10779/rcsi.12272663.v1
Aglecia Moda Vitoriano Budri
Aglecia
Moda Vitoriano Budri
Zena Moore
Zena
Moore
Declan Patton
Declan
Patton
Tom O'Connor
Tom
O'Connor
Linda E. Nugent
Linda E.
Nugent
Aisling McCann
Aisling
McCann
Pinar Avsar
Pinar
Avsar
Impaired mobility and pressure ulcer development in older adults excess movement and too little movement – two sides of the one coin?
Royal College of Surgeons in Ireland
2020
Pressure Injury
Pressure Ulcer
Risk Assessment
Screening Tools
Wound Care
Nursing not elsewhere classified
2020-05-12 08:08:07
Journal contribution
https://repository.rcsi.com/articles/journal_contribution/Impaired_mobility_and_pressure_ulcer_development_in_older_adults_excess_movement_and_too_little_movement_two_sides_of_the_one_coin_/12272663
<p><b>Aim:</b> To identify how activity and mobility lead to pressure ulcer
development, using two objective assessments, one for mobility and one for
early pressure ulcer detection. </p><p><br></p>
<p> </p>
<p><b>Methods:</b> 150 older persons from
long-term settings were followed-up for 20 days, using an observational,
quantitative, prospective study design. The study was conducted in accordance
with the Strengthening the Reporting of Observational Studies in Epidemiology
statement. Visual skin assessment and sub-epidermal moisture assessments were
undertaken daily. Activity was measured using the Braden subscale. Further, a
mobility profile of the participants was identified using a piezoelectric
motion sensor which provided a “movement score” (mean number of
movements/hour). Movement scores from 22 healthy participants were also
measured to better understand the mobility profile in a healthy population. </p><p><br></p>
<p> </p>
<p><b>Results: </b>Pressure ulcer incidence using visual skin assessment was 12.7%
(low movers=6.7%; high movers=6%) and 78.7% using sub-epidermal moisture
assessment (low movers=40.0%; high movers=38.7%). Sub-epidermal moisture
assessment detected pressure ulcers on average 8.2 days before they appeared
visually on the skin’s surface. Pressure
ulcer detection was 25 times greater using sub-epidermal moisture compared to visual skin
assessment. Considering the results of the ‘Movement Level’ assessment using
the motion sensor technology, of all those who were determined to be immobile
by Braden, 18.8% were assessed as high movers. </p><p><br></p>
<p> </p>
<p><b>Discussion & Conclusion:</b> Pressure ulcers occurred
both in low and high movers, which was unexpected as a similar finding has not
been previously reported in the literature.</p><p><br></p>
<p> </p>
<p><b>Relevance to Clinical Practice</b>: The traditional focus on
low movers/immobile individuals may detract from the identification of those
making an abnormally high frequency of
unsafe movements. Pressure ulcer assessment can be enhanced through a
combination of sub-epidermal moisture assessment and visual skin assessment,
and through the identification of both individuals with impaired mobility and
those abnormally high movements, such as among those who are agitated. </p>