Prevalence and Risk Factors of hospital-acquired pressure ulcers in hospitalized elderly patients
DOI:
https://doi.org/10.5281/zenodo.22814958Keywords:
pressure ulcer, hospital-acquired, elderly patients, prevalence, risk factorsAbstract
Background: Hospital-acquired pressure ulcers (HAPUs) remain a common, largely preventable adverse event among hospitalized older adults, whose skin fragility, reduced mobility, and comorbid disease burden place them at disproportionate risk.
Objective: This review synthesizes evidence on the prevalence, anatomical distribution, and risk factors for HAPU in elderly hospitalized patients, and examines standardized risk assessment tools and prevention strategies.
Methods: We synthesized point-prevalence and incidence surveys, prospective cohort studies, risk-scale validation studies, and systematic reviews addressing pressure ulcer occurrence and its determinants across medical, surgical, and critical care settings.
Findings: Reported HAPU prevalence in elderly cohorts commonly ranges from roughly 3% to over 20% by setting, with the sacrum, heels, and other bony prominences accounting for most lesions; immobility, advanced age, poor nutrition, moisture, multimorbidity, and prolonged surgical or ICU stay are consistently identified independent risk factors, and structured tools such as the Braden and Norton scales aid early identification when combined with clinical judgement.
Conclusions: HAPU risk reflects intrinsic physiological vulnerability combined with extrinsic care-process exposures; systematic risk screening, individualized repositioning, pressure-redistributing surfaces, and nutritional and skin-care management together form an effective prevention bundle, with further gains dependent on sustained implementation fidelity.
References
National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance (2019) Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. Cambridge Media, Osborne Park, Western Australia.
Lyder, C.H. (2003) Pressure ulcer prevention and management. JAMA, 289(2): 223-226.
Jaul, E. (2010) Assessment and management of pressure ulcers in the elderly: current strategies. Drugs & Aging, 27(4): 311-325.
Braden, B., Bergstrom, N. (1987) A conceptual schema for the study of the etiology of pressure sores. Rehabilitation Nursing, 12(1): 8-12.
Bergstrom, N., Braden, B.J., Laguzza, A., Holman, V. (1987) The Braden Scale for Predicting Pressure Sore Risk. Nursing Research, 36(4): 205-210.
VanGilder, C., Amlung, S., Harrison, P., Meyer, S. (2009) Results of the 2008-2009 International Pressure Ulcer Prevalence Survey and a 3-year, acute care, unit-specific analysis. Ostomy Wound Management, 55(11): 39-45.
Vanderwee, K., Clark, M., Dealey, C., Gunningberg, L., Defloor, T. (2007) Pressure ulcer prevalence in Europe: a pilot study. Journal of Evaluation in Clinical Practice, 13(2): 227-235.
Lahmann, N.A., Halfens, R.J., Dassen, T. (2006) Pressure ulcers in German nursing homes and acute care hospitals: prevalence, frequency, and ulcer characteristics. Ostomy Wound Management, 52(2): 20-33.
Igarashi, A., Yamamoto-Mitani, N., Gushiken, Y., Takai, Y., Tanaka, M., Okamoto, Y. (2013) Prevalence and incidence of pressure ulcers in Japanese long-term-care hospitals. Archives of Gerontology and Geriatrics, 56(1): 220-226.
Bauer, K., Rock, K., Nazzal, M., Jones, O., Qu, W. (2016) Pressure ulcers in the United States' inpatient population from 2008 to 2012: results of a retrospective nationwide study. Ostomy Wound Management, 62(11): 30-38.
Gunningberg, L. (2004) Risk, prevention and treatment of pressure ulcers--nursing staff knowledge and documentation. Scandinavian Journal of Caring Sciences, 18(1): 72-78.
Lindgren, M., Unosson, M., Fredrikson, M., Ek, A.C. (2004) Immobility--a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study. Scandinavian Journal of Caring Sciences, 18(1): 57-64.
Coleman, S., Gorecki, C., Nelson, E.A., Closs, S.J., Defloor, T., Halfens, R., et al. (2013) Patient risk factors for pressure ulcer development: systematic review. International Journal of Nursing Studies, 50(7): 974-1003.
Jaul, E., Barron, J., Rosenzweig, J.P., Menczel, J. (2018) An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatrics, 18: 305.
Margolis, D.J., Knauss, J., Bilker, W., Baumgarten, M. (2003) Medical conditions as risk factors for pressure ulcers in an outpatient setting. Age and Ageing, 32(3): 259-264.
Baumgarten, M., Margolis, D.J., Localio, A.R., Kagan, S.H., Lowe, R.A., Kinosian, B., et al. (2006) Extrinsic risk factors for pressure ulcers early in the hospital stay: a nested case-control study. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 61(4): 408-413.
Baumgarten, M., Margolis, D., Berlin, J.A., Strom, B.L., Kagan, S., Kavesh, W., et al. (2004) Risk factors for pressure ulcers among elderly hip fracture patients. Wound Repair and Regeneration, 12(1): 27-32.
Allman, R.M. (1997) Pressure ulcer prevalence, incidence, risk factors, and impact. Clinics in Geriatric Medicine, 13(3): 421-436.
Coleman, S., Nixon, J., Keen, J., Wilson, L., McGinnis, E., Dealey, C., et al. (2014) A new pressure ulcer conceptual framework. Journal of Advanced Nursing, 70(10): 2222-2234.
Cox, J. (2011) Predictors of pressure ulcers in adult critical care patients. American Journal of Critical Care, 20(5): 364-375.
Cox, J., Roche, S. (2015) Vasopressors and development of pressure ulcers in adult critical care patients. American Journal of Critical Care, 24(6): 501-510.
Suriadi, Sanada, H., Sugama, J., Kitagawa, A., Thigpen, B., Kinosita, S., et al. (2008) A new instrument for predicting pressure ulcer risk in an intensive care unit. Journal of Tissue Viability, 17(2): 39-49.
Reddy, M., Gill, S.S., Rochon, P.A. (2006) Preventing pressure ulcers: a systematic review. JAMA, 296(8): 974-984.
Norton, D., McLaren, R., Exton-Smith, A.N. (1962) An Investigation of Geriatric Nursing Problems in Hospital. National Corporation for the Care of Old People, London.
Waterlow, J. (1985) A risk assessment card. Nursing Times, 81(48): 49-55.
Pancorbo-Hidalgo, P.L., Garcia-Fernandez, F.P., Lopez-Medina, I.M., Alvarez-Nieto, C. (2006) Risk assessment scales for pressure ulcer prevention: a systematic review. Journal of Advanced Nursing, 54(1): 94-110.
Moore, Z.E., Cowman, S. (2014) Risk assessment tools for the prevention of pressure ulcers. Cochrane Database of Systematic Reviews, 2: CD006471.
Gorecki, C., Brown, J.M., Nelson, E.A., Briggs, M., Schoonhoven, L., Dealey, C., et al. (2009) Impact of pressure ulcers on quality of life in older patients: a systematic review. Journal of the American Geriatrics Society, 57(7): 1175-1183.
Demarre, L., Van Lancker, A., Van Hecke, A., Verhaeghe, S., Grypdonck, M., Lemey, J., et al. (2015) The cost of prevention and treatment of pressure ulcers: a systematic review. International Journal of Nursing Studies, 52(11): 1754-1774.
Padula, W.V., Delarmente, B.A. (2019) The national cost of hospital-acquired pressure injuries in the United States. International Wound Journal, 16(3): 634-640.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Sean Kelly, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.
