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Prasad A, Nunes AP, Jesdale BM, Nielsen NN, Naqvi SH, Xu S, Lim E, Dubé CE, Mack DS, Lapane KL. Skin Ulcer Development and Deterioration of Social Engagement among Nursing Home Residents. J Am Med Dir Assoc 2025; 26:105473. [PMID: 39892876 DOI: 10.1016/j.jamda.2024.105473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Revised: 12/12/2024] [Accepted: 12/13/2024] [Indexed: 02/04/2025]
Abstract
OBJECTIVES Skin ulcers are a critical indicator of quality of care in nursing homes that influence residents' physical, psychological, and social health. The objective of this study is to understand the influence of developing skin ulcers on deterioration in social engagement in nursing home residents. DESIGN Observational retrospective cohort study with 1-year follow-up. SETTING AND PARTICIPANTS Nursing home residents aged ≥50 years were followed quarterly (2008/2009-2009/2010), the latest years in which the Minimum Data Set 2.0 measured social engagement. METHODS Cumulative incidence ratios (CIRs) and 95% CIs quantified the association between skin ulcer development and deterioration in residents' social engagement levels. RESULTS About 1.25% first developed new skin ulcers at the annual follow-up assessment; 1.22% developed skin ulcers at a quarterly assessment that persisted at the annual assessment, and 4.53% developed skin ulcers at a quarterly assessment that were resolved by annual assessment. Compared with residents who remained ulcer-free, those with new skin ulcer at annual assessment and persistent skin ulcers were at increased risk of experiencing a reduction in social engagement (CIR, 1.26; 95% CI, 1.11-1.44; CIR, 1.32; 95% CI, 1.16-1.50, respectively). Those with resolved skin ulcers were also at increased risk of social engagement deterioration (CIR, 1.12; 95% CI, 1.04-1.21) than those who remained ulcer-free. CONCLUSION AND IMPLICATIONS Residents who develop skin ulcers are at a higher risk of deteriorating social engagement. Nursing home staff should strive not only to prevent and treat skin ulcers, but also to support social engagement for those with skin ulcers.
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Affiliation(s)
- Anyah Prasad
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Gerontology, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Anthony P Nunes
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bill M Jesdale
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Natalia N Nielsen
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Syed H Naqvi
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Shu Xu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Gerontology, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Emily Lim
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Gerontology, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Catherine E Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Deborah S Mack
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
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Sahay A, Willis E, Yu S. Pressure injury education for older adults and carers living in community settings: A scoping review. Int Wound J 2024; 21:e14894. [PMID: 38772749 PMCID: PMC11108764 DOI: 10.1111/iwj.14894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/23/2024] Open
Abstract
Older adults are at increased risk of pressure injuries (PIs) due to age-related changes. Traditionally, PI knowledge and education have been delivered in hospitals and residential aged care facilities, however, there remains a critical gap in understanding how PI knowledge on prevention and management is shared with older adults and their carers living in the community. We aimed to describe the nature and characteristics of structured and unstructured PI education programs available to community-dwelling older adults and their carers. As coping review was undertaken. We searched five databases: CINAHL, Medline, Scopus, Cochrane Library and ProQuest from 2009 to August 2023. The review was guided by Arksey and O'Malley's six-step framework and adhered to the PRISMA-ScR guidelines. It included primary peer-reviewed papers published in English, which focus on PI education for older adults and/or their carers living in community settings. Data extraction was organised in a table, and findings presented as a narrative summary. One-hundred and thirty-six papers were screened and four included in the review. Results indicate that consideration was placed on literacy levels and cognitive status of older adults and their carers when designing PI education materials. Educational materials such as leaflets/brochures, in-person training sessions or a combination of both were used. However, duration of these interventions varied, lasting for 1-4 weeks while others were completed over 12 months. Some improvements in PI knowledge such as how to treat PI, dietary requirements and importance of mobility were noted. However, information retention and its translation into effective long-term behaviour change remained unclear. In conclusion, adopting a multifaceted educational approach increases the effectiveness of PI knowledge translation. Continuous education, support and reinforcement on PIs over time are necessary when interacting with older adults and caregivers to ensure long-term management and prevention success. Conversations on PIs should start at the primary care levels when older adults and carers are visiting their GP clinics and accessing support services for other healthcare needs. Understanding older adults' and carers' literacy levels, cognitive status and cultural background can assist clinicians in designing and delivering fit-for-purpose PI educational interventions that are accessible, relatable and effective in promoting knowledge transfer and behaviour change. Carers are vital conduits in the care continuum. These factors will lead to a more informed, collaborative and person-centred approaches to PI management and prevention.
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Affiliation(s)
- Ashlyn Sahay
- School of Nursing, Midwifery and Social SciencesCQUniversityNorman GardensQueenslandAustralia
| | - Eileen Willis
- School of Nursing, Midwifery and Social SciencesCQUniversityNorman GardensQueenslandAustralia
| | - Stephen Yu
- School of Nursing, Midwifery and Social SciencesCQUniversityNorman GardensQueenslandAustralia
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Ibeh C, Hambridge K. A narrative review of patients' lived experience of having a pressure injury. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S10-S23. [PMID: 38386534 DOI: 10.12968/bjon.2024.33.4.s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
AIM To explore patients' experiences of living with pressure injuries. DESIGN A qualitative narrative review and thematic synthesis of qualitative research studies. DATA SOURCES Six electronic databases were searched: Medline, CINAHL, Scopus, Web of Science, Embase, and Google Scholar (for grey literature). The search was conducted between October 2022 and April 2023. Setting: Acute, community and care home settings across the UK, France, Belgium and the US. REVIEW METHODS The PRISMA checklist for reporting systematic reviews was used. The included studies were evaluated for quality using the CASP tool. The Joanna Briggs Institute data extraction tool was used to extract data from the included studies. Thematic synthesis was used to identify themes to present a coherent and nuanced understanding of patients' experiences of living with pressure injuries. RESULTS Nine studies involving 244 participants, aged 21 to 101, with pressure injuries, met the inclusion criteria. Three key themes emerged using thematic analysis: physiological, emotional and psychological, and social effects. Within these themes, subthemes such as endless pain and discomfort, loss of mobility and independence, and social isolation were dominant in all aspects of the lives of patients living with pressure injuries. CONCLUSIONS This narrative review gives clear and multifaceted insight into the impact of pressure injuries on individuals' lives, emphasising the necessity for patient-centred care and the integration of evidence-based tools for effective pain management and risk assessment. The impact of pain on emotional and psychological wellbeing was significant, and the financial implications are scarcely known. Future research is needed to explore the experiences of younger adults and the financial consequences of living with pressure injuries.
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Affiliation(s)
- Chioma Ibeh
- Final-year Student Nurse, School of Nursing and Midwifery, University of Plymouth
| | - Kevin Hambridge
- Lecturer in Adult Nursing, School of Nursing and Midwifery, University of Plymouth
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