Quality of Life and Pressure Ulcers: What is the Impact?

Diane K. Langemo, PhD, RN, FAAN

H aving a pressure ulcer (PU), particularly a stage 4 ulcer, impacts an individual’s life in overt as well as covert ways. Each individual defines this impact based on the sum of unique experiences. The elusive factor is quality of life (QoL), which can only be defined by the individual.
Quality of life is a vague, ethereal construct that reflects an individual’s perspective on life satisfaction regardless of the situation. Quality is a term that is best described by each individual at each stage of his or her life and may change day by day or, in some cases, hour by hour. Quality of life in an individual with a PU incorporates such variables as pain and suffering, the financial costs of healthcare, the strain on personal resources, and overall impact on one’s life and activities of daily living (ADLs). While this is not something one routinely communicates to other individuals, how one feels about life at any given time is not only important, but an important part of who the individual is. Overall QoL encompasses 4 primary domains of well-being and functioning. The domains include physical and occupational, psychosocial, social, and somatic.1 Quality of life indeed is defined by and has an impact on one physically, emotionally, and psychologically, as well as the individual’s work role in life and relationships.
In the 1980s, the term health-related quality of life (HRQoL) emerged in an attempt to narrow the all-encompassing QoL term and define it within the healthcare context.2 Health-related QoL refers to the “impact of disease and treatment on disability and daily living, or as a patient-based focus on the impact of a perceived health state on the ability to lead a fulfilling life.”2 In 1993, Patrick and Erickson3 defined it as the “value assigned to the duration of life and modified by impairments,” eg, a PU. Franks and Moffatt4 noted that when an individual with a chronic wound is feeling ill, he or she is likely experiencing “feelings of pain and discomfort or change in usual functioning and feeling.” This is the core consideration in HRQoL, as the individual’s own sense of well-being is the most important factor rather than what a healthcare provider might determine it to be.5 Culture also influences one’s perception of his or her HRQoL.
A wound is defined as a disruption in the integrity and function of body tissue, whereas having a wound, according to van Rijswijk,6 implies imperfection, which certainly impacts physical and emotional vulnerability. Any visible wound leads to greater emotional or psychological trauma than would an invisible wound, albeit feelings of shame and embarrassment might still be present. One type of wound, a PU, is defined as “any lesion caused by unrelieved pressure resulting in damage to underlying tissue. Pressure ulcers are usually located over bony prominences (such as the sacrum, coccyx, hips, heels) and are staged according to the extent of observable tissue damage. Pressure ulcers vary from superficial tissue damage to deep craters exposing muscle and bone.”7 Pressure ulcers are staged from stage 1, where there is non-blanchable erythema but no break in the skin, to stage 4, where the defect can extend into the muscle and even expose bone. Pressure ulcers can be prevented in many instances; however, those who are acutely ill, have their mobility affected, are older, and have multiple comorbidities are at greater risk.

Impact of a Pressure Ulcer on Health-Related Quality of Life

Relatively few studies have been done related to QoL or HRQoL in individuals with PUs. In 2000, Langemo et al.8 conducted a qualitative study. Using a phenomenological methodology, they interviewed 8 subjects, 4 with current PUs and 4 who had PUs previously. Of those with previous PUs, all had been healed at least 6 months. All PUs were stage 2–4, with the majority stage 4.



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