Pressure ulcer risk assessment: risk factors and risk screening in older persons – a validation study

Background: Mobility is acknowledged in the literature as the highest predictor

of pressure ulcer development, however most of clinical studies assess mobility

subjectively. The few studies that have analysed mobility objectively using

technology have the limitation of not measuring small postural changes, which

are important for pressure relief. A more comprehensive analysis of mobility,

including all types of movement is needed to better understand mobility and

pressure ulcer development, and to further correlate it with other risk factors.

Therefore, a quantitative, prospective, non-experimental study among the elderly

population was undertaken.

Aim: The primary objective of the study was to explore how activity and mobility,

along with other risk factors lead to pressure ulcer development in older persons

cared for in long-term facilities. The secondary objectives of the study were firstly

to report pressure ulcer incidence among the study participants using visual skin

assessment and sub-epidermal moisture (SEM) measurement. Secondly, to

explore mobility in healthy volunteers using a mobility sensor in order to compare

to mobility levels of older people cared for in long-term settings.

Methods: Ethical approval was received. The chosen explanatory variables were

included as they are common to the three most widely used risk assessment tools

(Waterlow, Norton and Braden), namely, mobility, activity, nutritional status and

incontinence. Following statistical advice and after the results of the pilot study of

48 participants, the sample size was recalculated based on the two causal factors

that varied over the 20-day follow-up, namely mobility and activity. Therefore, a

total of 150 participants were included. The pilot study also identified the need to

include healthy participants to better determine mobility among a healthy

population, in order to enhance the understanding of the older participants’

movements. Following ethical approval, a total of 22 healthy participants were

included and their mobility were assessed over a 2-night period, using the same

motion sensor employed within the main study.