Nutritional status and functional capacity predispose hospitalized patients to pressure ulcers
Keywords:
Functional residual capacity, Malnutrition, Hospitalizad patients, Pressure ulcerAbstract
Objective
This study investigated if pressure ulcer correlated with the nutritional status and functional capacity of hospitalized patients.
Methods
This cross-sectional study included 130 patients of two hospitals, 77 (59.2%) men and 53 (40.8%) women. The median age of the sample was 52 (14-85) years. Seventy-two (55.4%) patients were hospitalized for clinical treatment, 40 (30.8%) for surgical treatment and 18 (13.8%) for intensive care. Nutritional status was determined by subjective global assessment. The patients were then classified according to their functional capacity as bedridden or not. The number and severity of pressure ulcers was recorded. Grades 3 and 4 pressure ulcer were considered severe and grades 1 and 2 were considered mild.
Results
The incidence of pressure ulcers in the studied population was 19.2% (n=25). Pressure ulcer were not associated with gender, age and type of treatment. Bedridden patients were 7.5 times more likely to have pressure ulcer (19/50; 38.0%) than those who could walk (6/80; 7.5%; OR=7.5; CI95%: 2.7-20.7; p<0.001). The incidence of pressure ulcers in severely malnourished patients (20/49; 40.8%) was 10 times greater than that of better nourished patients (5/81; 6.1%; OR=10.4 CI95%: 3.6-30.5; p<0.0001). According to multivariate analysis, both functional capacity (bedridden, OR=9.2; CI95%: 2.8-30.1; p<0.001) and nutritional status (severe malnutrition, OR=3.8; CI95%: 1.0-13.9; p=0.04) are associated with pressure ulcer.
Conclusion
Pressure ulcers correlate directly with malnutrition and bedridden status in hospitalized patients.
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References
European Pressure Ulcer Advisory Panel. Pressure ulcer treatment guidelines, 2004. Available from:<http://www.epuap.org/gltreatment.html>.
Kerstetter JE, Holthausen BA, Fitz PA. Malnutrition in the institutionalized older adult. J Am Diet Assoc. 1992; 92(9):1109-16.
Allman RM, Laprade CA, Noel LB. Pressure sores among hospitalized patients. Ann Intern Med. 1986;105(3):37-42.
Rogenski NMB, Santos VLCG. Estudo sobre a incidência de úlceras por pressão em um hospital universitário. Rev Latino-Am Enfermagem 2005; 13(4): 474-80. doi:10.1590/S0104-11692005000400 003.
Souza DMST, Santos VLCG. Risk factors for pressure ulcer development in institutionalized elderly. Rev Latino-Am Enfermagem. 2007; 15(5):958-964. doi: 10.1590/S0104-11692007000500012
Mathus-Vliegen EH. Old age, malnutrition, and pressure sores: an ill-fated alliance. J Gerontol. 2004; 59(4):355-60.
Russell L. Physiology of the skin and prevention of pressure sores. Br J Nurs. 1998; 7(18):1084-100.
Thomas DR. Improving outcome of pressure ulcers with nutritional interventions: a review of the evidence. Nutrition. 2001; 17(2):121-5. doi:10.10 16/S0899-9007(00)00514-1
Waitzberg DL, Caisffa WT, Correa MI. Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. Nutrition. 2001; 17(7-8):573-80. doi:10.1016/S0899-9007 (01)00573-1.
Rauen MS, Moreira EAM, Calvo MCM, Lobo AS. Avaliação do estado nutricional de idosos institucionalizados. Rev Nutr. 2008; 21(3):303-10. doi: 10.15 90/S1415-52732008000300005.
Garcia ANM, Romani SAM, Lira PIC. Indicadores antropométricos na avaliação nutricional de idosos: um estudo comparativo. Rev Nutr. 2007; 20(4): 371-8. doi:10.1590/S1415-52732007000400004.
Bryant RA. An introduction to acute and chronic wound care: nursing management. J ET Nurs. 1992; 19(2):38-9.
American Society for Parenteral and Enteral Nutrition. Nutrition support core curriculum: a casebased approach: the adult patient. Silver Spring (MDP): ASPEN; 2007.
Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? J Parenter Enteral Nutr. 1987; 11(1)8-13. doi: 10.117 7/014860718701100108.
Tannen A, Dassen T, Halfens R. Differences in prevalence of pressure ulcers between the Netherlands and Germany: associations between risk, prevention and occurrence of pressure ulcers in hospitals and nursing homes. J Clin Nursing. 2008; 17(9):1237-44. doi:10.1111/j.1365-2702.20 07.02225x.
Chacon JM, Blanes L, Hochman B, Ferreira LM. Prevalence of pressure ulcers among the elderly living in long-stay institutions in São Paulo. Sao Paulo Med J. 2009; 127(4):211-5. doi: 10.1590/S1 516-31802009000400006.
Louro M, Ferreira M, Póvoa P. Avaliação de protocolo de prevenção e tratamento de úlceras de pressão. Rev Bras Ter Intensiva. 2007; 19(3):337-41. doi: 10.1590/S0103-507X2007000300012.
Blanes L, Duarte IS, Calil JA, Ferreira LM. Avaliação clínica e epidemiológica das úlceras por pressão em pacientes internados no Hospital São Paulo. Rev Assoc Med Bras. 2004; 50(2):182-7. doi: 10.15 90/S0104-42302004000200036.
Coellho SC, Silva RC. Perfil dos pacientes hospitalizados com úlcera de pressão. Rev Bras Nutr Clin. 2004; 19(2):64-9.
Thein HH, Gomes T, Krahn MD, Wodchis WP. Health status utilities and the impact of pressure ulcers in long-term care residents in Ontario. Qual Life Res. 2010; 19(1):81-9. doi:10.1007/s11136-009-9563-2
Holm B, Mesch L, Ove H. Importance of nutrition for elderly persons with pressure ulcers or a vulnerability for pressure ulcers: a systematic literature review. Aus J Adv Nurs. 2007; 25(1):77-84.
European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: quick reference guide. Washington (DC): National Pressure Ulcer Advisory Panel; 2009.
Fife C, Otto G, Capsuto EG, Brandt K, Lyssy K, Murphy K, et al. Incidence of pressure ulcers in a neurologic intensive care unit. Crit Care Med. 2001; 29(2):283-90. doi:10.1097/00003246-20010200 0-00011.
Allman RM, Goode PS, Patrick MM. Pressure ulcer risk factors among hospitalized patients with activity limitation. JAMA. 1995; 273(11):865-70. doi: 10.1001/jama.273.11.865.
Castilho LD, Calari MHL. Úlcera de pressão e estado nutricional: revisão da literatura. Rev Bras Enferm. 2005; 58(5):597-601. doi: 10.1590/S0034-716720 05000500018.
Stratton RJ, Ek AC, Engfer M, Moore Z, Rigby P, Wolfe R, et al. Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis. Ageing Res Rev. 2005; 4(3):422-50. doi: 10.1016/j.arr.2005.0 3.005.
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Copyright (c) 2023 Francine PERRONE, Adriene Alexandra PAIVA, Letícia Martins Ignácio de SOUZA, Cássia da Silva FARIA, Márcia Carolina de Siqueira PAESE, José Eduardo de AGUILAR-NASCIMENTO, Diana Borges DOCK-NASCIMENTO
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