Pressure Injury in the Critically Ill Elderly Patient

Pressure injuries are a major problem for all people, but they are especially problematic in the elderly patient. The goal of this review is to provide strategies for reducing the incidence of these problem wounds in the geriatric population. The review asks: what are the risk factors for developing pressure injuries? And how are these risks magnified in the elderly population?

There are several wound healing organizations that have developed definitions and strategies for dealing with pressure injuries. Risks can be divided into “intrinsic” and “extrinsic” factors. “Intrinsic” risk factors include limited mobility, malnutrition, comorbidities, and aging. “Aging” leads to inexorable body and skin changes. There are “intrinsic” skin alterations—wrinkling, thinning, sagging, increased fragility—that occur in everyone as they age. One can accelerate age-related changes in the skin with “extrinsic” factors—exposure to ultraviolet light, smoking, and other stresses. All of these “intrinsic” risks interact with “extrinsic” risk factors that are the forces that cause the actual injury. “Extrinsic” risk factors include pressure from a firm surface, friction, and moisture.

By addressing the specific risk factors that predispose the elderly to pressure injuries, any clinician can reduce the incidence of these problematic wounds.