References

Andreev A, Erdinc B, Shivaraj K The association between anemia of chronic inflammation and Alzheimer's disease and related dementias. Journal of Alzheimer's Disease Reports.. 2020; 4:(1)379-391 https://doi.org/10.3233/adr-200178

Andrès E, Federici L, Serraj K, Kaltenbach G. Update of nutrient-deficiency anemia in elderly patients. Eur J Intern Med.. 2008; 19:(7)488-493 https://doi.org/10.1016/j.ejim.2008.01.016

Azevedo Macena MS, Costa Silva RS, Dias Fernandes MIDC, Almeida Medeiros AB, Batista Lúcio KD, Carvalho Lira ALB. Pressure ulcer risk evaluation in critical patients: clinical and social characteristics. Open Nurs J.. 2017; 11:(1)91-97 https://doi.org/10.2174/1874434601711010091

Bapen. Malnutrition Universal Screening Tool. 2011. https://www.bapen.org.uk/pdfs/must/must_full.pdf (accessed 20 July 2020)

Baroni L, Bonetto C, Rizzo G, Bertola C, Caberlotto L, Bazzerla G. Association between cognitive impairment and vitamin B12, folate, and homocysteine status in elderly adults: a retrospective study. J Alzheimers Dis.. 2019; 70:(2)443-453 https://doi.org/10.3233/JAD-190249

Blackburn J, Ousey K, Taylor L, Moore B, Patton D, Moore Z, Avsar P. The relationship between common risk factors and the pathology of pressure ulcer development: a systematic review. J Wound Care.. 2020; 29:(Suppl 3)S4-S12 https://doi.org/10.12968/jowc.2020.29.Sup3.S4

Blom HJ, Smulders Y. Overview of homocysteine and folate metabolism. With special references to cardiovascular disease and neural tube defects. J Inherit Metab Dis.. 2011; 34:(1)75-81 https://doi.org/10.1007/s10545-010-9177-4

Børsting TE, Tvedt CR, Skogestad IJ, Granheim TI, Gay CL, Lerdal A. Prevalence of pressure ulcer and associated risk factors in middle- and older-aged medical inpatients in Norway. J Clin Nurs.. 2018; 27:(3-4)e535-e543 https://doi.org/10.1111/jocn.14088

Burney S, Ahmad S, Masroor R. Anaemia in elderly: a benign condition or an early warning? A hospital based study. Pakistan Armed Forces Medical Journal.. 2016; 66:(3)400-406

Cappellini MD, Motta I. Anemia in clinical practice-definition and classification: does hemoglobin change with aging?. Semin Hematol.. 2015; 52:(4)261-269 https://doi.org/10.1053/j.seminhematol.2015.07.006

Cappellini MD, Musallam KM, Taher AT. Iron deficiency anaemia revisited. J Intern Med.. 2020; 287:(2)153-170 https://doi.org/10.1111/joim.13004

Catic A. Cellular metabolism and aging. Prog Mol Biol Transl Sci.. 2018; 155:85-107 https://doi.org/10.1016/bs.pmbts.2017.12.003

Coger V, Million N, Rehbock C Tissue concentrations of zinc, iron, copper, and magnesium during the phases of full thickness wound healing in a rodent model. Biol Trace Elem Res.. 2019; 191:(1)167-176 https://doi.org/10.1007/s12011-018-1600-y

Dunn A, Carter J, Carter H. Anemia at the end of life: prevalence, significance, and causes in patients receiving palliative care. J Pain Symptom Manage.. 2003; 26:(6)1132-1139 https://doi.org/10.1016/j.jpainsymman.2003.04.001

Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System. J Wound Ostomy Continence Nurs.. 2016; 43:(6)585-597 https://doi.org/10.1097/WON.0000000000000281

European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers/injuries: quick reference guide. 2019. https://tinyurl.com/my2vvkd3 (accessed 20 July 2021)

Fraser C. The identification of barriers to pressure ulcer healing. Wound Care Canada.. 2010; 8:(2)20-25

Fuoco U, Scivoletto G, Pace A, Vona VU, Castellano V. Anaemia and serum protein alteration in patients with pressure ulcers. Spinal Cord.. 1997; 35:(1)58-60 https://doi.org/10.1038/sj.sc.3100340

Galivanche AR, Kebaish KJ, Adrados M Postoperative pressure ulcers after geriatric hip fracture surgery are predicted by defined preoperative comorbidities and postoperative complications. J Am Acad Orthop Surg.. 2020; 28:(8)342-351 https://doi.org/10.5435/JAAOS-D-19-00104

Gaskell H, Derry S, Andrew Moore R, McQuay HJ. Prevalence of anaemia in older persons: systematic review. BMC Geriatr.. 2008; 8:(1) https://doi.org/10.1186/1471-2318-8-1

Gefen A. How much time does it take to get a pressure ulcer? Integrated evidence from human, animal, and in vitro studies. Ostomy Wound Manage.. 2008; 54:(10)26-35

Gilfix BM. Vitamin B12 and homocysteine. CMAJ.. 2005; 173:(11) https://doi.org/10.1503/cmaj.1050170

Giorgi C, Marchi S, Simoes ICM Mitochondria and reactive oxygen species in aging and age-related diseases. Int Rev Cell Mol Biol.. 2018; 340:209-344 https://doi.org/10.1016/bs.ircmb.2018.05.006

Girelli D, Marchi G, Camaschella C. Anemia in the elderly. HemaSphere.. 2018; 2:(3) https://doi.org/10.1097/HS9.0000000000000040

Goodnough LT, Schrier SL. Evaluation and management of anemia in the elderly. Am J Hematol.. 2014; 89:(1)88-96 https://doi.org/10.1002/ajh.23598

Guo S, DiPietro LA. Factors affecting wound healing. J Dent Res.. 2010; 89:(3)219-229 https://doi.org/10.1177/0022034509359125

Halawi R, Moukhadder H, Taher A. Anemia in the elderly: a consequence of aging?. Expert Rev Hematol.. 2017; 10:(4)327-335 https://doi.org/10.1080/17474086.2017.1285695

Haloul M, Vinjamuri SJ, Naquiallah D Hyperhomocysteinemia and low folate and vitamin B12 are associated with vascular dysfunction and impaired nitric oxide sensitivity in morbidly obese patients. Nutrients.. 2020; 12:(7) https://doi.org/10.3390/nu12072014

Hare GMT, Tsui AKY, Ozawa S, Shander A. Anaemia: can we define haemoglobin thresholds for impaired oxygen homeostasis and suggest new strategies for treatment?. Best Pract Res Clin Anaesthesiol.. 2013; 27:(1)85-98 https://doi.org/10.1016/j.bpa.2012.12.002

Haynes WG. Hyperhomocysteinemia, vascular function and atherosclerosis: effects of vitamins. Cardiovasc Drugs Ther.. 2002; 16:(5)391-399 https://doi.org/10.1023/A:1022130217463

Hosseini SR, Zabihi A, Ebrahimi SH, Jafarian Amiri SR, Kheirkhah F, Bijani A. The prevalence of anemia and its association with depressive symptoms among older adults in north of Iran. J Res Health Sci.. 2018; 18:(4)

Jaul E, Barron J, Rosenzweig JP, Menczel J. An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatr.. 2018; 18:(1) https://doi.org/10.1186/s12877-018-0997-7

Jaul E, Factor H, Karni S, Schiffmiller T, Meiron O. Spasticity and dementia increase the risk of pressure ulcers. Int Wound J.. 2019; 16:(3)847-851 https://doi.org/10.1111/iwj.13110

Julian T, Syeed R, Glascow N, Angelopoulou E, Zis P. B12 as a treatment for peripheral neuropathic pain: a systematic review. Nutrients.. 2020; 12:(8) https://doi.org/10.3390/nu12082221

Khosravi M, Sotoudeh G, Amini M, Raisi F, Mansoori A, Hosseinzadeh M. The relationship between dietary patterns and depression mediated by serum levels of Folate and vitamin B12. BMC Psychiatry.. 2020; 20:(1) https://doi.org/10.1186/s12888-020-2455-2

Kim J, Lee JY, Lee E. Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence. J Nurs Manag.. 2019; https://doi.org/10.1111/jonm.12928

Kimmel HM, Grant A, Ditata J. The presence of oxygen in wound healing. Wounds.. 2016; 28:(8)264-270

Kosmachevskaya OV, Topunov AF. Alternate and additional functions of erythrocyte hemoglobin. Biochemistry (Mosc).. 2018; 83:(12-13)1575-1593 https://doi.org/10.1134/S0006297918120155

Kurtz SM, Silverman JD. The Calgary-Cambridge Referenced Observation Guides: an aid to defining the curriculum and organizing the teaching in communication training programmes. Med Educ.. 1996; 30:(2)83-89 https://doi.org/10.1111/j.1365-2923.1996.tb00724.x

Kurz T, Terman A, Gustafsson B, Brunk UT. Lysosomes in iron metabolism, ageing and apoptosis. Histochem Cell Biol.. 2008; 129:(4)389-406 https://doi.org/10.1007/s00418-008-0394-y

Lenche N, Katerina D, Nikolchev A, Lidija P, Biljana PZ, Milenko K. The influence of comorbidity on the prevalence of pressure ulcers in geriatric patients. Global Dermatology.. 2016; 3:(3)319-322 https://doi.org/10.15761/GOD.1000183

Liao X, Ju Y, Liu G, Zhao X, Wang Y, Wang Y. Risk factors for pressure sores in hospitalized acute ischemic stroke patients. J Stroke Cerebrovasc Dis.. 2019; 28:(7)2026-2030 https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.02.033

Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet.. 2016; 387:(10021)907-916 https://doi.org/10.1016/S0140-6736(15)60865-0

Lumbers M. An overview of ‘Pressure ulcers: revised definition and measurement’. Br J Community Nurs.. 2019; 24:(5)216-223 https://doi.org/10.12968/bjcn.2019.24.5.216

Marchi G, Busti F, Lira Zidanes A, Vianello A, Girelli D. Cobalamin deficiency in the elderly. Mediterr J Hematol Infect Dis.. 2020; 12:(1) https://doi.org/10.4084/mjhid.2020.043

Masselli E, Pozzi G, Vaccarezza M ROS in platelet biology: functional aspects and methodological insights. Int J Mol Sci.. 2020; 21:(14) https://doi.org/10.3390/ijms21144866

Mervis JS, Phillips TJ. Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. J Am Acad Dermatol.. 2019; 81:(4)881-890 https://doi.org/10.1016/j.jaad.2018.12.069

Mittal M, Siddiqui MR, Tran K, Reddy SP, Malik AB. Reactive oxygen species in inflammation and tissue injury. Antioxid Redox Signal.. 2014; 20:(7)1126-1167 https://doi.org/10.1089/ars.2012.5149

Mitchell A. Adult pressure area care: preventing pressure ulcers. Br J Nurs.. 2018; 27:(18)1050-1052 https://doi.org/10.12968/bjon.2018.27.18.1050

Mitchell A. Assessment of wounds in adults. Br J Nurs.. 2020; 29:S18-S24 https://doi.org/10.12968/bjon.2020.29.20.S18

Moreno Chulilla JA, Colás MSR, Martín MG. Classification of anemia for gastroenterologists. World J Gastroenterol.. 2009; 15:(37)4627-4637 https://doi.org/10.3748/wjg.15.4627

Morton LM, Phillips TJ. Wound healing and treating wounds: differential diagnosis and evaluation of chronic wounds. J Am Acad Dermatol.. 2016; 74:(4)589-605 https://doi.org/10.1016/j.jaad.2015.08.068

Nadukkandiyil N, Syamala S, Saleh HA Implementation of pressure ulcer prevention and management in elderly patients: a retrospective study in tertiary care hospital in Qatar. Male.. 2019; 1-7

Nagao T, Hirokawa M. Diagnosis and treatment of macrocytic anemias in adults. Journal of General and Family Medicine.. 2017; 18:(5)200-204 https://doi.org/10.1002/jgf2.31

Neloska L, Damevska K, Nikolchev A, Pavleska L, Petreska-Zovic B, Kostov M. The association between malnutrition and pressure ulcers in elderly in long-term care facility. Open Access Maced J Med Sci.. 2016; 4:(3)423-427 https://doi.org/10.3889/oamjms.2016.094

National Institute for Health and Care Excellence. Pressure ulcers: prevention and management. Clinical guideline CG79. 2014. https://www.nice.org.uk/guidance/cg179 (accessed 20 July 2021)

National Institute for Health and Care Excellence. Pressure ulcers overview. 2020. https://pathways.nice.org.uk/pathways/pressure-ulcers (accessed 20 July 2021)

Olivo S, Canova C, Peghetti A, Rossi M, Zanotti R. Prevalence of pressure ulcers in hospitalised patients: a cross-sectional study. J Wound Care.. 2020; 29:S20-S28

Poulia KA, Yannakoulia M, Karageorgou D Evaluation of the efficacy of six nutritional screening tools to predict malnutrition in the elderly. Clin Nutr.. 2012; 31:(3)378-385 https://doi.org/10.1016/j.clnu.2011.11.017

Rasero L, Simonetti M, Falciani F, Fabbri C, Collini F, Dal Molin A. Pressure ulcers in older adults: a prevalence study. Adv Skin Wound Care.. 2015; 28:(10)461-464 https://doi.org/10.1097/01.ASW.0000470371.77571.5d

Recalcati S, Gammella E, Cairo G. Ironing out macrophage immunometabolism. Pharmaceuticals.. 2019; 12:(2) https://doi.org/10.3390/ph12020094

Saxena S, Vekaria H, Sullivan PG, Seifert AW. Connective tissue fibroblasts from highly regenerative mammals are refractory to ROS-induced cellular senescence. Nat Commun.. 2019; 10:(1) https://doi.org/10.1038/s41467-019-12398-w

Soares MP, Hamza I. Macrophages and iron metabolism. Immunity.. 2016; 44:(3)492-504 https://doi.org/10.1016/j.immuni.2016.02.016

Sree VD, Rausch MK, Tepole AB. Linking microvascular collapse to tissue hypoxia in a multiscale model of pressure ulcer initiation. Biomech Model Mechanobiol.. 2019; 18:(6)1947-1964 https://doi.org/10.1007/s10237-019-01187-5

Staiculescu M, Foote C, Meininger G, Martinez-Lemus L. The role of reactive oxygen species in microvascular remodeling. Int J Mol Sci.. 2014; 15:(12)23792-23835 https://doi.org/10.3390/ijms151223792

Stanhewicz AE, Kenney WL. Role of folic acid in nitric oxide bioavailability and vascular endothelial function. Nutr Rev.. 2017; 75:(1)61-70 https://doi.org/10.1093/nutrit/nuw053

Stephen-Haynes J, Maries M. Pressure ulcers and the prone position. Br J Nurs.. 2020; 29:(12) https://doi.org/10.12968/bjon.2020.29.12.S6

Styszynski A, Mossakowska M, Chudek J Prevalence of anemia in relation to socio-economic factors in elderly Polish population: the results of PolSenior study. J Physiol Pharmacol.. 2018; 69:(1)75-81

Tchanque-Fossuo CN, Dahle SE, Buchman SR, Rivkah Isseroff R. Deferoxamine: potential novel topical therapeutic for chronic wounds. Br J Dermatol.. 2017; 176:(4)1056-1059 https://doi.org/10.1111/bjd.14956

Thomas A. Investigation and management of anaemia. Medicine (Baltimore).. 2017; 45:(4)209-213 https://doi.org/10.1016/j.mpmed.2017.02.015

Thomas C, Lumb AB. Physiology of haemoglobin. Contin Educ Anaesth Crit Care Pain.. 2012; 12:(5)251-256 https://doi.org/10.1093/bjaceaccp/mks025

Walton-Geer PS. Prevention of pressure ulcers in the surgical patient. AORN J.. 2009; 89:(3)538-551 https://doi.org/10.1016/j.aorn.2008.12.022

Waterlow J. From costly treatment to cost-effective prevention: using Waterlow. Br J Community Nurs.. 2005; 10:(9)S25-S30

Watson J, Lee M, Garcia-Casal MN. Consequences of inadequate intakes of vitamin A, vitamin B12, vitamin D, calcium, iron, and folate in older persons. Curr Geriatr Rep.. 2018; 7:(2)103-113 https://doi.org/10.1007/s13670-018-0241-5

Wlaschek M, Singh K, Sindrilaru A, Crisan D, Scharffetter-Kochanek K. Iron and iron-dependent reactive oxygen species in the regulation of macrophages and fibroblasts in non-healing chronic wounds. Free Radic Biol Med.. 2019; 133:262-275 https://doi.org/10.1016/j.freeradbiomed.2018.09.036

World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. 2019. https://www.who.int/vmnis/indicators/haemoglobin/en/ (accessed 17 October 2020)

Wright JA, Richards T, Srai SKS. The role of iron in the skin and cutaneous wound healing. Front Pharmacol.. 2014; 5 https://doi.org/10.3389/fphar.2014.00156

Tissue Viability
Elderly care

The influence of anaemia on pressure ulcer healing in elderly patients

12 August 2021
Pressure Ulcers
02 August 2021
Volume 30 · Issue 15

Abstract

Anaemia is a common and multifactorial blood disorder in elderly individuals. This condition may be a significant barrier to pressure ulcers healing as it is associated with a decreased level of oxygen being supplied to body tissues. Some nutritional deficiencies such as iron, vitamin B12 and folate may also cause anaemia and have a negative impact on pressure ulcer healing. An increased iron demand in hard-to-heal pressure ulcers is a significant factor associated with the risk of anaemia of chronic disease in elderly patients. Anaemia screening and correction may need to be considered as well as iron supplementation if required in pressure ulcer prevention and management.

Anaemia is a common condition with prevalence of 20% and is greater in patients over 85 years of age (Goodnough and Schrier, 2014). It varies in elderly patients depending on various factors such as an individual's socioeconomic status (Styszynski et al, 2018), psychological state (Hosseini et al, 2018), dementia diagnosis (Andreev et al, 2020), and available support. This condition may affect almost one in two elderly individuals in nursing homes or those admitted to hospital (Gaskell et al, 2008) and also can be highly associated with elderly patients in palliative care as anaemia was found in 77% of men and 68% of women in a study by Dunn et al (2003). Anaemia in elderly patients is often multifactorial (Thomas, 2017) and usually mild (haemoglobin level 11-12.9 g/dl for men and 11-11.9 g/dl for women) (Gaskell et al, 2008); however, the most common cause of this condition is iron deficiency due to malnutrition, decreased iron absorption, chronic gastrointestinal blood loss or chronic inflammatory conditions (Andrès et al, 2008; Girelli et al, 2018; Cappellini et al, 2020).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content

Register
Or continue by

Signing in with your registered email address

Anaemia
Pressure ulcers
Elderly patients
Assessment
Nutrition