Risk assessment and prevention techniques for pressure ulcers in elderly hospitalized patients: A

Risk assessment and prevention techniques for pressure ulcers in elderly hospitalized patients: A


Annotated Bibliography

In this essay, six sources are analyzed and evaluated to determine if risk assessment helps prevent pressure ulcers in hospitalized elderly patients. Bed sores, also known as pressure ulcers, are injuries to the skin that stem from prolonged pressure on the skin. Areas with more bone density tend to develop calluses, such as the hips, ankles, heels, and tailbone due to their sensitive skin. Also, the underlying tissue is affected by this type of skin injury. Limited mobility is a widespread disease for the elderly caused by health conditions. With aged skin, the likelihood of pressure ulcers increases when dry, thin, or weak. Highly painful and causing infection and complications, these ulcers need immediate attention. In addition to these factors, dementia, paralysis, obesity, and confinement to bed can cause ulcers. Conducting risk assessments helps identify patients prone to pressure ulcers. By evaluating a patient’s condition and health status, risk assessments are conducted using multiple tools. Preventive measures are identified and organized with the help of this process. Throughout this essay, a detailed study is conducted on the benefits of several methods. At the end of the essay, a condensed summary of the six articles offers an evaluative view of the research topic. Evidence-based, a research question has also been formulated, which may be relevant in forthcoming research.

This study examines the effectiveness of using pressure ulcer tools to determine risk levels in high-risk patients, including: B. Elderly people in various health care facilities. Several risk assessment tools are used in various clinical settings, including the Braden tool, Waterlow tool, Norton scale, and Ramstadius tool, but the most effective tools are still unknown. Therefore, the purpose of this study is to compare the accuracy of these tools in determining pressure ulcer risk in patients. These tools were found to make no difference in prevention compared to clinical nursing assessments.

Each patient has different requirements, so no single tool is sufficient to measure the risk of disease occurring in all patients. The authors investigated that these tools may even produce false-positive results. If caregivers follow these findings, they may unnecessarily use preventive techniques in patients who are not at risk. This was confirmed in another study, where 80% of patients received unnecessary precautions due to these inaccurate results. The authors argued that risk assessment is only useful if it is followed by ways to counteract the effects of risk factors. Therefore, risk assessment alone is not sufficient to prevent pressure ulcers. Bedsores have always been a big problem for the nursing care industry. This book considers in detail the various aspects of this disease, its diagnosis and intervention procedures. Two common International that arise before creating a pressure ulcer prevention plan are which risk assessment tools are most effective and how often should risk assessments be performed on patients?

The Norton Scale, which is widely used in the United Kingdom, has five subscales to assess mental status, physical status, mobility, activity, and risk, including incontinence, and is similar to the Braden Scale, which is widely used in the United States. has six subscales for assessing risk, including: Moisture, mobility, activity, sensation, friction and shear, nutrition, etc. Although these two measures have shown good sensitivity and specificity, they are very poor at predicting risk, and their predictive power can vary widely even under the same circumstances. For example, the Norton scale may identify a person as being at risk of developing an ulcer, but the Braden scale may classify the person as not at risk. These limitations of risk assessment tools can impact nurses’ treatment and care of patients. Therefore, a prior risk assessment is not always helpful.

This article details the study of the prevalence of pressure ulcers in the population and the implementation of appropriate strategies for the prevention of pressure ulcers accordingly. The authors found that the disease was most common in hospitalized patients, especially those in intensive care units, with a range of 5% to 15%. The prevalence of this disease in older adults is about the same for both men and women. Age increases the risk of disease because most older people have limited mobility and are commonly confined to a wheelchair or bed. As you age, your natural skin texture changes, making your skin more prone to splitting and cracking, increasing your risk of ulcers. People are more likely to go for prevention because prevention strategies are more cost-effective than treatment strategies. One study found that the cost of treating pressure ulcers in the UK ranges from $1,500 to $18,000.

Therefore, preventive strategies are meaningful and can only be implemented after risk assessment. The Norton, Waterlow, and Braden scales are commonly used for this purpose, but each has been found to have advantages and disadvantages. Inaccuracy in the results of these tools does not affect the reduction in disease incidence. It can be concluded that an incorrect risk assessment means the implementation of inappropriate precautionary measures. This study aimed to investigate the relationship between nurses’ ability to visually assess the skin and a widely used risk assessment tool in assessing the risk of developing pressure ulcers in hospitalized patients. The earlier a risk assessment is carried out, the sooner risk management measures can be put in place. The disease can be avoided if risk factors are accurately identified.

Elderly people are more commonly affected as the skin undergoes several pathological changes as we age. Decreased levels of collagen and elastin in the skin reduce the protective effect of the skin and increase the risk of pressure ulcers. Visual skin assessment (VSA) by nurses requires appropriate knowledge and understanding of the subject. The authors argue that VSA is not always the appropriate tool because the underlying skin problem is not visible to nursing staff and therefore the threat cannot be detected early. Although the sensitivity and specificity values ​​of VSA were found to be higher than the Norton and Waterlow scales, respectively, the authors claim that this method is not completely reliable. The newly developed sub-epidermal moisture measurement (SEM) technique is primarily used to detect the onset of disease in paralyzed or immobilized patients and has proven effective in determining risk.

The sensitivity and specificity values ​​were 100% and 83.33%, respectively. It is based on biophysical and physiological principles and is highly effective in early detection of disease. SEM scanners test the biopotency of the tissue being examined to produce accurate results. It is very sensitive to the water content in tissues and can pinpoint any changes. Advances in this technology may help detect pressure ulcers early, thereby opening opportunities to provide appropriate interventions in a timely manner. Currently, there are no other technological advances available to detect tissue inflammation. The main difference between VSA and SEM is that VSA is only effective when the underlying problem shows up on the skin, whereas SEM measurements can detect problems early. Therefore, SEM can detect pressure ulcers almost 4 days earlier than VSA, making it an effective measurement tool for preventing pressure ulcers in the elderly and other populations. This will certainly help experts develop preventive strategies at an early stage.

The authors noted that pressure ulcers are the most common phenomenon in elderly care facilities and hospitals. Several traditional screening tools are used by these institutions, but none have been proven reliable. International pressure ulcer guidelines recommend screening patients within 8 hours of admission to prevent the risk of disease. However, there is no concrete evidence for this recommendation. The authors claim that 30 minutes to 6 hours is enough for ulcers to form. Therefore, it is important to properly examine the patient to take preventive measures.

They state that the inefficiency of screening tools is often due to measuring elements within the tool that are not clinically relevant. Risk assessment tools often produce false positive results. This can hinder the process of risk prevention, as patients may be incorrectly identified as being at high risk, while those who are actually at high risk of being affected may be ignored. there is. Therefore, the effort spent on risk assessment is completely wasted. According to the authors, people identified as being at high risk of developing pressure ulcers should change their position once every two hours throughout the day. Switching between mattresses and air mattresses has also led to a reduction in the incidence of this disease.

The main theme of the above six articles is risk management and the efficiency of risk management tools. The research question was formulated as follows using the PICO (Patient, Intervention, Comparison, Outcome) framework.

Patient – ​​elderly hospitalized patient

Interventions – risk assessment tools and tests

Comparison of light-skinned patients and dark-skinned patients

Result: pain relief

Therefore, the research question is:

Are older hospitalized patients with darker skin at a higher risk of developing pressure ulcers than those with lighter skin?


From the five papers mentioned above, this assignment critically analyzed the risk assessment methods commonly implemented in most healthcare facilities and their effectiveness in preventing pressure ulcers in patients, especially elderly and hospitalized patients. We can conclude. This paper demonstrated the importance of risk assessment and how specific techniques and technologies can be used to identify risks. Risk assessment is important because it helps caregivers make informed decisions and plan ahead to fight the disease. False results can have negative consequences, while positive results can save an elderly person’s life. A negative result could result in non-risk patients being labeled as at risk and receiving unnecessary treatment. However, positive results can help implement interventions earlier than symptoms become apparent. SEM management technology is one of the best tools available in healthcare settings to accurately and accurately detect pressure ulcer risk.


Lydia, C.H. and Aiello, E.A., 2008. Pressure ulcers: a patient safety issue. Patient safety and quality: An evidence-based handbook for nurses.

Mervis, J.S. and Phillips, T.J., 2019. Pressure ulcers: pathophysiology, epidemiology, risk factors, and symptoms. Journal of the American Academy of Dermatology, 81(4), pp. 881-890. Moore, Z.E. and Patton, D., 2019. Risk assessment tool for pressure ulcer prevention. Cochrane Database of Systematic Reviews, (1).

O’Brien G., Moore Z., Patton D., O’Connor T., 2018. Association between nurse assessment of early pressure ulcer injury and subepidermal water measurements: A prospective exploratory study. Journal of Tissue Viability, 27(4), pages 232-237.

Sharp, C.A., Schultz-Moore, J.S., and McLaws, M.L., 2019. Two-hour repositioning to prevent pressure ulcers in the elderly: patient safety or elder abuse? Journal of Bioethics Research, 16(1), pp. 17-34.

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