Meeting Healthcare Demands of an Aging Population

Introduction

The field of nursing to be focused in the study is Adult nursing which the field were nurses mainly provide and arrange care for the adults over 18 year to elderly. Adult nursing has been focused because the adult population in the UK is growing at an exponential rate (Wareing et al., 2017; Barron and West, 2017). It is evident as in 2019 elderly of 65 and over years of age in the UK were nearly 12 million (18% of the population), people between 40-60 years of age were 18 million and the overall adult population is predicted to be increased to 20 million by 2050 (ONS, 2019). The exponential increase in the adults would lead to consider more healthcare been required by them out of age-related and disease-related complication and discussion regarding the nursing field is important to develop overview regarding the condition to be faced by elderly (Halter et al., 2017).

The choice of the topic in the Adult nursing field that is to be focused in the study is impact of nutritional status on pressure ulcers among adults. This is because in the UK nearly 4-10% of the patients who are adults and admitted to the hospital are seen to develop pressure ulcer. The exact rate of pressure ulcer among the elderly in the care home and community is unknown (NICE, 2019). The statistics indicates that pressure ulcer is one of the key problems faced by most adults. It is also evident from the study of Pressler et al. (2018) where it is mentioned that pressure ulcer develops in 70% of the frail elderly or adults due to various issues. The study by Jaul et al. (2018) mentioned malnutrition creates worsening of pressure ulcer and leads to raise overall cost and healing time for the condition in the adults. It leads to compromise the health and well-being if the adult patients (Lannering et al., 2017; Carryer et al., 2017). Thus, to understand to what extent the nutritional status is effective in managing pressure ulcer in elderly or adults, the current study is been developed. In this process, five annotated bibliography are provided and summarised to mention their link with the topic. Finally, the research question arising the discussed information is to be mentioned.

Annotated Literature Sources

Article 1:

The study by Alhaug et al. (2017) has the key aim to examine the impact of nutritional status based on NRS (Nutritional Risk Screening) 2002 on pressure ulcer (PU) in inpatients of the hospital. The source is chosen for explaining the topic because it highlights through effective presentation of screening reports of patients the impact of nutritional status among elderly on their risk of pressure ulcer development or pressure ulcer management in hospital. The study is quantitative cross-sectional analysis which used information from 10 screening days between September 2012 and Mat 2014 regarding 651 adult inpatient who were suffering from PU. The study followed effective ethical consideration which is evident as it took informed consent from participants and followed confidentiality of participants and was approved by the Regional Ethical Committee for medical and health-related research ethics (REK South-East)

The results informed that prevalence of PU among patients is 8% and initial screening indicates 48% were suffering from low malnutrition and 52% were at possible risk of malnutrition. In the final screening, 32% patients were found to be suffering from risk of malnutrition. The odd ratio indicated that patient who were at risk of malnutrition or suffering from malnutrition are at increased risk of facing worsen PU compared to the patient who were at low risk of malnutrition (OR = 2.58 and 2.55, respectively). Thus, the results conclude that nutritional risk or malnutrition is associated with negative management and increased risk of PU among adults. The limitation of the study is that it uses cross-sectional analysis which led to precluded usefulness of NRS 2002 in identifying risk of PU. The other limitation is that the eligibility criteria lead to exclude patients with highest risk of PU due to which the association between malnutrition and general hospital population is underestimated in the study.

Article 2:

The study by Tsaousi et al. (2015) asserted that it aimed to ascertain the factors responsible for developing pressure ulcer (PU) as a result of poor nutritional status in hospitalised population. The source was selected because it provides information about the factors responsible in making nutritional status responsible in management of PU which helped to understand reason behind link with nutrition and PU. The study used prospective cohort study design and included 471 adult inpatients who were suffering from PU. The data analysis is executed by using χ2 analysis, independent-sample t-test and logistic regression. In the study, whether ethical consideration is followed in not separately mentioned and no approval from any ethics authorities are taken in conducting the research. The results revealed that low food intake, abnormal status of appetite, increased age and lower autonomy in life contributed to develop of poor nutrition in the patients which worsened their risk of development of PU and hindered management of PU. The limitation of the study is that it used sample size due to which generalisation of results are hard to be reached and no evidence was present regarding the outcome of the dietary intervention in case of PU.

Article 3:

The study by Neloska et al. (2016) mentioned that they have the aim to determine the influence of nutritional status on prevalence of pressure ulcer (PU) and risk of malnutrition rate in hospitalised adult patients. The source is used for explaining the topic because it informed not only the impact of nutritional status on PU management but to what extent it is actually present in the care settings to consider it as a major health issue in regard to risk of PU. The study followed ethical consideration in all aspect and is approved by the Hospital Ethic Committee where the study is been performed. The study used descriptive, cross-sectional and observational study design and include 2099 patient report in performing the research.

The results inform that PU prevalence was 12.9% and nearly 27.5% were malnourished with 61.7% patient found to be with good nutrition. The poor nutritional status was found to be statistically significantly different in people with PU and patient without PU. The study also mentioned hypoproteinemia, low RBC count and hypoalbuminemia are related with increased PU prevalence. Thus, the study concluded that poor nutritional status is related with increased PU prevalence in patients. The limitation of the study is that it used convenience sampling in recruiting the participants due to which they may not have been representative of the population that resulted in raising selection bias in the study.

Article 4:

The study by Cereda et al. (2015) informed that they aimed to determine if good nutritional formula that contains zinc, arginine, high-calorie, high-protein and antioxidants are helpful in promoting management of pressure ulcer (PU). The source is chosen for explaining the topic because it helps to provide information about impact of good and poor nutrition in managing PU in adult. The study used randomised-control trial in executing the reserch and included 200 adult malnourished patient who were suffering from stage II, III and IV PU. The study followed ethical considerations and took informed consent from participants in executing the study along with it was approved by the ethic committee. The results revealed that patients (n=101) who were malnourished and provided supplemented nutritional formula expressed greater reduction in the condition of PU compared to the patients who were malnourished and no provided good nutrition to manage their condition. In 8-weeks follow-up results, 40% reduction in pressure ulcer is seen in patients who were provided good nutrition. The study limitation was that participation was restricted to patients who were malnourished, allowed to have oral supplements and living in long-term condition that raised selection bias in the study.

Article 5:

The study by Stracci et al. (2018) aimed to determine the impact of enteral nutrition on the pressure sores or ulcer developed in adult patients. The source is been used in explaining the topic because it mentions the nature of nutritional status effective for pressure ulcer or sores and management in adult individuals. The study used quantitative cross-sectional design in which the researchers included 50 individuals suffering from pressure ulcer (PU). The study was executed between June and September 2015 and two nutritional assessment were used in determining the impact of different nutritional status of individual in PU. The participants are divided into two groups one of which received artificial nutrition (group A) and another group received oral nutritional intake at home (group B).

The results informed that group A expressed significant improvement in their nutritional status which is also found to be co-related with enhanced PU control. However, the group B expressed significant difference in intake of nutrients and showed worsening of PU stage due to presence of lack of effective nutrients in the body. It led to conclude that target nutritional intake helps in better healing of PU in adults, elderly and older population. The limitation of the study is presence of small sample size that lead to create hindrance in generalisation of results. The other limitation was that it was a single-centre study due to which the varied results to be faced in other centres can be judged through it. The other limitation is that the comparison groups were no homogenous at the T0 level that may have led to bias in the study result presentation.

Evaluation Summary

The evaluation of the above five studies commonly mentioned that nutritional status is one of the major factors related to development and management of pressure ulcer in elderly and adult individuals. The poor nutritional status and specifically malnutrition is found to be related in raising the risk of pressure ulcer in individuals and worsening the stage of pressure ulcer in patients. This is evident from the studies of Alhaug et al. (2017) and Neloska et al. (2016) where the researcher mentioned direct link of malnutrition with increased risk of pressure ulcer and study of Cereda et al. (2015) where the researcher mentioned malnourished adults express increased worsening of pressure ulcer in all stages. The facts are true because without presence of enhanced nutrition such as protein, vitamins, minerals and specific calories the body becomes incapable to arrange energy and supportive function require in healing of wound (Barchitta et al., 2019; Basiri et al., 2020; Serena et al., 2018; Citty et al., 2019). Thus, it leads to worsen the risk of pressure ulcer as they are mostly wounds developed due to continuous pressure on single area of the body. The fact is supported by the study of Cereda et al. (2015) where the researcher mentioned intake of zinc, arginine, protein and others as nutritional components are effective in lowering risk and netter stage control of pressure ulcer in adults. In contrast to these studies, the study by Tsaousi et al. (2015) highlighted the factors that led to the rise of the malnutrition or poor nutrition in adults that is responsible in worsening their pressure risk and stage and provided linked information that low nutritional status is directly related with worsening of pressure ulcer. The study mentioned that lack of appetite, autonomy in eating, low intake of food and others are raising the risk of the condition.

Research Question

The research question that is raised from the summarisation of the studies is that:

How does different nutritional status impact on pressure ulcer in adults and elderly?

The research question aims to contribute to gathering nursing evidence for the mentioned topic by exploring different nutritional condition that contribute to the positive or negative management of pressure ulcer in individuals. Moreover, it would explore the comparison of poor nutrition status with good nutritional status to determine the way they differentially impact the risk of pressure ulcer in adults.

Conclusion

The above discussion informs that the adult nursing field is the key focus of nursing in the current study. The topic regarding pressure ulcer and its link with nutritional status of the individuals suffering from pressure ulcer is been focussed. This is because most of the adults who are suffering from long-term condition and confined in bed show prevalent risk of develop pressure ulcer (Nadukkandiyil et al., 2019). They are also mostly found to be suffering from poor malnutrition and therefore if the nutritional status has a direct link with pressure ulcer worsening is determined (Moor, 2019). For this purpose, the studies evaluated proved and mentioned through different screening of patients that pressure ulcer worsening and development risk is directly related with the condition in patients. Therefore, it is to determine which nature of good nutritional status and specific nature of poor nutritional status responsible for worsening the risk of pressure ulcer in patients.

References

Alhaug, J., Gay, C.L., Henriksen, C. and Lerdal, A., 2017. Pressure ulcer is associated with malnutrition as assessed by Nutritional Risk Screening (NRS 2002) in a mixed hospital population. Food & nutrition research, 61(1), p.1324230.

Barchitta, M., Maugeri, A., Favara, G., Magnano San Lio, R., Evola, G., Agodi, A. and Basile, G., 2019. Nutrition and wound healing: an overview focusing on the beneficial effects of curcumin. International journal of molecular sciences, 20(5), p.1119.

Barron, D.N. and West, E., 2017. The quasi-market for adult residential care in the UK: Do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care?. Social Science & Medicine, 179, pp.137-146.

Basiri, R., Spicer, M.T., Levenson, C.W., Ormsbee, M.J., Ledermann, T. and Arjmandi, B.H., 2020. Nutritional supplementation concurrent with nutrition education accelerates the wound healing process in patients with diabetic foot ulcers. Biomedicines, 8(8), p.263.

Carryer, J., Weststrate, J., Yeung, P., Rodgers, V., Towers, A. and Jones, M., 2017. Prevalence of key care indicators of pressure injuries, incontinence, malnutrition, and falls among older adults living in nursing homes in New Zealand. Research in nursing & health, 40(6), pp.555-563.

Cereda, E., Klersy, C., Serioli, M., Crespi, A. and D'Andrea, F., 2015. A nutritional formula enriched with arginine, zinc, and antioxidants for the healing of pressure ulcers: a randomized trial. Annals of internal medicine, 162(3), pp.167-174.

Citty, S.W., Cowan, L.J., Wingfield, Z. and Stechmiller, J., 2019. Optimizing nutrition care for pressure injuries in hospitalized patients. Advances in wound care, 8(7), pp.309-322.

Halter, M., Pelone, F., Boiko, O., Beighton, C., Harris, R., Gale, J., Gourlay, S. and Drennan, V., 2017. Interventions to reduce adult nursing turnover: a systematic review of systematic reviews. The open nursing journal, 11, p.108.

Jaul, E., Barron, J., Rosenzweig, J.P. and Menczel, J., 2018. An overview of co-morbidities and the development of pressure ulcers among older adults. BMC geriatrics, 18(1), pp.1-11.

Lannering, C., Ernsth Bravell, M. and Johansson, L., 2017. Prevention of falls, malnutrition and pressure ulcers among older persons–nursing staff's experiences of a structured preventive care process. Health & social care in the community, 25(3), pp.1011-1020.

Moor, F., 2019. Role of nutrition in pressure ulcer management. Journal of Community Nursing, 33(1).pp.78-90.

Nadukkandiyil, N., Syamala, S., Saleh, H.A., Sathian, B., Ahmadi Zadeh, K., Acharath Valappil, S., Alobaidli, M., Elsayed, S.A., Abdelghany, A., Jayaraman, K. and Al Hamad, H., 2019. Implementation of pressure ulcer prevention and management in elderly patients: a retrospective study in tertiary care hospital in Qatar. The Aging Male, pp.1-7.

Neloska, L., Damevska, K., Nikolchev, A., Pavleska, L., Petreska-Zovic, B. and Kostov, M., 2016. The association between malnutrition and pressure ulcers in elderly in long-term care facility. Open access Macedonian journal of medical sciences, 4(3), p.423.

ONS 2019, National population projections: 2018-based, Available at:

Pressler, S.J., Jung, M., Titler, M., Harrison, J. and Lee, K., 2018. Symptoms, nutrition, pressure ulcers, and return to community among older women with heart failure at skilled nursing facilities: a pilot study. Journal of Cardiovascular Nursing, 33(1), pp.22-29.

Serena, T.E., Yaakov, R.A., DeLegge, M., Mayhugh, T.A. and Moore, S., 2018. Nutrition in patients with chronic non-healing ulcers: a paradigm shift in wound care. Chronic Wound Care Management and Research, 5, p.5.

Stracci, G., Scarpellini, E., Rinninella, E., Mignini, E.V., Clementi, N., Boni, M.V., Valeri, M.V., Sansoni, D., Abenavoli, L., Gasbarrini, A. and Rasetti, C., 2020. Effects of enteral nutrition on patients with pressure lesions: a single center, pilot study. European review for medical and pharmacological sciences, 24(3), pp.1563-1570.

Tsaousi, G., Stavrou, G., Ioannidis, A., Salonikidis, S. and Kotzampassi, K., 2015. Pressure ulcers and malnutrition: results from a snapshot sampling in a university hospital. Medical Principles and Practice, 24(1), pp.11-16.

Wareing, M., Taylor, R., Wilson, A. and Sharples, A., 2017. The influence of placements on adult nursing graduates' choice of first post. British Journal of Nursing, 26(4), pp.228-233.

Take a deeper dive into Medicines Optimization in Healthcare with our additional resources.