Comorbidity, frailty, and evolution of pressure ulcers in geriatrics.
BACKGROUND
The prevalence of pressure ulcers (PUs) ranges from 1 to 18% of in-patients and from 3 to 28% in long-term settings. The aim of our study was to verify how comorbidity and frailty influenced the course of PUs in a population of elderly subjects hospitalized in a long-term care setting.


METHODS
The charts of 125 patients with pressure ulcers were evaluated retrospectively. For each subject we took note of PU characteristics (stage, ulcer surface, evolution), and clinical characteristics (comorbidity, adverse clinical events, and cognitive, functional, and nutritional status). Frailty was defined considering age, cognitive functions, and functional and nutritional status.


RESULTS
In 58 patients (46.4%) there was overall resolution of the lesions, while in 39 patients (31.2%) we had "improvement" of PUs. The course of PU was not significantly influenced by the patient's physiological characteristics, cognitive status, or the initial characteristics of PU. We noticed a significant difference in the course of PUs as a function of autonomy level and clinical and nutritional status. During the observation period we found significant differences in the frailty scores: 87.2% of those who showed an improvement in the score had resolution or improvement in PUs, while this occurred in only 27.3% of those who had a worsening in the level of frailty.


CONCLUSIONS
We maintain that integration of multidimensional assessment, with special attention to comorbidity status and to frailty (particularly autonomy level and nutritional status), and the different approaches may allow optimal healing of PUs.
Donini
Lorenzo M
LM
Istituto di Scienza dell'Alimentazione dell'Universitŕ di Roma La Sapienza, Italy. lorenzomaria.donini@uniroma1.it
De Felice
Maria Rosaria
MR
Tagliaccica
Angelo
A
De Bernardini
Laura
L
Cannella
Carlo
C
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000453:epidemiology / Q000503:physiopathology*; D012189:Retrospective Studies