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Date of Award


Document Type

Restricted Thesis: Campus only access

Degree Name

Master of Public Health


Health Science and Human Ecology

First Reader/Committee Chair

Chen-Maynard, Dorothy


Background Pressure-related injuries (PI) among the elderly continues to be a major contributing factor of morbidity and mortality for this vulnerable population. The elderly often suffers from multiple chronic diseases (diabetes, heart disease, and impaired blood circulation), which can complicate the wound healing process. This problem is further complicated for those that are bedbound or have limited mobility, due to impaired ability to relieve the constant pressure on areas of the body prone to developing PI.

During the COVID19 pandemic, skilled nursing facilities and long-term care homes throughout the nation went into lockdown, confining patients to their rooms and limiting social interaction with other patients, family and friends. As patients spent more time in bed, the risk for an increase in severity and incidence of PI was real public health threat. This threat was further compounded by malnutrition and multiple co-factors, such the on-set of depression from social isolation, decreased appetite, worsening dementia and chronic diseases such as diabetes. Nursing staff shortages that were further exacerbated by COVID19, put patients in skilled nursing facilities at higher risk for developing PI due to decreased patient hygiene and grooming care, infrequent turning of bedbound patients, and decreased overall assistance with physical and mental care.

Methods This study used a non-experimental design, and utilized cross-sectional and correlational methods. A total of 135 cases (n = 135) of PI were compiled between 2019 to 2021 for this study at a skilled nursing facility. Patients involved in this study ranged from age 44 to 97 years old, but approximately 84% of the subjects were 60 years and older. Retrospective chart review from the electronic medical records from a skilled nursing facility in Southern California was used for this study. patient

Results The results showed that the group with patients older than 71 years had a significantly higher chance (6x higher) of acquiring PI than younger age groups in this study. There was no increase in the incidence of PI post-COVID19 (2020 and 2021) as compared to pre-COVID19 pandemic (2019). Surprisingly, the number of PI in 2019 pre-COVID19 pandemic was significantly higher than post-COVID19 in 2020 or 2021. However, there was a significant relationship in the severity of stage of PI post-COVID19 versus pre- COVID19. Tests showed that post-COVID19, (2021 and 2020) had an average severity of PI higher than pre-COVID19 in 2019. Finally, results showed a significant correlation between having a history of diabetes and stage of PI, but there was no significant relationship between the HbA1C of patients with diabetes and stage of PI.

Conclusion From this study, it showed that there is a strong relationship between acquiring a PI and having history of diabetes. We also found that the population at greatest risk for skin breakdown are ages 71 years and older. Prevention of PI in this vulnerable population is imperative to reducing morbidity and mortality, which remains a big threat to public health.