Relatively upstream factors associated with pressure injury occurrence and staging in older hospitalized patients: a prospective observational study

BACKGROUND: The Braden Scale is widely used to assess the direct physiological risks of pressure injuries. However, there is limited research on the relatively upstream risk factors for the parameters assessed by the Braden Scale, such as pre-admission living environment, education, and chronic disease history, as well as proximal factors such as, incontinence and mobility. METHODS: This prospective observational study enrolled 86 older patients. Patient age, education, pre-admission living environment, diet, hypertension, diabetes, urinary and bowel function, relationship between caregivers and patients during hospitalization, and functional mobility were analyzed. Risk factor analysis and screening were conducted using a chi-square test or Fisher's exact test. The relationship between risk factors and pressure injury staging was analyzed using unconditional logistic regression. RESULTS: Univariate analysis indicated that the risk factors for pressure injury in older patients during hospitalization included the patient's living environment before admission (P = 0.032), urinary and fecal incontinence (P = 0.004), and mobility (P = 0.008). Further unconditional logistic regression results indicated that urinary and fecal incontinence were also associated with pressure injury staging. CONCLUSION: In this observational study, urinary and fecal incontinence were associated with both the occurrence and severity of pressure injuries in older hospitalized patients, whereas associations with pre-admission living environment and mobility were not sustained after adjustment. These exploratory findings suggest that graded continence assessment and care may be a worthwhile focus for future interventional research.