Pressure Injury Prevention in Older People Across Viet Nam’s Care Continuum: From Risk Assessment to Individualized Prevention, Skin Integrity and Safer Care
LONG-TERM CARE QUALITYMEASUREMENT, IMPLEMENTATION & LEARNING
Pressure Injury Prevention in Older People Across Viet Nam’s Care Continuum: From Risk Assessment to Individualized Prevention, Skin Integrity and Safer Care
LONG-TERM CARE QUALITY & AGE-FRIENDLY CARE QUALITY
Last reviewed: October 2026
A pressure injury can begin quietly. An older person becomes less mobile after pneumonia, stroke, surgery or a fall. They spend more time in bed or in a chair, eat less than usual, become incontinent or need help changing position. The skin may initially look only slightly different, yet by the time tissue damage is obvious, the problem may already be much more difficult to reverse.
For older people, pressure injury is rarely explained by one factor alone. It usually develops through an interaction between mechanical loading, immobility, frailty, nutritional risk, skin and tissue vulnerability, moisture, impaired perfusion, medical devices, pain, cognition, dependency and the reliability of day-to-day care. This makes prevention a quality and safety issue across the entire care continuum: hospital, transitional or rehabilitation care, home, community services and long-term care.
The central question is therefore not simply “Does this person have a high pressure-injury risk score?” A more useful question is “What is placing this particular person at risk, and what are we actually doing about it?”
That distinction is increasingly relevant in Viet Nam as more older people live with frailty, disability and complex care needs across different settings. Decision No. 1976/QĐ-BYT of 1 July 2026, which issued professional guidance on caring for older people at home and in the community, includes practical positioning support for people who remain in one position for prolonged periods or cannot reposition themselves, with the aim of helping prevent pressure-area ulcers, muscle atrophy, joint stiffness and hypostatic pneumonia associated with prolonged immobility. Internationally, the Fourth Edition of the Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline provides updated guidance across risk assessment, skin and tissue assessment, repositioning and mobilization, seating, support surfaces, nutrition, heel pressure injuries, device-related pressure injuries and other prevention domains.
Pressure injury is not just a skin problem
The current International Guideline defines a pressure injury as localized damage to the skin and/or underlying tissue resulting from pressure or pressure in combination with shear. Pressure injuries usually occur over bony prominences but can also be related to medical devices or other objects that remain in close contact with the skin.
The visible wound is therefore only the outward manifestation of a deeper mechanical and biological process. Prolonged loading can deform tissue and, when tissue tolerance is exceeded, lead to injury. Shear can further increase tissue deformation, while factors such as impaired perfusion, reduced mobility, nutritional problems and tissue vulnerability influence how well an individual tolerates that loading.
This is why pressure-injury prevention cannot be reduced to “checking the skin.” Skin and tissue assessment is essential, but prevention also involves mobility, positioning, seating, nutrition, continence, support surfaces, medical devices, comfort, caregiver capability and communication.
The International Guideline treats risk assessment as a starting point that should lead to an individualized prevention plan addressing the person's actual modifiable risks. The principle is simple:
A risk score is not a prevention plan.
Vietnamese evidence shows a real problem, but not a national prevalence
Reliable contemporary national data on pressure injuries among older people across Viet Nam's different care settings remain limited. Available studies should therefore be interpreted according to their population and setting rather than presented as national prevalence or incidence estimates.
A study published in 2022 examined 250 inpatients aged 60 years and older at the National Geriatric Hospital, using data collected from November 2020 to August 2021. Pressure ulcers were identified in 11.6% of the study population, with the sacral and coccygeal region the most frequently reported site. This provides useful evidence from an older inpatient population, but it was a single-center cross-sectional study and cannot establish national prevalence.
A prospective cohort at Cho Ray Hospital, published in 2025, followed 120 patients in a medical-surgical intensive care unit. Fifteen developed pressure injuries, giving an incidence of 12.5% during the study period. Higher compliance with the pressure-injury prevention care bundle was associated with improvement in Braden scores. The study provides useful Vietnamese evidence on pressure-injury risk and prevention in critical care, but the mean age was 47.7 years, so the cohort should not be interpreted as representative of older people.
More recent Vietnamese evidence reinforces the need for caution as well as action. A study published in 2026 from the Intensive Care and Toxicology Department at Duc Giang General Hospital reported newly developed pressure ulcers in 14% of patients studied during 2025. The mean age was 70.5 years, and age 80 years or older, mechanical ventilation and hospital stays longer than seven days were associated with pressure-ulcer occurrence. Another study of mechanically ventilated patients at the A9 Emergency Center of Bach Mai Hospital reported pressure ulcers in 25% after seven days of mechanical ventilation, with older age, edema, severe nutritional risk, high Braden risk and multiple chronic conditions among the associated factors. These are clinically important findings, but both studies involved selected high-risk hospital populations and should not be extrapolated to older people nationally.
The appropriate conclusion is therefore not that Viet Nam has one established pressure-injury prevalence figure. It is that pressure injury is already a documented patient-safety and care-quality problem in Vietnamese hospitals, while nationally representative evidence spanning hospitals, rehabilitation, home care, community care and long-term care remains insufficient.
Risk often accumulates rather than appearing as one obvious factor
An older person does not need to be completely immobile to be at risk. Someone who usually walks independently can become vulnerable after several days of acute illness. A person living with dementia may remain in one position for prolonged periods because they do not recognize discomfort or cannot communicate it clearly. Someone with arthritis may technically be able to move but avoid doing so because movement hurts. Frailty and loss of muscle or soft-tissue padding can further reduce tissue tolerance.
Other contributors can include poor nutritional status or recent weight loss, reduced sensation, compromised perfusion, edema, acute illness, moisture, incontinence, friction and shear during movement, medical devices and prolonged sitting in a wheelchair or chair.
The important point is that risk accumulates. Limited mobility alone may be manageable; limited mobility combined with poor intake, incontinence, reduced sensation and high dependency creates a very different risk profile. Pressure-injury prevention therefore fits poorly into a checklist mentality. The care team needs to understand the whole person and the whole pattern of risk, not simply whether one diagnosis or one score crosses a threshold.
Risk assessment should change care
Structured risk assessment can help identify people who need closer attention, but no tool can replace clinical judgment. Current international guidance emphasizes assessing relevant individual risk factors and using that information to develop and implement an individualized prevention plan.
The practical test is straightforward: when risk is identified, what changes? Does the person need more frequent skin and tissue assessment, more assistance with repositioning, a mobility or rehabilitation plan, heel offloading, a more appropriate mattress or seating surface, nutrition assessment, better continence and moisture management, review of a device creating pressure, or more help because pain, cognition or weakness is limiting spontaneous movement?
If the answer is “nothing,” the risk assessment has become documentation rather than prevention.
A stronger pathway is:
risk assessment → individualized intervention → reassessment → adjustment.
Risk also changes over time. Acute infection, surgery, delirium, sedation, hemodynamic deterioration, reduced oral intake, worsening mobility or transition to another care setting can rapidly alter a person's vulnerability. Reassessment should therefore respond to changes in clinical and functional status rather than occurring only because an administrative schedule says it is due.
Skin assessment should look for early tissue change, not wait for an established wound
Pressure-related tissue damage may be detectable before an open wound appears. The International Guideline therefore emphasizes both visual and tactile assessment of the skin and underlying tissues.
Assessment should look not only for obvious skin breakdown but also for changes from the person's usual skin color, differences in temperature, changes in tissue consistency, edema and localized pain or tenderness. Bony prominences, heels, areas beneath or adjacent to medical devices and other sites exposed to sustained mechanical loading deserve particular attention.
An important contemporary emphasis is that early pressure damage does not look identical across all skin tones. Persistent erythema may be readily visible in lighter skin, while clinically important color change may be less obvious in medium or darker skin tones. Assessment should therefore not rely on “redness” alone. Palpation for differences in temperature or tissue consistency, together with assessment for localized pain and comparison with the individual's usual skin appearance, can provide additional information.
This is relevant in Viet Nam because skin tone varies between individuals, and bedside assessment should respond to the person's actual skin rather than assume that early pressure-related change will always appear as obvious bright redness.
Pressure-related injury must also be distinguished from other forms of skin damage. Sacral skin change, for example, may reflect pressure, incontinence-associated dermatitis, friction or more than one mechanism at the same time. Treating every area of discoloration as though it has the same cause risks choosing the wrong intervention.
Early detection matters because it creates an opportunity to change the prevention plan before tissue damage progresses.
Repositioning matters, but there is no single clock for everyone
Repositioning is one of the best-known pressure-injury prevention strategies, but contemporary guidance is more individualized than simply instructing everyone to “turn every two hours.”
Mechanical loading is fundamental to pressure-injury development. Prolonged lying or sitting without sufficient pressure redistribution can deform tissue and eventually cause injury. The International Guideline therefore recommends an individualized repositioning regimen based on factors including activity and mobility, ability to reposition independently, skin and tissue tolerance, clinical condition, comfort, sleep patterns, goals of care and the pressure-redistribution support surface being used.
For most people at risk who are using an appropriate pressure-redistribution full-body support surface, the guideline suggests that either two-hourly or three-hourly repositioning could be implemented. Importantly, this is a conditional recommendation based on very-low-certainty evidence. It should not be converted into a universal rule requiring every older person to be turned at exactly the same interval.
The guideline also suggests not routinely extending repositioning intervals to four, five or six hours while an individual remains at risk. Again, individualization matters. Progressive extension may be reasonable for some people when risk decreases, effective independent repositioning improves and skin and tissue remain normal.
One person may make frequent spontaneous movements and need only prompting or minor assistance. Another may be completely dependent and require active repositioning. Someone with severe pain, fractures, respiratory compromise, hemodynamic instability or palliative-care needs may tolerate movement differently, and comfort, safety and goals of care may appropriately change the plan.
The right regimen therefore depends on the person, their response, the support surface and the care available—not simply on the clock.
Decision 1976/QĐ-BYT provides a useful Vietnamese foundation for home and community care. It includes practical positioning techniques for older people who remain in one position for prolonged periods or who have hemiparesis and cannot reposition themselves comfortably, with the aim of helping prevent pressure-area ulcers and other complications of prolonged immobility.
However, Decision 1976 should not be described as a comprehensive Vietnamese pressure-injury clinical guideline. It is broader professional guidance for caring for older people at home and in the community. Higher-risk or clinically complex situations still require individualized professional assessment, appropriate referral and a broader prevention strategy.
Mobility is part of prevention
Pressure-injury prevention should not focus so narrowly on turning an older person in bed that it loses sight of a larger objective: helping the person move as much as safely and realistically possible.
For many people recovering from stroke, surgery, infection or hospitalization, improving mobility reduces sustained mechanical loading while also supporting function and independence. Physiotherapy, occupational therapy, transfer practice, strength and balance work, pain management, appropriate assistive devices and reablement may therefore become part of the pressure-injury prevention plan.
Even a small functional improvement can matter. Moving from complete dependence for repositioning to being able to shift weight or adjust posture with minimal assistance changes both pressure exposure and caregiver burden.
Prevention should therefore ask not only how often a person needs to be repositioned, but also whether they can regain some ability to move, stand, shift weight or transfer. The objective is not simply to protect the skin. Wherever possible, it is also to preserve or restore functional movement.
Sitting deserves as much attention as lying
Pressure injury is often associated with people who are bedbound, but prolonged sitting can create substantial risk as well.
An older person may spend much of the day in a wheelchair, recliner or dining chair. If they cannot shift their weight effectively, sustained loading can affect the sacral, ischial and other pressure-vulnerable areas.
The International Guideline treats pressure injury in seated individuals as a specific prevention issue. Assessment should consider posture, duration and pattern of sitting, ability to weight-shift, the seating surface, foot support and positioning across the day.
A wheelchair may improve mobility and independence while still creating pressure risk if the seating system is poorly matched to the person's body or the person remains in one position for prolonged periods. Prevention therefore needs to consider the whole 24-hour positioning pattern, not only what happens in bed.
Support surfaces help, but mattresses do not replace care
Specialized mattresses, overlays and integrated support systems are designed to redistribute pressure and, depending on their characteristics, may also assist with friction, shear and microclimate management. Current international guidance therefore considers appropriate pressure-redistribution support surfaces an important component of prevention for people at risk.
But a pressure-redistributing mattress is not a substitute for an individualized prevention plan.
The person still needs appropriate movement or repositioning, skin and tissue assessment, moisture management, nutrition intervention when indicated and reassessment as their condition changes. The support surface needs to match the person's body size, clinical condition, mobility, goals of care and care environment, and it must be used and maintained correctly.
A sophisticated mattress can create false reassurance if the rest of prevention disappears.
This is especially relevant to home and long-term care in Viet Nam, where access to specialized equipment can vary substantially. High-cost technology should not be treated as the only route to safer care. Equipment should be matched to risk, needs, available resources and the care environment, while reliable basic prevention remains essential.
Heels need specific protection
The heel is particularly vulnerable because relatively little soft tissue separates the skin from underlying bone. Current international guidance identifies the heel as one of the common anatomical sites for pressure injury and emphasizes reducing sustained mechanical loading in people at risk.
Depending on the person's condition, heel offloading may involve positioning strategies, appropriately placed pillows or purpose-designed heel-offloading devices. Whatever method is used, alignment and safety need to be maintained, and the intervention itself should not create a new pressure point.
The heel illustrates an important practical point: a person can be repositioned regularly and still experience continuous heel loading. Turning the whole body is therefore not the same as comprehensively redistributing pressure.
Nutrition is part of skin and tissue protection
Malnutrition and pressure-injury risk are closely connected. The International Guideline identifies malnutrition and risk of malnutrition as important factors associated with pressure-injury development and severity, while adequate macro- and micronutrients are required for tissue maintenance and repair.
The guideline recommends nutrition screening for people at pressure-injury risk and comprehensive nutrition assessment for people with an existing pressure injury and for at-risk people who screen positive for malnutrition risk. Nutritional supplementation may be considered for people at pressure-injury risk who are malnourished or at risk of malnutrition when usual dietary intake does not meet their needs, but this recommendation remains conditional and the certainty of evidence is very low.
For older people, this connection is especially relevant because poor appetite, acute illness, dysphagia, oral disease, dementia, depression, medications and treatment burden can all reduce food and fluid intake. Recent unintended weight loss, reduced intake, swallowing difficulty and hydration therefore deserve attention alongside the skin.
Nutrition intervention should remain individualized. Prevention should not become automatic supplement prescribing without understanding nutritional status, clinical condition, renal function, swallowing ability, preferences and goals of care.
Continence and skin care belong in the same prevention plan
Urinary or fecal incontinence does not cause pressure injury through the same mechanism as pressure and shear, but prolonged exposure to moisture and irritants can damage the skin barrier and increase vulnerability.
Pressure-injury prevention and continence care should therefore not operate as separate silos.
An older person who remains in a wet absorbent product for too long may develop incontinence-associated dermatitis, discomfort and skin fragility. Harsh or repeated cleansing can cause additional damage. Current international guidance on preventive skin care emphasizes structured skin-care regimens, appropriate nutrition and hydration, mobilization and prevention or management of other skin conditions, including incontinence-associated dermatitis.
Good care therefore includes timely continence care, gentle cleansing, appropriate skin protection and attention to the underlying continence problem. A pressure-injury prevention plan that ignores moisture and skin integrity is incomplete.
Medical devices can create pressure injuries too
Pressure injuries are not limited to the sacrum, hips and heels. Oxygen-delivery devices, tubing, splints, braces, casts, cervical collars and other medical devices can create sustained mechanical loading that damages skin and underlying tissue. Non-medical objects that remain pressed against the body can also create injury.
The risk is easy to overlook because a device may be clinically necessary. But necessary does not mean risk-free.
Skin around and beneath devices should therefore be assessed when clinically appropriate and safe. Fit and securement should be reviewed, unnecessary pressure reduced and devices repositioned, supported, alternated or removed when medically feasible and consistent with their purpose.
Older people may be particularly vulnerable because of fragile skin and tissue and because illness, cognitive impairment or reduced sensation may make discomfort harder to recognize or communicate.
Device-related pressure injury is another reason prevention cannot belong only to a wound-care specialist. It needs to be part of routine observation by everyone involved in the person's care.
Pressure-injury prevention depends on caregivers and workforce capability
Many preventive actions are performed by the people closest to an older person every day.
A family caregiver may first notice that a heel has changed color or become painful. A care worker may recognize that a resident has stopped shifting weight independently. A nurse may notice poor intake, increasing dependency or pressure beneath a device.
People providing day-to-day care therefore need practical competence. They should know what early skin and tissue changes may look or feel like, how to assist repositioning safely, how to minimize friction and shear, how to use available equipment, when skin changes require escalation and when the prevention plan needs review.
Training should not consist only of a rule such as “turn every two hours.” Caregivers need to understand why positioning matters, why different people may need different plans and how to recognize when the current approach is not working.
Recent Vietnamese evidence reinforces this point. A 2026 study of primary caregivers of stroke patients at Nam Dinh General Hospital found that although 71.1% met the study's overall threshold for pressure-ulcer prevention knowledge, important gaps remained. Only 36.3% answered correctly about pressure-ulcer prevention diet, and some caregivers had poor knowledge relating to mobility-based prevention. The study was single-center and used convenience sampling, so it should not be generalized nationally, but it illustrates why caregiver education cannot be assumed.
This is especially relevant in Viet Nam because families remain central to home care. Decision 1976/QĐ-BYT provides a useful foundation for practical caregiver support, but families should not be expected to substitute for a functioning care system or to perform complex care without appropriate education, equipment and professional support.
Care transitions are a high-risk moment
Pressure-injury risk does not reset when an older person leaves hospital.
A hospital team may know that the patient is at high risk, but that information may not reach a rehabilitation service or family. A pressure-redistribution mattress may be available in hospital but not at home. A new area of skin change may be missing from discharge documentation. The family may not know how much assistance with movement, transfer or positioning the person now requires.
A safer transition should communicate current skin and tissue status, existing pressure injuries, major risk factors, mobility and transfer ability, capacity to reposition, seating and support-surface needs, continence issues, nutritional concerns and the current prevention plan.
If equipment, caregiver training or professional follow-up will be needed at home, planning should begin before discharge whenever possible. This is particularly important after stroke, hip fracture, critical illness or prolonged hospitalization, when mobility, cognition, dependency and nutritional status may be very different from baseline.
Pressure-injury prevention should therefore form part of the functional handover, not appear in transfer information only after a wound already exists.
Home prevention needs to be realistic
Pressure-injury prevention at home cannot simply copy a hospital protocol. There may be no electric profiling bed, specialized mattress, mechanical lifting equipment or staff available around the clock. The primary caregiver may be an older spouse or an adult child balancing employment and other family responsibilities.
The plan therefore needs to be clinically appropriate and feasible.
Families may need guidance on positioning, transfers, heel protection, skin and tissue observation, continence and moisture care, nutrition, equipment and warning signs that require professional assessment. Equipment choices also need to reflect affordability, availability and the physical home environment.
The International Guideline recognizes that home repositioning plans need to consider access to pressure-redistribution support surfaces, carers and manual-handling equipment, as well as the needs of informal caregivers. In some situations, frequent small body shifts and pressure-relief movements may supplement full repositioning when continuous caregiver assistance is not available, although they do not replace appropriate support surfaces or required full repositioning.
A prevention plan that depends on one exhausted caregiver repeatedly moving a fully dependent adult throughout the day and night without appropriate equipment, training or support is not a sustainable quality system.
Good care asks not only what should happen in theory, but also whether the actual care arrangement can safely and reliably deliver it.
Long-term care should make prevention routine rather than reactive
Pressure injury is a useful test of long-term care quality because prevention depends on many ordinary actions being performed reliably over time.
Residents may require risk assessment, regular skin and tissue assessment, mobility support, individualized repositioning, appropriate seating and mattresses, nutrition and continence care, device monitoring and timely escalation when changes occur.
No single action is dramatic. Reliability is what matters.
A long-term care organization should therefore know not only how many residents currently have pressure injuries but whether its prevention system is functioning. Are people at risk identified promptly? Are prevention plans individualized and updated? Are early skin and tissue changes acted upon? Are seating and support surfaces appropriate? Are nutrition and continence needs integrated? Are device-related injuries recognized? Do staff and caregivers receive practical education, supervision and feedback? Are changes during care transitions communicated reliably?
These are governance questions, not simply bedside-care questions.
Pressure injury should trigger review and learning, not automatic blame
Pressure injuries are important quality and safety outcomes, but their interpretation requires care.
The occurrence of a pressure injury does not, by itself, prove poor care. Some people have profound physiological vulnerability because of critical illness, impaired perfusion, severe immobility, end-of-life deterioration or inability to tolerate particular preventive interventions. Appropriate prevention can reduce risk but cannot guarantee that every pressure injury will be avoided.
The opposite assumption is equally problematic. Describing an injury as unavoidable without examining the care that preceded it can conceal preventable failures.
A mature quality system avoids both extremes.
When a pressure injury develops, the organization should review what happened. Was risk identified and reassessed when the person's condition changed? Were skin and tissues being examined appropriately? Did mobility decline? Was the support surface suitable? Was repositioning individualized and actually feasible? Were nutrition and moisture addressed? Was a device involved? Were early changes recognized, documented and escalated? Were there clinical reasons why recommended preventive interventions could not be implemented?
The purpose should be accountability, learning and improvement, not reflexive blame. Likewise, any conclusion that an injury was unavoidable should be made cautiously and supported by evidence that appropriate assessment, prevention, monitoring and adjustment occurred within the constraints of the person's clinical condition and goals of care.
This distinction also matters for safety culture. If every pressure injury automatically produces punishment, staff may become defensive or less willing to report early deterioration. Quality governance should maintain accountability while encouraging transparent reporting, timely escalation and learning.
Measurement needs more than a prevalence number
Pressure-injury prevalence and incidence are useful quality indicators, but they are not enough on their own.
Organizations also need to understand severity, anatomical location, whether an injury was present on admission or developed during the episode of care, whether a medical device was involved, and what the person's underlying risk profile was.
Process measures can reveal different problems. Examples include the proportion of at-risk older people with an individualized prevention plan, timely completion of appropriate skin and tissue assessment, access to suitable support surfaces, documentation of prevention requirements during transitions and demonstrated workforce competency in prevention.
Comparisons also require context. A service caring for highly dependent, medically complex residents has a very different risk profile from a community day-care program. Raw rates should therefore be interpreted in light of case mix, exposure, setting and the quality of data collection.
Measurement should help organizations understand and improve care rather than create misleading league tables.
Pressure injury connects many parts of older-person care
Pressure-injury prevention sits at the intersection of many other domains of older-person care. Effective prevention may depend on frailty recognition, nutrition, continence, rehabilitation, falls prevention, pain management, caregiver readiness, workforce competency, care transitions and long-term care governance.
WHO's 2024 Long-term care for older people: package for universal health coverage explicitly includes skin pressure injury among the health-care needs that long-term care systems should be prepared to assess and manage, alongside mobility limitations, falls, malnutrition, polypharmacy, pain, urinary and fecal incontinence, infection and oral disease.
WHO also makes an important distinction: the LTC package is intended primarily to help governments and policy-makers plan, prioritize and organize long-term care services. It is not a daily-practice clinical guideline, standard operating procedure or step-by-step clinical manual. Detailed pressure-injury prevention therefore needs to draw on appropriate clinical guidance and be adapted to local service structures, professional scope of practice, available resources and individual needs.
The broader message remains important: pressure injury is not a narrow wound-care topic. It is part of the infrastructure of high-quality long-term care.
A practical pressure-injury prevention framework for Viet Nam
Viet Nam does not need to wait for a stand-alone national pressure-injury guideline before strengthening prevention within existing professional responsibilities and applicable policies. Current Vietnamese older-person care guidance, contemporary international clinical guidance and an expanding body of Vietnamese evidence already provide useful building blocks for quality improvement.
Risk assessment should identify the person's actual pressure-injury risk factors rather than rely on a total score alone. Skin and tissue assessment should detect early changes using both visual and tactile assessment and distinguish pressure-related injury from other skin conditions. Mobility, repositioning and seating should minimize sustained mechanical loading through an individualized approach rather than a single fixed schedule for everyone.
Support surfaces and heel protection should reflect risk, body position, clinical condition and functional needs. Nutrition and hydration should be screened and addressed when relevant. Continence and preventive skin care should protect the skin barrier and reduce moisture-related damage. Medical devices should be monitored for fit and mechanical loading.
Transition management should communicate skin status, risk, mobility, equipment and prevention requirements between settings. Caregiver and workforce capability should make prevention practical and reliable in everyday care. Finally, measurement and learning should show whether prevention processes are functioning and whether new pressure injuries lead to appropriate review and improvement.
These components work best as a system. A good mattress does not compensate for serious nutritional problems that have not been recognized. A repositioning plan does not compensate for a medical device exerting continuous pressure. A completed risk score does not compensate for a prevention plan that was never implemented.
From pressure relief to preserving function and dignity
For an older person, pressure-injury prevention is not really about a mattress, a turning chart or a score. It is about being able to move without avoidable pain, sit safely with family, recover after illness, remain comfortable, avoid a wound that can become difficult to heal and preserve as much function and independence as possible.
For families, good prevention means knowing what to watch for without being expected to manage complex care alone. For hospitals, it means identifying risk early and ensuring that prevention survives discharge. For home and community services, it means translating evidence into a plan that families can realistically deliver. For long-term care, it means making prevention part of everyday quality rather than waiting for a wound to appear.
As Viet Nam develops a more integrated continuum of care for older people, the question should therefore not simply be “Did we assess pressure-injury risk?”
A more meaningful question is:
“Did we understand this person's risks, act on what could be changed, protect skin and tissue, preserve movement where possible and maintain that prevention plan across every care setting?”
That is the difference between documenting risk and delivering high-quality prevention.
References
National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline: Fourth Edition. Haesler E, ed. 2026.
National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Pressure Injuries/Ulcers: Definition and Etiology. In: Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline: Fourth Edition. Haesler E, ed. 2026.
National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Pressure Injury Risk. In: Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline: Fourth Edition. Haesler E, ed. 2026.
National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Skin and Tissue Assessment. In: Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline: Fourth Edition. Haesler E, ed. 2026.
National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Repositioning and Mobilization. In: Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline: Fourth Edition. Haesler E, ed. 2026.
National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Full Body Support Surfaces for Prevention of Pressure Injuries. In: Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline: Fourth Edition. Haesler E, ed. 2026.
National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Pressure Injuries in Seated Individuals. In: Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline: Fourth Edition. Haesler E, ed. 2026.
National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Preventing Heel Pressure Injuries. In: Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline: Fourth Edition. Haesler E, ed. 2025.
National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Device-Related Pressure Injuries. In: Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline: Fourth Edition. Haesler E, ed. 2025.
National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Preventive Skin Care. In: Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline: Fourth Edition. Haesler E, ed. 2026.
National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Nutrition in Pressure Injury Prevention and Treatment. In: Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline: Fourth Edition. Haesler E, ed. 2026.
World Health Organization. Long-term care for older people: package for universal health coverage. Geneva: World Health Organization; 2024.
Ministry of Health of Viet Nam. Decision No. 1976/QĐ-BYT issuing professional guidance on care for older people at home and in the community. 1 July 2026.
Duong TTH, Do TKH. Current situation of pressure ulcer in elderly patients who treated at Central Geriatric Hospital. Vietnam Journal of Community Medicine. 2022;63(3):71–77.
Luu CTM, Han TC, Trieu NHK, et al. Incidence of pressure injuries and effectiveness of a prevention care bundle in critically ill Vietnamese patients: A prospective cohort study. Australian Critical Care. 2025;38(5):101262.
Tran YM, Tran TO, Nguyen PH. Pressure injuries and associated factors among patients treated in the Intensive Care and Toxicology Department at Duc Giang General Hospital in 2025. Vietnam Journal of Community Medicine. 2026;67(Special Issue 5).
Le TH, Nguyen AT, Nguyen HQ, et al. Prevalence of pressure injuries and associated factors among mechanically ventilated patients at the Emergency Center A9, Bach Mai Hospital. Vietnam Medical Journal. 2025;557(2).
Nguyen QD, Nguyen HL, Vu TTT, Nguyen THN, Vu TTT. Current status of knowledge on pressure ulcer prevention and related factors among primary caregivers of stroke patients at Nam Dinh General Hospital in 2025. Vietnam Journal of Community Medicine. 2026;67(8).