Evidence-based guidelines for pressure ulcer management at the end of life

Abstract

It is important to develop an individualised plan of care for people at the end of life to prevent pressure ulcers, and to treat them if they do occur. This article discusses patient and risk assessment, prevention and care for pressure ulcers for the palliative care patient and the recommendations given in the palliative care section of the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline (National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance, 2014).

Pressure ulcers in palliative ward patients: hyponatremia and low blood pressure as indicators of risk

“…Deterioration of physical, psychological, and social health due to pressure ulcers within susceptible patients is often devastating7,8 and increases the risk of death 9. While prolonged skin pressure, shear stress, and/or friction are primary causal factors leading to ulcer formation, variability of pressure ulcer risk factors, prevalence, incidence, and prognosis have been observed in different patient populations 1–3. Advanced chronic illness, defined as patients receiving supportive and palliative care,10 combined with nutritional deterioration, weakness, immobility, and skin alterations, is particularly associated with the risk of pressure ulcer development 1,3,10.…”

“…While prolonged skin pressure, shear stress, and/or friction are primary causal factors leading to ulcer formation, variability of pressure ulcer risk factors, prevalence, incidence, and prognosis have been observed in different patient populations 1–3. Advanced chronic illness, defined as patients receiving supportive and palliative care,10 combined with nutritional deterioration, weakness, immobility, and skin alterations, is particularly associated with the risk of pressure ulcer development 1,3,10. Excessive skin moisture, urine or fecal incontinence, and urinary catheterization are other factors that have previously been shown to increase pressure ulcer incidence in terminally ill patients 3.…”

“…Advanced chronic illness, defined as patients receiving supportive and palliative care,10 combined with nutritional deterioration, weakness, immobility, and skin alterations, is particularly associated with the risk of pressure ulcer development 1,3,10. Excessive skin moisture, urine or fecal incontinence, and urinary catheterization are other factors that have previously been shown to increase pressure ulcer incidence in terminally ill patients 3. Major surgery may contribute to increased formation of pressure ulcers in patients with colorectal cancer 11.…”

“…Major surgery may contribute to increased formation of pressure ulcers in patients with colorectal cancer 11. Advanced age, alterations to sensory perception, body temperature alterations, as well as poor general and mental health are conditions that can augment the individual risk for pressure ulcer development 3. Pressure ulcerations may result from impaired tissue perfusion and oxygenation as sequelae of general health-related conditions12 or local factors (peripheral vascular disease, diminished skin vascular density) 13.…”

“…Infection is a common, potentially serious pressure ulcer complication with local and systemic effects 17. Nearly all individuals in palliative care are susceptible to pressure ulcer development; thus, risk assessment and prevention strategies are strongly recommended 3. Pressure ulcer prevention is an essential component of palliative care for maintaining patient quality of life 1.…”