The 8th Edition of the Geriatric Review Syllabus (GRS8) released this year contains a brief but significant addition to the chapter on pressure ulcers: a section on the unavoidable pressure ulcer. This is the first time an official study guide for the medical specialty of geriatrics acknowledges that pressure ulcers can occur in the regular course of care delivery.

Jeff Levine, Jeffrey Levine MD geriatrician physician artist photographerThe GRS is published by the American Geriatrics Society, an organization that provides leadership to healthcare professionals, policy makers and the public, and is dedicated to improving health, independence and quality of life for older people. The GRS8 is a comprehensive review of best practices in geriatrics based on the latest evidence and knowledge. It is required reading for physicians preparing for the geriatrics board certification examination. The GRS rollout is accompanied by a website that enables customized content download, or purchase of individual chapters. This includes Chapter 38–Pressure Ulcers and Wound Care.

The pressure ulcer chapter was written by Courtney Lyder, an internationally known expert in gerontology and wound care who is Professor of Nursing, Medicine, and Public Health and Dean of the UCLA School of Nursing. Dr. Lyder’s extensive research credential includes validating the Braden Scale, the widely used tool for predicting pressure ulcers, in black and Latino/Hispanic elders.

The section on unavoidable ulcers states that the determination of unavoidability is “One of the most challenging decisions that are made in providing pressure ulcer care.” The author refers to the CMS determination of unavoidability based on evaluation of whether the processes of care were consistently followed, and further cites the NPUAP consensus conference which acknowledged that there are some individuals in which pressure ulcer development is unavoidable.

In the 19th Century the great physician Jean Martin Charcot taught that all pressure ulcers were unavoidable when accompanied by trauma to the brain and spinal cord, but his conclusions were based upon hypothetical nerve fibers that were never proven to exist. In the 20th Century, Charcot’s work was forgotten and pressure ulcers became considered an indicator of quality of care.

The GRS8 will undoubtedly add to the growing recognition that many pressure ulcers are unavoidable. This is a welcome concept for geriatric practitioners who interact daily with patients and families who expect and deserve quality care, but sometimes must cope with the devastating consequences of pressure ulcers.

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Download my article:  The Unavoidable Pressure Ulcer: A Retrospective Case Series.

Related posts:

CMS Recognizes the Kennedy Terminal Ulcer in Long-Term Care Hospitals
Historical Roots of the ‘Avoidable-Unavoidable’ Pressure Ulcer Controversy
New Research Sheds Light on Hospital-acquired Pressure Ulcers.
Determining the Avoidability of Pressure Ulcers.
New Pocket Guide to Pressure Ulcers.