Geriatrik Hastalarda Kronik Yara Yönetimi; Bir Evde Sağlık Hizmetleri Örneği

Year 2023, Volume: 10 Issue: 2, 65 - 73, 31.08.2023

Arzu Ayraler , Muhammed Emin Göktepe , Aslı Dikmen , Ceren Varer Akpınar

https://doi.org/10.56941/odutip.1317255

Abstract

Amaç: Kronik yaralar geriatrik popülasyonda önemli bir sağlık sorunudur ve sıklıkla yaşam kalitesinin düşmesine ve sağlık bakım maliyetlerinin artmasına neden olur. Evde bakım hizmeti alan 65 yaş üstü bireylerde kronik hastalıkların ve beslenme durumunun bası yarası gelişimine etkisini değerlendirmek.
Gereç ve Yöntem: Bu çalışma 15.12.2022 - 15.01.2023 tarihleri arasında Giresun Eğitim ve Araştırma Hastanesi'nde yapılmıştır. Evde Sağlık Hizmetlerine (ESH) kayıtlı ve 65 yaş ve üstü bireyler dahil edildi. Sosyodemografik özellikler, tıbbi öykü, Nutrisyonel Risk Taraması (NRS-2002), Görsel ağrı skalası, Braden Bası ülseri risk skalası ve yara evrelemesini değerlendirme skalası uygulandı.
Bulgular: Çalışmaya alınan 76 hastanın yaş ortalaması 83,64±8,11 idi. Hastaların %80,3'ü kadındı, %86,8'i tıbbi bakıma ihtiyaç duyuyordu. %52,6'sı nörolojik, %36,8'i kardiyovasküler ve %7,8'i solunum yolu hastalıkları nedeniyle SKS almıştır. Beslenme risk durumu incelendiğinde %40,8'i ön değerlendirme sonucunda birincil değerlendirmeye sahipti. Ana değerlendirme sonucuna göre hastaların %97,4'ünde beslenme riski vardı. Fizik muayene sonucunda hastaların %16'sında yara tespit edildi. Hastaların bası ülseri gelişme riskine bakıldığında %6,8'i yüksek, %21,6'sı orta ve %35,1'i düşük risk taşıyordu. Ortalama Braden basınç skalası skoru 16.86±3.03 idi. Katılımcılardan sadece biri orta derecede ağrı tanımlamıştır.
Sonuç: Geriatrik hastalarda kronik yaraların etkili yönetimi, altta yatan nedenleri ele alan, yara iyileşmesini destekleyen ve komplikasyonları önleyen kapsamlı ve multidisipliner bir yaklaşım gerektirir.

Keywords

Bası yarası, Geriatrik bireyler, Evde bakım hizmetleri

Supporting Institution

Yoktur

Project Number

Yoktur

Chronic Wound Management in Geriatric Patients; A Case of Home Care Services

Abstract

Objective: Chronic wounds are a major health problem in the geriatric population and often lead to reduced quality of life and increased healthcare costs. To evaluate the impact of chronic diseases and nutritional status on pressure ulcer development in individuals over 65 years of age enrolled in home care services.
Methods: This study was conducted between 15.12.2022 - 15.01.2023 at Giresun Training and Research Hospital. Individuals registered to the Home Care Services (HCS) and aged 65 years and over were included. Sociodemographic characteristics, medical history, Nutritional Risk Screening (NRS-2002), Visual pain scale, Braden Pressure ulcus risk scale and a scale to analyze wound staging were applied.
Results: The mean age of the 76 patients included in the study was 83.64±8.11 years. 80.3% of the patients were female, 86.8% needed medical care. 52.6% received HCS for neurologic, 36.8% for cardiovascular and 7.8% for respiratory diseases. When nutritional risk status was analyzed, 40.8% had a primary assessment as a result of the preliminary assessment. According to the main assessment result, 97.4% of the patients had nutritional risk. As a result of physical examination, wounds were detected in 16% of the patients. Considering the risk of pressure ulcus development, 6.8% of the patients were at high risk, 21.6% were at medium risk and 35.1% were at low risk. The mean Braden pressure scale score was 16.86±3.03. Only one of the participants described moderate pain.
Conclusion: Effective management of chronic wounds in geriatric patients requires a comprehensive and multidisciplinary approach that addresses the underlying causes, promotes wound healing, and prevents complications.

Keywords

Pressure ulcer, Geriatric individuals, Home care services

Project Number

Yoktur

References

• 1. Taşdemir R. Oğuzöncül AF. Evaluation of Illness Status and Socio-demographic Characteristics of Individuals Given Home Health Care. Journal of Performance and Quality in Health. 2019;17(2):11–28.
• 2. Prime Ministry Legislation Development and Publication General Directorate. Regulation on the Delivery of Home Care Services. Ankara, 10.03.2005; Official Gazette:URL: https://www.resmigazete.gov.tr/eskiler/2015/02/20150227-14.htm (ET: 01.10.2023)
• 3. Enginyurt Ö.Öngel K. Sociodemographic characteristics and medical conditions of patients in home care service. Smyrna Medical Journal. 2012;2(1):45–8.
• 4. Uçkuş P. Yıldırım T. Evaluation of Quality of Life of Individuals aged 65 and over who receive home health services. Hacettepe Journal of Health Administration, 2021;24(2):319-334.
• 5. Lo SF, Chuang ST, Liao PL. [Challenges and Dilemmas of Providing Healthcare to Patients in Home Care Settings With Hard-to-Heal Wounds]. Hu Li Za Zhi. 2021;68(4):89-95. Chinese. doi: 10.6224/JN.202108_68(4).11. PMID: 34337707.
• 6. Cross K, Harding K. Risk profiling in the prevention and treatment of chronic wounds using artificial intelligence. Int Wound J. 2022;19(6):1283-1285. doi:10.1111/iwj.13952.
• 7. Bowers S, Franco E. Chronic Wounds: Evaluation and Management. Am Fam Physician. 2020;101(3):159-166.
• 8. Sen CK. Human Wound and Its Burden: Updated 2020 Compendium of Estimates. Adv Wound Care (New Rochelle). 2021;10(5):281-292. doi:10.1089/wound.2021.0026.
• 9. Guest JF, Fuller GW, Vowden P. Cohort study evaluating the burden of wounds to the UK's National Health Service in 2017/2018: update from 2012/2013. BMJ Open. 2020;10(12):e045253. Published 2020 Dec 22. doi:10.1136/bmjopen-2020-045253
• 10. Braden BJ, Bergstrom N. Clinical utility of the Braden Scale for predicting pressure sore risk. Decubitus 1989; 2: 44-51.
• 11. Jastrzab G. Kerr S. Fairbrother G. Misinterpretation of the Face Pain Scale-Revised in adult clinical practice.Acute Pain.2009;11(2):51-5.
• 12. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M, Educational and Clinical Practice Committee ErSoPaENE. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415-421.
• 13. Oğuz S, Olgun N. Determining the risks of patients with the Braden Scale and determining the effectiveness of planned nursing care in the prevention of pressure ulcers. Nursing Forum, 1998;1(3):131-135.
• 14. Kottner J, Halfens R, Dassen T. An interrater reliability study of the assessment of pressure ulcer risk using the Braden scale and the classification of pressure ulcers in a home care setting. Int J Nurs Stud. 2009;46(10):1307-1312. doi:10.1016/j.ijnurstu.2009.03.014.
• 15. Bolayır B. Evaluation of the validity and reliability of the nutritional assessment test NRS2002 (Nutritional Risk Screening-2002) in hospitalized patients. Unpublished Specialization Thesis, 2014, Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Ankara
• 16. Blair MJ, Jones JD, Woessner AE, Quinn KP. Skin Structure-Function Relationships and the Wound Healing Response to Intrinsic Aging. Adv Wound Care (New Rochelle). 2020;9(3):127-143. doi:10.1089/wound.2019.1021
• 17. Wilkinson HN, Hardman MJ. Wound healing: cellular mechanisms and pathological outcomes. Open Biol. 2020;10(9):200223. doi:10.1098/rsob.200223.
• 18. Nussbaum SR. Carter MJ. Fife CE et al. An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds. Value Health. 2018;21(1):27-32. doi:10.1016/j.jval.2017.07.007
• 19. Demirci Şahin A. Seyrek S. Ertürk A et al. Pressure Sores in Home Care Patients and Demographic Characteristics of the Patients. Konuralp Medical Journal 2017;9(1):14-18.doi:10.18521/ktd.286610
• 20. Parker CN, Finlayson KJ, Edwards HE, MacAndrew M. Exploring the prevalence and management of wounds for people with dementia in long-term care. Int Wound J. 2020;17(3):650-659. doi:10.1111/iwj.13325
• 21. Black M, Bowman M. Nutrition and Healthy Aging. Clin Geriatr Med. 2020;36(4):655-669. doi:10.1016/j.cger.2020.06.008.
• 22. Yeniçağ R. Rakıcıoğlu N. Pressure Sores in the Elderly and Nutritional Treatment. Sakarya Medical Journal 2019;9(3):387-397.
• 23. Eglseer D, Hödl M, Lohrmann C. Nutritional management of older hospitalised patients with pressure injuries. Int Wound J. 2019;16(1):226-232. doi:10.1111/iwj.13016
• 24. Jansen RCS, Silva KBA, Moura MES. Braden Scale in pressure ulcer risk assessment. Rev Bras Enferm. 2020;73(6):e20190413. doi:10.1590/0034-7167-2019-0413