Comorbidity, frailty and evolution of pressure ulcers in geriatric age

BACKGROUND: The prevalence of pressure ulcers (PUs) ranges from 1 to 18% of in-patients and from 3 to 28% in long-term settings. The aim of our study was to verify how comorbidity and frailty influenced the course of PUs in a population of elderly subjects hospitalized in a long-term care setting. MATERIAL/METHODS: The charts of 125 patients with pressure ulcers were evaluated retrospectively. For each subject we took note of PU characteristics (stage, ulcer surface, evolution), and clinical characteristics (comorbidity, adverse clinical events, and cognitive, functional, and nutritional status). Frailty was defined considering age, cognitive functions, and functional and nutritional status. RESULTS: In 58 patients (46.4%) there was overall resolution of the lesions, while in 39 patients (31.2%) we had "improvement" of PUs. The course of PU was not significantly influenced by the patient's physiological characteristics, cognitive status, or the initial characteristics of PU. We noticed a significant difference in the course of PUs as a function of autonomy level and clinical and nutritional status. During the observation period we found significant differences in the frailty scores: 87.2% of those who showed an improvement in the score had resolution or improvement in PUs, while this occurred in only 27.3% of those who had a worsening in the level of frailty. CONCLUSIONS: We maintain that integration of multidimensional assessment, with special attention to comorbidity status and to frailty (particularly autonomy level and nutritional status), and the different approaches may allow optimal healing of PUs

Nutritional status and evolution of pressure sores in geriatric patients

The prevalence of pressure sores (PS) ranges from 1 to 18% of in-patients and from 3 to 28% of those admitted to long-term settings. The aim of our study was to verify, a posteriori, how nutritional status influenced the evolution of PS in a population of elderly subjects hospitalised in a long-term care setting. MATERIALS AND METHODS: The charts of 125 patients with ulcerative or necrotic pressure ulcers were evaluated retrospectively. For each subject we took note of: PS characteristics (stage, ulcer surface, evolution), clinical characteristics (comorbidity, adverse clinical events, cognitive, functional and nutritional status). RESULTS: In 58 patients (46.4%) there was overall healing of the lesions while in 39 patients (31.2%) we had however an "improvement" of PS. The course of PS was not significantly influenced by the patient's physiological characteristics, by cognitive status or by initial characteristics of PS. Instead, we noticed a significant difference in the course of PS as a function of the level of autonomy and clinical status. The course of PS, and in particular the Healing Index, were influenced by the Nutritional Status and, above all, by its course during the treatment period. CONCLUSIONS: The development of PS is multifactorial. Whereas, it is clear that factors other than nutrition influence the risk of developing PS, an important role for nutrition in the development and resolution of PS is suggested. Our data certainly confirm the "Quality indicators for prevention and management of pressure ulcers in vulnerable elders", especially were they say "if a vulnerable elder is identified as at risk for pressure ulcer development and has malnutrition, then nutritional intervention or dietary consultation should be instituted because poor diet, particularly low dietary protein intake, is an independent predictor of pressure ulcer development"

Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia

Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the “Delirium Day” study, a nationwide Italian point-prevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors