THE EFFECT OF PRESSURE ULCERS ON THE SURVIVAL IN PATIENTS WITH ADVANCED DEMENTIA AND COMORBIDITIES

Global Wound Care Congress

September 12-13, 2016 San Antonio, USA

Efraim Jaul

Hebrew University Medical School, Israel

Keynote: J Nurs Care

Abstract :

Background: The mortality rates for many leading causes of death have declined over the past decade. Advanced dementia with comorbidities has steadily increased to become one of the leading causes of death in the elderly population. Therefore, we examined the effect of pressure ulcers on the survival time of patients with advanced dementia and comorbidities. Method: Data was reviewed from all the files of 147 patients hospitalized over a period of three and a half years. 99 tube-fed patients suffering from advanced dementia were included; 72(66.5%) had pressure ulcers and 27(33.5%) were without pressure ulcers at admission. Logistic regression analysis was used to estimate the odds ratio and 95% confidence intervals for pressure ulcers group versus non-pressure ulcers group. Unadjusted Cox model and Cox proportional Hazards model were used to assess the hazard ratio for pressure ulcers and the association between pressure ulcers and survival time, respectively. Kaplan- Meier model was used to visually confirm the existence of proportional hazards of pressure ulcers on survival. Results: The median survival of advanced dementia patients with pressure ulcers was significantly shorter, compared to those without pressure ulcers (96 days vs 863 days respectively (p=0.001, log rank test). The Hazard Ratio for the advanced dementia patients with pressure ulcers; was 2.81, 95% CI: 1.51-5.22, p<0.01. Significant lower hemoglobin and serum albumin levels were found in the patients with pressure ulcers; (10.46 vs 11.7 p= 0.001) and (26.2 vs 29.6 p=0.02). Conclusion: Advance dementia and pressure ulcers in the same patient results in earlier mortality. Advanced dementia patients with pressure ulcers, had significantly lower survival expectancy in comparison to similar patients without pressure ulcers. Clinical and ethical implications are discussed.

Biography :

Efraim Jaul is a specialist in Family Medicine and Geriatric Medicine. He is the Head of the Geriatric Skilled Nursing Department at the Sarah Herzog Hospital, Jerusalem, Israel. It is affiliated with the Hebrew University-Hadassah Medical School, Jerusalem. He is a Clinical Senior Lecturer in the Hebrew Medical School Faculty. He supervises clinical practice and mentors students. He developed and established a pioneering inpatient unit at the Herzog Hospital specifically for the treatment of pressure ulcers concerning the need for a special unit and the resulting benefits for the immobile elderly patients. This unit has elicited interest in serving as a model for geriatric treatment facilities around the world and has set the standard for developing specialized pressure ulcer units.

Email: EfraimJ@herzoghospital.org