Which assessment tool is used for older adults when predicting pressure sore risk

Introduction

Why: Pressure ulcers are serious problems that occur frequently in hospitalized, community-dwelling and nursing home older adults, accounting for 3-11% in acute facilities, and 24% in long-term facilities. Once they occur, pressure ulcers in the older adult may lead to sepsis and death. A key to prevention is early detection of at-risk patients with a valid and reliable pressure ulcer risk assessment instrument.

Best Tool: The Braden Scale for Predicting Pressure Sore Risk is among the most widely used tools for predicting the development of pressure ulcers. Clinicians typically use the tool to assess six risk areas for developing pressure ulcers: sensory perception, skin moisture, activity, mobility, nutrition and friction/shear. Each risk area is assigned a score ranging from one (highly impaired) to three/four (no impairment). All risk areas are then added and the total overall risk, ranging from 6 to 23 is determined. Those scores at or below 16 indicate high risk, while scores above 16 indicate moderate to no risk.

Target Population: The Braden scale is commonly used with medically and cognitively impaired older adults. It has been extensively used in long-term care settings but is also used in acute and community care.

Validity/Reliability: The ability of the Braden Scale to predict the development of pressure ulcers has been tested extensively. Specificity of scores 16 or below ranges from 83% to 100% and 17 and higher ranges from 64% to 90%, supporting the predictive validity of the instrument. Its validity increases when used in conjunction with the Norton Scale to predict the development of pressure ulcers. In addition, inter-rater reliability between .83 and .99 is reported.

Strengths and Limitations: When utilized correctly and consistently, the Braden Scale will help identify the associated risk for pressure ulcers so that appropriate preventive interventions may be implemented. Although the Braden Scale has been used primarily with white older adults, current research addressing the efficacy of the Braden scale among Black and Latino populations suggests that a higher risk cut-off score of 17 or 18 is needed to prevent under-prediction of pressure ulcer risk in these populations.

More on the Topic

Bergstrom, N., Braden, B., Kemp, M., Champagne, M., Ruby, E. (1996). Multi-Site Study of Incidence of Pressure Ulcers and the Relationship Between Risk Level, Demographic Characteristics, Diagnoses, and Prescription of Preventive Interventions. Journal of the American Geriatrics Society, 44, 22-30.

Braden, B. J. ( 1997). Risk Assessment in Pressure Ulcer Prevention in Krasner, D., Kane, D. Chronic Wound Care: A Clinical Source Book for Healthcare Professionals. 2nd edition. Health Management Publication: Wayne, PA.

Lyder, C.H., Yu, C., Stevenson, D., Mangat, R., Empleo-Frazier, O., Emrling, J., McKay, J. (1998). Validating the Braden Scale for the Prediction of Pressure Ulcer Risk in Blacks and Latino/Hispanic Elders: A Pilot Study. Ostomy/Wound Managemen 44(3A) Suppl:42S-50S.

U.S. Department of Health and Human Services, (1992). Pressure Ulcers in Adults: Prediction and Prevention. (AHCPR Publication No. 92-0047). Rockville, MD: Author.

Figure.

Braden Scale For Predicting Pressure Ulcer Sore Risk

Dermatology Nursing is pleased to publish this regular feature, "Try This: Best Practices in Nursing Care to Older Adults," developed by the Hartford Institute for Geriatric Nursing.

This article was reprinted with permission from "Try This: Best Practices in Nursing Care to Older Adults" series from the John A. Hartford Foundation Institute for Geriatric Nursing. Mathy Mezey, EdD, RN, FAAN, is Director of the Institute and Terry Fulmer, PhD, RN, FAAN is Co-Director. Series Editor is Sheila Molony, MS, RN,C.

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What is the Braden assessment tool?

Who is Braden Scale used for?

What is the Waterlow assessment tool used for?

Which of the following measuring tools predicts severity of risk in patients at risk for pressure ulcers?