ULCER IN ELDERLY PEOPLE

Ulcer in Elderly People

Ulcer in Elderly People

Introduction

Pressure ulcers (PU) are a significant burden to all health care systems. Once a deep Stage 4 PU exposing muscle and bone develops, the cost associated with treatment of just one such PU has been estimated at $61,230.00 and legal action as much as $632,500. Patients may be admitted to, or discharged from, any healthcare facility, with one or more PU. Pressure ulcers result in an increased length of stay increase morbidity and mortality and are very painful, causing suffering for the poor patient. There have been so many advancements in the prevention of PU so I question why they still occur, especially in this day and age. Should we be seeing any PU at all? Most hospitals and facilities would have a protocol in place to prevent PU from occurring, along with a risk assessment tool to predict which patients are 'at risk' of developing a PU (Ankrom, 2005).

The aim of the risk assessment tool is to distinguish risk factors considered associated with the cause and to identify patients 'at risk' of a PU then intervene immediately with appropriate equipment to reduce the incidence of these nasty ulcers. Many numerical assessment tools have been used to assess the patient to determine whether they are 'at risk;' the Norton 1962, Waterlow 1962, Braden 1984 just to mention a few, but are they truly evidence-based? In 1992, Brenda Ramstadius, a clinical nurse consultant in wound care in Australia noticed that nurses were not using the available PU risk assessment tool (Norton) in her hospital, to identify “at risk” patients. Nurses said they found it time consuming evaluating the numerous variables. Ramstadius then designed an assessment tool that reflected pressure ulcer aetiology, which has more clinical relevance and was able to determine “not at risk” status earlier in the assessment process (Ankrom, 2005) (Ankrom, 2005).

Discussion

In 1992, Brenda Ramstadius, a clinical nurse consultant in wound care in Australia noticed that nurses were not using the available PU risk assessment tool (Norton) in her hospital, to identify “at risk” patients. Nurses said they found it time consuming evaluating the numerous variables. Ramstadius then designed an assessment tool that reflected pressure ulcer aetiology, which has more clinical relevance and was able to determine “not at risk” status earlier in the assessment process. In 1996 this brought about a collaborative clinical research study between University academics and nurse clinicians in Australia, comparing the “Ramstadius Tool with the “Waterlow scale” in four nursing homes. The Waterlow scale was chosen as the comparison tool as nurses said they thought it the most suitable for all patients. In 1999 Annette Hoskins, a senior lecturer at Wollongong University, Australia, decided to conduct further study to assess the validity and reliability of the Ramstadius Pressure Ulcer Risk Assessment Tool, as well as to explore if mobility is the primary factor for PU formation. The idea created a new excitement among the different nurses and made the study more interested for nursing ...