Keywords
Pressure Injuries
End-of-life Care
Prevalence
Incidence
How to Cite
Abstract
Introduction. Pressure injuries (PIs) are a frequent complication among patients receiving palliative and end-of-life (EoL) care. However, epidemiological estimates vary widely across clinical settings, and the understanding of pressure-related skin damage in palliative populations has evolved considerably in recent years. This systematic review aimed to update the evidence on the prevalence, incidence, and risk factors associated with PIs in palliative care settings.
Methods. A systematic review was conducted according to the PRISMA 2020 guidelines. PubMed/MEDLINE, CINAHL, Embase, and Scopus were searched to identify studies reporting the prevalence and/or incidence of PIs in palliative care or EoL care settings. Eligibility criteria were defined using the CoCoPop framework. Risk of bias was assessed using design-specific critical appraisal tools, and results were synthesised narratively.
Results. The search identified 443 records, of which eight studies met the inclusion criteria. Studies were conducted across multiple palliative care settings, including home care services, hospice facilities, and hospital-based palliative care units. Reported PI prevalence ranged from 9.0% to 34.1%, while incidence ranged from 3.9% to 26.5%. Most lesions were stage 1 or 2 and commonly located in the sacral region. Identified risk factors included advanced age, reduced mobility, impaired nutritional status, comorbidities, and the presence of medical devices such as urinary catheters.
Discussion. PIs remain a common complication in palliative and EoL care populations. Their development reflects the multifactorial interaction between clinical deterioration, functional decline, and skin failure. Preventive strategies should therefore be integrated with comfort-focused care and careful clinical assessment, recognising that some PIs may be unavoidable in patients approaching the EoL.
References
Artico, M., Dante, A., D’Angelo, D., et al (2018). Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: A retrospective chart review. Palliat Med, 32(1), 299-307. https://doi.org/10.1177/0269216317737671
Artico, M., D’Angelo, D., Piredda, M., et al (2018). Pressure Injury Progression and Factors Associated With Different End-Points in a Home Palliative Care Setting: A Retrospective Chart Review Study. J Pain Symptom Manage, 56(1), 23-32. https://doi.org/10.1016/j.jpainsymman.2018.03.011
Artico, M., Piredda, M., D’Angelo, D., et al (2020). Prevalence, incidence and associated factors of pressure injuries in hospices: A multicentre prospective longitudinal study. Int J Nurs Stud, 111, 103760. https://doi.org/10.1016/j.ijnurstu.2020.103760
Barker, T. H., Habibi, N., Aromataris, E., et al (2024). The revised JBI critical appraisal tool for the assessment of risk of bias for quasi-experimental studies. JBI Evid Synth, 22(3), 378-388. https://doi.org/10.11124/JBIES-23-00268
Cerullo, G., Figueiredo, T., Coelho, C., et al (2024). Palliative Care in the Ageing European Population: A Cross-Country Comparison. Int J Environ Res Public Health, 21(1), 113. https://doi.org/10.3390/ijerph21010113
EPUAP/NPIAP/PPPIA. (2019). Prevention and treatment of pressure ulcers/injuries: Clinical practice guideline. Emily Haesler.
Ferris, A., Price, A., Harding, K. (2019). Pressure ulcers in patients receiving palliative care: A systematic review. Palliat Med, 33(7), 770-782. https://doi.org/10.1177/0269216319846023
Jakobsen, T. B. T., Pittureri, C., Seganti, P., et al (2020). Incidence and prevalence of pressure ulcers in cancer patients admitted to hospice: A multicentre prospective cohort study. Int Wound J, 17(3), 641-649. https://doi.org/10.1111/iwj.13317
Jaul, E., Barron, J., Rosenzweig, J. P., Menczel, J. (2018). An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatr, 18(1), 305. https://doi.org/10.1186/s12877-018-0997-7
Kaya, F. O., Şimşek, S. (2025). Clinical and systemic factors associated with pressure ulcer development: a retrospective evaluation of 339 patients in a palliative care unit. Front Med (Lausanne), 12, 1686611. https://doi.org/10.3389/fmed.2025.1686611
Kwan, Z., Han, W. H., Yong, S. S., et al (2024). Dermatological Issues Among Individuals Receiving Palliative Care - A Review. Am J Hosp Palliat Care, 41(8), 952-964. https://doi.org/10.1177/10499091231198752
Latimer, S., Harbeck, E., Walker, R. M., et al (2023). Development of a Wound Assessment Tool for Use in Adults at End of Life: A Modified Delphi Study. Adv Skin Wound Care, 36(3), 142-150. https://doi.org/10.1097/01.ASW.0000911992.83362.eb
Latimer, S., Shaw, J., Hunt, T., Mackrell, K., Gillespie, B. M. (2019). Kennedy Terminal Ulcers: A Scoping Review. J Hosp Palliat Nurs, 21(4), 257-263. https://doi.org/10.1097/NJH.0000000000000563
Levine, J. M., Delmore, B., Cox, J. (2022). Skin Failure: Concept Review and Proposed Model. Adv Skin Wound Care, 35(3), 139-148. https://doi.org/10.1097/01.ASW.0000818572.31307.7b
Li, Z., Lin, F., Thalib, L., Chaboyer, W. (2020). Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. Int J Nurs Stud, 105, 103546. https://doi.org/10.1016/j.ijnurstu.2020.103546
Marutani, A., Okuwa, M., Sugama, J. (2019). Use of 2 Types of Air-cell Mattresses for Pressure Ulcer Prevention and Comfort Among Patients With Advanced-stage Cancer Receiving Palliative Care: An Interventional Study. Wound Manag Prev, 65(5), 24-32.
Munn, Z., Moola, S., Lisy, K., Riitano, D., Tufanaru, C. (2015). Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc, 13(3), 147-153. https://doi.org/10.1097/XEB.0000000000000054
National Heart, Lung, and Blood Institute. (n.d.). Study quality assessment tools. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools
Page, M. J., McKenzie, J. E., Bossuyt, P. M., et al (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev, 10(1), 89. https://doi.org/10.1186/s13643-021-01626-4
Radbruch, L., De Lima, L., Knaul, F., et al (2020). Redefining Palliative Care—A New Consensus-Based Definition. J Pain Symptom Manage, 60(4), 754-764. https://doi.org/10.1016/j.jpainsymman.2020.04.027
Raine G. Is it time to re-evaluate the inevitability of ulcers at the end of life? International Journal of Palliative Nursing. 2021;27(9):440-448. doi:10.12968/ijpn.2021.27.9.440
Roca-Biosca, A., Rubio-Rico, L., De Molina-Fernández, M. I., Martinez-Castillo, J. F., Pancorbo-Hidalgo, P. L., García-Fernández, F. P. (2021). Kennedy terminal ulcer and other skin wounds at the end of life: An integrative review. J Tissue Viability, 30(2), 178-182. https://doi.org/10.1016/j.jtv.2021.02.006
Stoian, M., Stoian, A., Bănescu, C., Bandila, S. R., Babă, D. F., Azamfirei, L. (2025). Nutrition and Hydration at the End of Life in Intensive Care and General End-of-Life Care Settings: Balancing Clinical Evidence, Patient-Centered Care, and Ethical and Legal Principles—A Narrative Review. Nutrients, 17(23), 3705. https://doi.org/10.3390/nu17233705
Ven, S., Steele, M., Burston, A., et al (2026). Incidence and Characteristics of Hospital-Acquired Pressure Injuries in Acute Palliative Care Patients: A Four-Year Analysis. J Clin Nurs, 35(1), 255-267. https://doi.org/10.1111/jocn.17829
World Health Organization. (2021, October 5). WHO takes steps to address glaring shortage of quality palliative care services. https://www.who.int/news/item/05-10-2021-who-takes-steps-to-address-glaring-shortage-of-quality-palliative-care-services
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