Zhongguo quanke yixue (Jul 2022)
Prevalence and Epidemiologic Features of Skin Injuries in Chinese Older Adults: a Multicenter Cross-sectional Study
Abstract
Background Population aging is a major challenge in the global healthcare field. Due to pathological and physiological changes in ageing skin, skin injuries are highly prevalent in older population. And epidemiological studies on skin injuries in this population has become a research hotspot recently. Objective To examine the prevalence and epidemiological characteristics of three types of skin injuries 〔pressure injuries (PI) , incontinence-associated dermatitis (IAD) and skin tears (ST) 〕in elderly inpatients using a multicenter cross-sectional study, providing a basis for formulating strategies for the prevention of skin injuries in older people. Methods A multicenter study was carried out in 52 hospitals selected from 16 provinces, two autonomous regions and two municipalities of China, from which 1 067 nurses who had completed the online homogenization training conducted by our research group and passed the relevant examination were selectedas investigators. Every 2-3 nurses were divided into a investigation group. Eligible older inpatients were selected as participants. Full body skin examination for screening skin injuries was conducted in participants in each hospital by nurses using the same tools and methods. PI, IAD and ST were defined and classified by relevant international guideline or expert consensus, respectively. Then demographics, length of stay (LOS) , chronic disease history, use of medications in the past month, living independence and risk of PI assessed by the Braden Scale of the participants were collected. After that, two nurses of each group signed to confirm the results, and uploaded to https://www.wjx.cn. SPSS 22.0 was used for statistical analysis. Results A total of 14 675 elderly inpatients were investigated, and all of them responded effectively (100.0%) . The respondents had an average age of (73.5±9.0) years and a median LOS of 7 (4, 13) days, among whom 56.3% (8 262/14 675) were men, and 43.7% (6 413/14 675) were women; 95.5% (14 020/14 675) were Han people, and 4.5% (655/14 675) were 19 ethnic minorities. The overall prevalence of the three types of skin injuries was 6.0% (881/14 675) , of which the prevalence of PI, IAD, ST and at least two types of skin injuries was 3.3% (484/14 675) , 1.4% (199/14 675) , 0.8% (110/14 675) and 0.6% (88/14 675) , respectively. Epidemiologic characteristics: Han people had higher prevalence of skin injuries compared with ethnic minorities (6.2% vs 2.9%, P=0.001) . Eighty-year-olds had higher prevalence of skin injuries than 71-80-year-old (10.2% vs 6.1%, P<0.001) and 60-70-year-old (10.2% vs 3.8%, P<0.001) . Those suffering from at least two chronic diseases had higher prevalence of skin injuries compared with those without chronic diseases (5.7%-12.0% vs 2.9%, P<0.005) or those with only one chronic disease (5.7%-12.0% vs 4.4%, P<0.005) . Users of two or more medications had higher prevalence of skin injuries compared with non-medication users (6.1%-10.2% vs 2.7%, P<0.005) or users of one medication (6.1%-10.2% vs 4.6%, P<0.005) . Those with LOS of over 30 days had higher prevalence of skin injuries compared with those with LOS of 8-30 days (10.7% vs 4.4%, P<0.016 7 ) or ≤7 days (10.7% vs 7.1%, P<0.016 7) . The prevalence of skin injuries in those with PI risk was higher than that in those without risk (20.5% vs 1.6%, P<0.05) . The prevalence of skin injuries in dependent-living individuals was higher than that of independent-living individuals (7.0% vs 0.9%, P<0.05) . The frequently-occurring sites were caudal sacral (57.9%) and heel (14.3%) for PI, peri-anal region (68.3%) and hip fissure (24.6%) for IAD, and lower limbs (38.2%) and upper limbs (28.2%) for ST. PI combined with IAD mostly occurred in sacrococcygeal region (71.0%) . PI combined with ST were common in sacrococcygeal region (50.0%) and heel (35.7%) . ST combined with IAD mostly occurred in caudal sacral (33.3%) , perianal region (33.3%) and gluteal fissure (33.3%) . PI, IAD and ST coexisted mostly in caudal sacral (50.0%) and gluteal fissure (50.0%) . Conclusion The prevalence of skin injuries in Chinese older people is high, and may increase with age, prevalence of chronic diseases and use of systemic medications, and dependent-living. In particular, PI risk may be associated with significantly higher possibility of developing skin injuries. Coexistence of multiple types and anatomical sites of skin injuries are important characteristics. The above-mentioned epidemiologic characteristics should be considered when formulating prevention strategies of skin injuries in the elderly.
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