Pressure Ulcers in the Aging Population: A Guide for Clinicians PDF
Preview Pressure Ulcers in the Aging Population: A Guide for Clinicians
Aging Medicine Series Editors: Robert J. Pignolo · Mary Ann Forciea · Jerry C. Johnson David R. Thomas Gregory A. Compton Editors Pressure Ulcers in the Aging Population A Guide for Clinicians A ging Medicine Robert J. Pignolo, MD, PhD; Mary Ann Forciea, MD; Jerry C. Johnson, MD, Series Editors F or further volumes: h ttp://www.springer.com/series/7622 D avid R. T homas • G regory A . Compton E ditors P ressure Ulcers in the Aging Population A Guide for Clinicians E ditors D avid R. T homas, MD Gregory A. Compton, MD, CMD D ivision of Geriatric Medicine G eriatric Medicine and Palliative Care Saint Louis University Wound Care Consultant Saint Louis, MO, USA Hospice Care of South Carolina Johns Island, SC, USA I SBN 978-1-62703-699-3 ISBN 978-1-62703-700-6 (eBook) D OI 10.1007/978-1-62703-700-6 S pringer New York Heidelberg Dordrecht London Library of Congress Control Number: 2013953703 © Springer Science+Business Media New York 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Humana Press is a brand of Springer Springer is part of Springer Science+Business Media (www.springer.com) D rs. Thomas and Compton would like to dedicate this book to their ever-patient wives, Janice and Bonnie, respectively, who support them in their lifelong learning and pursuit of excellence in geriatric care. Many a long days were spent in putting this project together. P refa ce T he Pressure ulcer volume is a welcome addition to the Springer Aging Medicine Series. It is written for the nursing and medical generalist, student, or practitioner. It is a collection of scholarly review articles written by respected active wound care clinicians and teachers. One additional aim is to be a reference for medical and surgical trainees caring for older adults in all settings. T he subjects range from basic biology of skin and the cellular response of injured tissue to wound assessment, prevention, and treatment. The role of nutrition and bacterial colonization augments the sections on specifi c medical and surgical treat- ment. A chapter is devoted to palliation and skin as an organ failure. Legal issues are addressed in an afterword. M uch has been learned about the causes, prevention, and treatment of pressure ulcers since the publication of P ressure Ulcers in America: Prevalence, Incidence and Implications for the Future by the NPUAP in 2001. In 1989 the prevalence of pressure ulcers in all groups in all settings varied from 3 % to as high as 25 %. More recent data from larger, multisite studies show a gradual downward trend in preva- lence from 2004 to 2009. It is too early to say, based on the data, that the trend is signifi cant. Overall the current prevalence rate of 12–16 % did not meet the Healthy People 2010 Objective 1–16 to reduce the prevalence of pressure ulcers in nursing homes by 50 %. O ne explanation for not signifi cantly reducing pressure ulcer prevalence over the last decade is case-mix. The elderly experience the vast majority of the pressure ulcers in the USA. Prevalence numbers are more diffi cult to impact than incidence rates because of ongoing technical advancements in treatment that is based on better understanding of the mechanisms of healing and its impediments. The pressure ulcer patient is sicker and living longer. The typical elderly inpatient or nursing home resident is older and has multiple comorbidities, hence the emphasis of this treatise on the aging population. vii viii Preface T o the extent that consensus exists, best practices are identifi ed in this volume. Several of the contributors have spent their careers teaching and advancing excel- lence in geriatric wound care. T he book’s scope is purposely narrow, pressure ulcers in the elderly, so to pro- vide in-depth coverage of the subject. It covers the entire range of care from preven- tion and assessment to surgical care. It exposes the reader to newer concepts such as deep tissue injury and differentiating heavy bacterial wound colonization from infection. The editors’ intention is to provide focused knowledge to allow the gen- eralist to be more involved in the care of pressure ulcer patients. Pressure ulcers are one of the major geriatric syndromes that all primary providers need to address. The training of most generalists involves little or no wound care exposure. This volume is designed to bridge that gap. Saint Louis, MO, USA David R. Thomas Johns Island, SC, USA Gregory A. Compton C ontents 1 The Biology of Wound Healing .............................................................. 1 Gregory A. Compton and David R. Thomas 2 Incidence and Prevalence of Pressure Ulcers ....................................... 19 Dan Berlowitz 3 Prevention of Pressure Ulcers ................................................................ 27 Kim W. House and Theodore M. Johnson 4 Assessment and Documentation of Pressure Ulcers ............................ 47 Jan Kottner and Kathrin Raeder 5 General Principles of Pressure Ulcer Management ............................. 67 David R. Thomas 6 Local Wound Treatment in Pressure Ulcer Management ................... 81 David R. Thomas 7 Surgical Management of Pressure Ulcers ............................................. 99 Dean P. Kane 8 The Role of Nutrition in the Management and Prevention of Pressure Ulcers .................................................................................... 127 David R. Thomas 9 Assessment and Management of Wound Colonization and Infection in Pressure Ulcers ............................................................ 143 Gregory A. Compton 10 Palliative Wound Care and Treatment at End of Life ......................... 161 Kevin Y. Woo, Diane L. Krasner, and R. Gary Sibbald ix
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