapy Department, Herzog Medical Center, Jerusalem, Israel
| | | | - Oded Meiron
- Electrophysiology and Neurocognition Lab, Clinical Research Center for Brain Sciences, Herzog Medical Center, Jerusalem, Israel
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