Pressure Injury Risk Factors in Hospice and Palliative Care

Pressure injuries are common complications among patients with terminal cancer receiving inpatient hospice care, and the physiological changes that occur at the end of life may not be fully reflected in conventional risk assessment. This retrospective cross-sectional study examined factors associated with pressure injuries at admission among 1158 patients with terminal cancer admitted to an inpatient hospice and palliative care unit in South Korea, of who 386 (33.3%) had pressure injuries at admission. It also examined whether adding end-of-life (EOL) symptoms and care-related factors to a Braden Scale-based model could improve its ability to identify at-risk patients. Several demographic, clinical, and functional factors, including older age, reduced activity, and impaired consciousness, were significantly associated with pressure injury, along with EOL symptoms, such as delirium and edema, and care-related factors, such as catheters. Adding EOL symptoms to the Braden Scale improved its ability to identify at-risk patients more than adding care-related factors, suggesting that EOL symptoms may provide clinically meaningful information beyond the Braden Scale in this population. These findings support incorporating EOL symptoms into nursing assessments upon hospice admission, which may help nurses identify high-risk patients earlier and plan care that balances the potential benefits and burdens of preventive interventions with each patient's comfort and goals of care. They may also inform the development of a pressure injury risk assessment tool tailored to inpatient hospice settings.