The Effect of Pressure Ulcers on the Survival in Patients With Advanced Dementia and Comorbidities

Jaul, Efraim; Meiron, Oded; Menczel, J

doi:10.1080/0361073x.2016.1191863

Cited by 31 publications

(29 citation statements)

References 15 publications

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“…Assessment methods and duration of follow‐up were extracted and presented in Table . Four articles scored eight points, and two of them were deducted by one point because of the non‐response rate. The other two were deducted one point because of insufficient follow‐up time.…”

Section: Resultsmentioning

confidence: 99%

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The relationship between pressure injury complication and mortality risk of older patients in follow‐up: A systematic review and meta‐analysis

Song

Shen

Cai

et al. 2019

International Wound Journal

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Pressure injuries (PIs) have now become a common complication of the elderly patients. Some studies have observed that pressure injuries may increase mortality, but this area of evidence has not been evaluated and summarised. The aim of this study was to compare the mortality of patients with pressure injuries and those without pressure injuries. A meta-analysis of observational studies was performed. PubMed, Cochrane Library, Embase, and Web of Science were searched up to April 2019. Studies about mortality among the elderly patients with and without pressure injuries were included. Methodological quality was assessed by the Newcastle-Ottawa Scale (NOS). The fixed effect or random effect model was determined by the test of heterogeneity. The subgroup analysis was performed based on the pressure injuries stages, the region, and the type of study design. The meta-regression analysis was performed to investigate the relationship between the mortality and patients' enrolled year, average age, the incidence of pressure injuries, and gender ratio. The sensitivity analysis was used to explore the impact of an individual study by excluding one at a time. The hazard ratio (HR) and 95% confidence intervals (CIs) in terms of the comparison of two groups were extracted for meta-analysis. A survival curve between two groups by individual patient-level was drew. Eight studies with 5523 elderly patients were included in the analysis.Follow-up periods for the included studies ranged from about 0.5 to 3 years. The elderly patients who complicated with pressure injuries had a higher risk of death. The pooled HR was 1.78 (95% CI 1.46-2.16). A funnel plot showed no publication bias. Further subgroup analysis showed that HR values for the patient stage 3 to 4 pressure injuries (HR:2.41; 95% CI:1.08-5.37) were higher than stage 1-4 and 2-4 pressure injuries (HR: 1.66; 95% CI: 1.35-2.05; HR: 1.74; 95% CI: 1.16-2.60). The meta-regression analysis found that patients' enrolled year, average age, the incidence of pressure injuries, and gender ratio were not the sources of heterogeneity. Sensitivity analyses showed that the outcomes of the study did not change after removing the Onder's article. The survival curve at the individual patient-level also indicated that patients complicated with pressure injuries significantly increased the risk of death (HR: 1.958; 95% CI: 1.79-2.14) in elderly patients. Our metaanalysis indicated that patients complicated with pressure injuries are estimated to

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Section: Resultsmentioning

confidence: 99%

“…Table summarised the characteristics of these eight studies . These studies included a total of 5523 people, one of which was followed up to death or to hospital discharge; two studies were retrospective and six studies were prospective; five studies were from Europe, two were from Asia, and one was from North America …”

Section: Resultsmentioning

confidence: 99%

The relationship between pressure injury complication and mortality risk of older patients in follow‐up: A systematic review and meta‐analysis

Song

Shen

Cai

et al. 2019

International Wound Journal

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“…Intrinsic factors such as advanced chronic diseases, low level of albumin, haemoglobin, and low BMI appear to play a significant role in inducing the onset of PUs . Recent data suggested a link between dementia and PU and cardiovascular diseases and heart failure . In addition to immobilisation, the positioning of the body or body posture may also significantly affect the onset or prevention of PUs .…”

Section: Introductionmentioning

confidence: 99%

“…3 Recent data suggested a link between dementia and PU and cardiovascular diseases and heart failure. 2,4,5 In addition to immobilisation, the positioning of the body or body posture may also significantly affect the onset or prevention of PUs. 6 Correspondingly, the clinical consequences of severe spasticity, which are directly associated with body positioning, should be further investigated as a possible risk factor in the development of PU.…”

mentioning

confidence: 99%

Spasticity and dementia increase the risk of pressure ulcers

Jaul¹,

Factor

Karni

et al. 2019

International Wound Journal

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The aim of this study was to identify and characterise the association between the prevalence of pressure ulcers, spasticity levels, and advanced dementia in disable elderly patients. Data were obtained from the patient medical files. Patients were hospitalised in the geriatric skilled nursing department. A total of 40 frail elderly patients, bedbound and suffering from advanced chronic diseases, advanced dementia, and high‐grade pressure ulcers, were examined. Pressure ulcer grades and spasticity in advanced dementia versus non‐dementia patients were evaluated. Logistic regression indicated that only advanced dementia and spasticity were significantly associated with the development of pressure ulcers versus those without dementia or without spasticity. Patients with advanced dementia displayed a significantly higher prevalence of severe spasticity. In multivariate logistic regression analyses, spasticity was significantly associated with pressure ulcers. The strong association of spasticity with the onset of pressure ulcers in advanced dementia should encourage clinicians to implement preventative measures to delay the onset of pressure ulcers.

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“…Advanced dementia and pus in the same patient results in earliermortality. The median survival is significantly shorter in comparison with similar patients without PUs [3]. Trajectories of treatable, burdensome symptoms such as PU at the end of life in specialized centres should be a priority focus for quality improvement.…”

Section: Editorialmentioning

confidence: 99%

Dementia and Pressure Ulcers in Greece During The Economic Crisis, The Last Samurai

Tsoucalas¹

2017

J Univer Surg

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The Effect of Pressure Ulcers on the Survival in Patients With Advanced Dementia and Comorbidities

Abstract: Advance dementia and pressure ulcers in the same patient results in earlier mortality. Advanced dementia patients with pressure ulcers had significantly lower survival expectancy in comparison with similar patients without pressure ulcers. Clinical and ethical implications are discussed.

Cited by 31 publications

References 15 publications

The relationship between pressure injury complication and mortality risk of older patients in follow‐up: A systematic review and meta‐analysis

The relationship between pressure injury complication and mortality risk of older patients in follow‐up: A systematic review and meta‐analysis

Spasticity and dementia increase the risk of pressure ulcers

Dementia and Pressure Ulcers in Greece During The Economic Crisis, The Last Samurai

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