Pressure ulceration and palliative care: prevention, treatment, policy and outcomes

Abstract

Pressure ulcer development and management have particular significance in palliative and end-of-life care owing to the prevalence of mobility issues and the skin changes that can occur with ageing, chronic illness, and at the end of life. Hence, it is important for nurses working in palliative care to be vigilant for pressure ulcer development and to possess knowledge relating to the prevention and management of pressure ulceration. This article considers current UK policy regarding pressure ulcers, highlighting contradictions of relevance to patients requiring palliative care. It then provides a brief overview of pressure ulcer prevention, prescription, preservation, and palliation, highlighting areas of specific consideration to pressure ulcer care within palliative care.

Evaluation of Repositioning in Pressure Ulcer Prevention

“…With advanced age, the skin becomes more vulnerable to pressure and shear due to loss of connective tissue cells, nerve endings, and blood vessels (Bliss, 1993). In addition, with advanced age the papilla become more flattened as the epidermis gradually thins and reduces the skin´s resistance to shearing forces (Stephen-Haynes, 2012). It is clear that blood flow responses such as PIV, vasodilation due to heat stress, and reactive hyperaemia tend to be significantly altered among the elderly (Ek et al, 1984;McLellan et al, 2009), but research on how blood flow responses among the elderly are affected by loading in different positions and over prolonged time is limited.…”

Pressure ulcer prevention in patients with advanced illness

“…We found four review articles [18][19][20][21]. Three of them discussed comprehensive strategies of risk assessment, repositioning, mattress and cushion support surface selections, nutritional supplementation, and skin integrity/incontinence issues [18,20].…”

“…Three of them discussed comprehensive strategies of risk assessment, repositioning, mattress and cushion support surface selections, nutritional supplementation, and skin integrity/incontinence issues [18,20]. The remaining review did not incorporate mattress or cushion support surface into the discussion [21].…”

“…The review authors agreed that for patients in advanced illness repositioning is not always feasible [18,20,21]. In these patients, repositioning may be contraindicated in the setting of hemodynamic instability, may cause increased pain, or may worsen nausea and vomiting.…”

“…The clinician needs to discuss with the patient and family the goals of care. Comfort may be the predominant goal, even if this goal goes against national guidelines [21].…”