Marco Artico1,2, Angelo Dante3, Daniela D'Angelo4, Luciano Lamarca2, Chiara Mastroianni5, Tommasangelo Petitti6, Michela Piredda4, Maria Grazia De Marinis4. 1. 1 Department of Biomedicine and Prevention, School of Nursing, Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy. 2. 2 Department of Palliative Care and Pain Therapy Unit, Azienda ULSS n. 4 Veneto Orientale, San Donà di Piave, Italy. 3. 3 Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy. 4. 4 Research Unit Nursing Science, Campus Bio-Medico University of Rome, Rome, Italy. 5. 5 Centro ANTEA, Rome, Italy. 6. 6 Research Unit Hygiene, Statistics and Public Health, Campus Bio-Medico University of Rome, Rome, Italy.
Abstract
BACKGROUND: Terminally ill patients are at high risk of pressure ulcers, which have a negative impact on quality of life. Data about pressure ulcers' prevalence, incidence and associated factors are largely insufficient. AIM: To document the point prevalence at admission and the cumulative incidence of pressure ulcers in terminally ill patients admitted to an Italian home palliative care unit, and to analyse the patients' and caregivers' characteristics associated with their occurrence. DESIGN: Retrospective chart review. SETTING/PARTICIPANTS: Patients ( n = 574) with a life expectancy ⩽6 months admitted to a palliative home care service were included in this study. RESULTS: The prevalence and incidence rates were 13.1% and 13.0%, respectively. The logistic regression models showed body mass index ( p < 0.001), Braden score at risk ( p < 0.001), Karnofsky Performance Scale index <30 ( p < 0.001), patients' female gender, patients' age >70 and >1 caregiver at home as the dichotomous variables predictors of presenting with a pressure ulcer at time of admission and during home palliative care. CONCLUSION: The notable pressure ulcers' incidence and prevalence rates suggest the need to include this issue among the main outcomes to pursue during home palliative care. The accuracy of body mass index, Braden Scale and Karnofsky Performance Scale in predicting the pressure ulcers risk is confirmed. Therefore, they appear as essential tools, in combination with nurses' clinical judgment, for a structured approach to pressure ulcers prevention. Further research is needed to explore the home caregivers' characteristics and attitudes associated with the occurrence of pressure ulcers and the relations between their strategies for pressure ulcer prevention and gender-related patient's needs.
BACKGROUND: Terminally ill patients are at high risk of pressure ulcers, which have a negative impact on quality of life. Data about pressure ulcers' prevalence, incidence and associated factors are largely insufficient. AIM: To document the point prevalence at admission and the cumulative incidence of pressure ulcers in terminally ill patients admitted to an Italian home palliative care unit, and to analyse the patients' and caregivers' characteristics associated with their occurrence. DESIGN: Retrospective chart review. SETTING/PARTICIPANTS: Patients ( n = 574) with a life expectancy ⩽6 months admitted to a palliative home care service were included in this study. RESULTS: The prevalence and incidence rates were 13.1% and 13.0%, respectively. The logistic regression models showed body mass index ( p < 0.001), Braden score at risk ( p < 0.001), Karnofsky Performance Scale index <30 ( p < 0.001), patients' female gender, patients' age >70 and >1 caregiver at home as the dichotomous variables predictors of presenting with a pressure ulcer at time of admission and during home palliative care. CONCLUSION: The notable pressure ulcers' incidence and prevalence rates suggest the need to include this issue among the main outcomes to pursue during home palliative care. The accuracy of body mass index, Braden Scale and Karnofsky Performance Scale in predicting the pressure ulcers risk is confirmed. Therefore, they appear as essential tools, in combination with nurses' clinical judgment, for a structured approach to pressure ulcers prevention. Further research is needed to explore the home caregivers' characteristics and attitudes associated with the occurrence of pressure ulcers and the relations between their strategies for pressure ulcer prevention and gender-related patient's needs.
Entities:
Keywords:
Pressure ulcers; caregivers; cohort study; home nursing; palliative care; terminally ill patients; wound care
Authors: Francisco José García-Sánchez; Vicente Martínez-Vizcaíno; Beatriz Rodríguez-Martín Journal: Int J Environ Res Public Health Date: 2019-07-30 Impact factor: 3.390