Departmental Bulletin Paper 療養施設入所中の高齢者における浮腫と皮膚損傷の横断研究
A cross-sectional study of elderly individuals with oedema and skin injuries in long-term care facilities

佐藤, 文  ,  臺, 美佐子  ,  藤本, 由美子  ,  Saldy, Yusuf  ,  土屋, 紗由美  ,  井内, 映美  ,  田端, 恵子  ,  山下, 明美  ,  中谷, 壽男  ,  真田, 弘美  ,  須釜, 淳子

39 ( 2 )  , pp.63 - 73 , 2016-01-27 , 金沢大学つるま保健学会 = Tsuruma Health Science Society, Kanazawa University
[Purpose] When nurses provide care for individuals with oedema, the objective is to protect the skin and avoid applying external force to the skin, but the efficacy of gentle care is currently not well understood. This study was performed to clarify the relationships between oedema and skin injury caused by external force in elderly individuals with oedema.  [Methods] This cross-sectional study was performed in patients ≥ 65 years old at a long-term care hospital with 500 beds and a nursing home with 100 beds in Japan. These facilities fulfilled the selection criteria for prevention of pressure ulcers and external force preventive care, standardized for elderly patients with a history of skin tears on the limbs. Patients with severe conditions or for whom consent to participate was not obtained directly or from their family members were excluded. Data collected included age, sex, duration of hospitalization, main disease, body mass index (BMI), immobility, paralysis, articular contracture, Braden Scale, and risk factors for development of pressure ulcers. To identify edema and skin injury, the whole body of each participant was divided into 55 anatomical sites. Degree of oedema was evaluated using the modified Fukazawa method, from 0 to 4. Degree of oedema ≥ 2 was defined as “with oedema.” Skin injury was defined as “pressure ulcers, skin tears, and other external force-related skin injuries.”  [Results] Of the 579 patients recruited, 269 were excluded from the analysis based on the exclusion criteria. Of the 310 participants remaining in this study, 205 participants showed ≥ 1 anatomical location with degree of oedema ≥ 2. The characteristics of these 205 participants were: mean (± standard deviation) age, 87.2 ± 7.3 years; female, 75.1%; median duration of hospitalization, 2 years (interquartile range (IQR), 0.72 ‒ 3.56 years); median BMI, 18.2 kg/㎡ (IQR, 15.8 ‒ 20.4 kg/㎡); cerebrovascular disease present, 62.0%. Braden Scale total score = 12 (IQR, 11 ‒ 15), and 73.2% of participants were bedridden, 23.9% were chair-bound, 58.0% had paralysis, 60.5% had contracture of the upper limbs, and 67.8% had contracture of the lower limbs. Skin injuries were identified in 41 regions, and 58.5% of total skin injuries were on the lower limbs. Five sites (12.2%) showed both oedema and skin injuries, all of which were on the lower limbs. The odds ratio for oedema by cross-tabulation of oedema and skin injury was 0.87 (95% confidence interval, 0.467 ‒ 1.616).  [Conclusion] We examined the relationship between oedema and skin damage in elderly patients at facilities providing standardized preventive care for pressure ulcers and skin tears. No significant relationship was identified between oedema and skin injury, and the odds ratio of oedema was 0.87. Only the lower limbs showed skin injury coexisting with oedema. These results suggest that nurses can reduce skin damage in elderly patients with oedema using external force adjustment preventive care.

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