Development and progression of pressure ulcers in relation to the nutritional status of hospitalised overweight and obese patients older than 65 years: A longitudinal study

Authors

DOI:

https://doi.org/10.12923/pielxxiw-2026-0041

Keywords:

pressure ulcers, risk factors, nutritional status, elderly, obesity

Abstract

Aim. The present study focuses on the connection between the development of pressure ulcers (PU) and selected risk factors in overweight or obese patients aged ≥ 65 years.

Material and methods. A longitudinal study included 102 patients (59 males, 43 females; mean age 78.43±7.3 years). The monitoring occurred at admission, discharge, and 5±1 weeks post-hospitalisation and included the measurement of somatometric indicators and clinical-nutritional variables.

Results. The prevalence of pressure ulcers ranged between 31.37% and 43.13%, and Stage 2 pressure ulcers in the area of the sacrum were recorded most frequently. Age and nutritional score have proved to be the most signifi cant predictors of pressure ulcer development. The other factors analysed between the phases indicated some correlations but their signifi cance has proved to be inconsistent. The Braden score has proved to be a highly sensitive tool.

Conclusions. The development of pressure ulcers in these patients is conditioned by multiple factors. Older age, the nutritional score and a low score of the Braden scale have proved to be the key indicators. The study results may help medical staff in identifying at-risk patients in a timely manner and contribute to reducing the prevalence of pressure ulcers.

References

1. European pressure ulcer advisory panel, National pressure injury advisory panel, Pan Pacific pressure injury alliance. Prevention and treatment of pressure ulcers/injuries: clinical practice guideline. The International Guideline. 2019. https://internationalguideline.com/s/CPG2019edition-digital-Nov2023version.pdf

2. Zhou Q, Yu T, Liu Y, et al. The prevalence and specific characteristics of hospitalised pressure ulcer patients: A multicentre cross-sectional study. J. Clin. Nurs. 2018; 27:694-704. https://doi.org/10.1111/jocn.14019

3. Braden B, Bergstrom N. A conceptual schema for the study of the etiology of pressure sores. Rehabil. Nurs.1987;12(1):8-12. https://doi.org/10.1002/j.2048-7940.1987.tb00541.x

4. Hajhosseini B, Longaker MT, Gurtner GC. Pressure Injury. Ann. Surg. 2020;271(4):671-679. https://doi.org/10.1097/SLA.0000000000003567

5. Munoz N, Posthauer ME, Cereda E, et al. The role of nutrition for pressure injury prevention and healing: The 2019 International clinical practice guideline recommendations. Adv. Skin Wound Care. 2020;33(3):123-136. https://doi.org/10.1097/01.ASW.0000653144.90739.ad

6. Tatucu-Babet OA, Ridley EJ. Under pressure: Nutrition and pressure injury development in critical illness. Intensive Crit Care Nurs. 2021;62:102960. https://doi.org/10.1016/j.iccn.2020.102960

7. Sanson G, Bertocchi L, Dal Bo E, et al. Identifying reliable predictors of protein-energy malnutrition in hospitalized frail older adults: A prospective longitudinal study. Int. J. Nurs. Stud. 2018;82:40-48. https://doi.org/10.1016/j.ijnurstu.2018.03.007

8. Rezaei M, Forouzan K, Eini-Zinab H, et al. Dietary diversity and its association with changes in anthropometric indices of community-dwelling older adults in Tehran, Iran: a longitudinal study (2017-2021). BMC Public Health. 2024;24(1):2253. https://doi.org/10.1186/s12889-024-19635-y

9. Bellanti F, Lo Buglio A, Quiete S, et al. Malnutrition in hospitalized old patients: screening and diagnosis, clinical outcomes, and management. Nutrients. 2022;14(4):910. https://doi.org/10.3390/nu14040910

10. Bereded DT, Salih MH, Abebe AE. Prevalence and risk factors of pressure ulcer in hospitalized adult patients; a single center study from Ethiopia. BMC Res. Notes. 2018;11(1):847. https://doi.org/10.1186/s13104-018-3948-7

11. Jomar RT, Jesus RP, Jesus MP, et al. Incidence of pressure injury in an oncological intensive care unit. Rev. Bras. Enferm. 2019;72(6):1490-1495. https://doi.org/10.1590/0034-7167-2018-0356

12. Nadukkandiyil N, Syamala S, Saleh HA, et al. Implementation of pressure ulcer prevention and management in elderly patients: a retrospective study in tertiary care hospital in Qatar. Aging Male. 2020;23(5):1066-1072. https://doi.org/10.1080/13685538.2019.1670156

13. von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) Statement: guidelines for reporting observational studies. EQUATOR. Network. 2007. https://www.equator-network.org/reporting-guidelines/strobe/

14. Kopecký M, Matejovičová B, Cymek L et al. Manual of physical anthropology. Olomouc: Palacký University, 2019.

15. Dodd JM, Kannieappan LM, Grivell RM, et al. Effects of an antenatal dietary intervention on maternal anthropometric measures in pregnant women with obesity. Obesity (Silver Spring). 2015;23(8):1555-1562. https://doi.org/10.1002/oby.21145

16. Schumacher P, Santos E, Wandl B, et al. Construct validity of the Braden scale in acute- and long-term care settings in Austria: A structural equation modeling analysis. JNEP. 2024;14(8):44-52. https://doi.org/10.5430/jnep.v14n8p44

17. Barendrekt K, Soeters PB, Allison SP. Diagnosis of malnutrition: Screening and assessment. [in:] L. Sobotka (Ed.), Basics in Clinical Nutrition. Praha: Galén, 2000.

18. Kohout P, Havel E, Matějovič M, et al. Klinická výživa. Praha: Galén, 2021.

19. World Medical Association. WMA Declaration of Helsinki – Ethical principles for medical research involving human participants. WMA. 2025. Available from: https://www.wma.net/policies-post/wma-declaration-of-helsinki/

20. Chaboyer W, Bucknall T, Gillespie B, et al. Adherence to evidence-based pressure injury prevention guidelines in routine clinical practice: a longitudinal study. Int. Wound J. 2017;14:1290-1298. https://doi.org/10.1111/iwj.12798

21. Lannering C, Ernsth Bravell M, Johansson L. Prevention of falls, malnutrition and pressure ulcers among older persons – nursing staff’s experiences of a structured preventive care process. Health Soc. Care Community. 2017;25(3):1011-1020. https://doi.org/10.1111/hsc.12400

Downloads

Published

2026-10-20

Issue

Section

Original papers

How to Cite

Hujová, A., & Kopecký, M. (2026). Development and progression of pressure ulcers in relation to the nutritional status of hospitalised overweight and obese patients older than 65 years: A longitudinal study. Nursing in the 21st Century, 25(AOP). https://doi.org/10.12923/pielxxiw-2026-0041