Elderly and Pressure Ulcers

Background and Objective: One of the most common problems in health care is pressure ulcer in elderly.Method: In this article, we review the results of articles related to pressure ulcers and its risk factors and treatment, which were conducted between ۲۰۱۹ and ۲۰۲۲.Findings: This complication is caused by decreased soft tissue blood flow following compression of the tissue between two hard surfaces, such as the bone surface from the inside and the surface of the bed or chair from the outside, and the necrotic cells themselves destroy adjacent cells. This complication affects the quality of life of patients and if not treated properly, can cause irreparable problems for the patient. Pressure ulcers increase the cost of health care and are known as the third most costly disorder after cancer and cardiovascular disease. The disease affects three million adults in the United States and is a major burden on the health care system. Pressure ulcers or injuries are seen predominantly in patients who belong to geriatric group, severely malnourished, paraplegic or neuropathic population. It can also be seen as a consequence of prominent implants/medical devices causing skin pressure. The condition becomes more complex and challenging to manage when it is associated with other comorbidities such as diabetes, infection, immunosuppression and poor tissue perfusion. One of the important points of pressure ulcers management is in obese patients. several studies have shown that obesity is associated with an increased risk of pressure ulcer. Increased duration of surgery and postoperative urinary tract infections are also two important risk factors for pressure ulcer.The most important stages are stage three and stage four pressure ulcers which generally require multiple surgeries including debridements, washouts and wound closures. There are different surgical techniques described in the literature including myocutaneous flaps, perforator flaps and muscular flaps to provide adequate tissue cover and to achieve satisfactory healing of the ulcers. The possible common post-operative complications include infection, seroma formation, necrosis of the flaps, hematoma formation with subsequent infection and wound dehiscence. Along with surgical techniques, there are other measures such as the use of vacuum-assisted drainage, nutritional supplements and a variety of dressings which are in use and can play a role in achieving the aim of healing the ulcers depending on their stages and accompanying comorbidities of the patients. Dressings include the use of advanced nano-dressings, negative-pressure dressings, intelligent dressings with advanced sensors, oscillating magnetic fields, electrical excitation, ultrasound and infrared light, the use of biofilms and topical antimicrobials such as silver. Honey and polyhexamethylene bioguanide, herbal medicines ،Platelet growth factors, omega-۳ oils can help accelerate the healing of pressure ulcers.Conclusion: The overall positive outcome of managing such wounds depends on a number of factors, and therefore requires a multidisciplinary approach to address nutrition, patient's immune system, well-equipped nursing care and training, and indeed an appropriate approach.

Keywords:

pressure ulcer , dressing , risk factor.