Pressure Ulcers Associated Mortality among Older Patients in a Large Teaching Hospital in Malaysia

H M Khor ； J Tan ； S B Kamaruzzaman ； A V Chin ； P J H Poi ； M P Tan

《台灣老年醫學暨老年學雜誌》 9卷2期 (2014/05) Pp. 59-59(2)

並列摘要

Objective: Pressure ulcers are increasingly common with age, with 70% occurring in people aged ＞ 70years old. There are currently no published national data on the prevalence of pressure ulcers in Malaysia. The objective of this study is to evaluate the risk factors associated with mortality among patients with pressure ulcers. Methods: A prospective observational study was performed between Oct 2012 and May 2013. Patients with preexisting pressure ulcers on admission and those with hospital acquired pressure ulcers were recruited into the study. Information on patient demographics, functional status, nutritional level, stages of pressure ulcer and their complications were obtained. Cox proportional hazard analysis was used to assess the risk of death in all patients. Results: 76/684 (11.1%) patients had pre-existing pressure ulcers on admission and 30/684 (4.4%) developed pressure ulcers in hospital. These patients were frail individuals with multiple co-morbidities, poor functional status and malnourished. There were 68 (66%) deaths by the end of the median follow-up period of 12 (interquartile range 2.5 to 14) weeks. Factors associated with mortality included nursing home residence, pressure ulcer infection, stage IV pressure ulcer, urinary incontinence, being bedbound, scoring high risk on the Braden scale, hypoalbuminaemia and neutrophilia. Our Cox regression model revealed that nursing home residence (Hazard Ratio, HR= 2.33, 95% confidence interval, CI=1.30, 4.17; p=0.005), infected deep pressure ulcers (HR=2.21, 95% CI=1.26, 3.87; p=0.006) and neutrophilia (HR=1.76; 95% CI 1.05, 2.94; p=0.031) were independent predictors of mortality in our elderly patients with pressure ulcers. Conclusion: The prevalence of pressure ulcers in our setting is comparable to previously reported figures in Europe and North America. Mortality in patients with pressure ulcer was high, and was predicted by institutionalization and infection with high neutrophils count. This information is invaluable in informing healthcare decisions on life-prolonging treatment and end-of-life care in this group of extremely frailty and highly dependent individuals.