Call for a new approach to preventing bed sores

Interrupting residents sleep to prevent pressure ulcers is ineffective and abusive and could be linked to behavioural concerns, the author of a recent study tells Australian Ageing Agenda.

The University of New South Wales published in the Journal of Bioethical Inquiry investigated if the repositioning of residents every two hours around the clock was effective in reducing pressure ulcers and whether the frequent disruption to resident’s sleep was considered elder abuse.

It found that residents repositioned every two hours were still at risk of developing bedsores and pressure ulcers, said lead researcher Professor Mary-Louise McLaws.

Professor Mary-Louise McLaws

“Nurses are required to reposition residents every two hours, however the standards committee needs to reconsider this for the purpose of preventing pressure ulcers,” senior author of the report Professor McLaws told Australian Ageing Agenda.

The study examined the records of 80 residents over the age of 65, 70 per cent of whom had a diagnosis of dementia, during their last week of life from eight residential aged care facilities.

It found that at time of admission to the facility, 91 per cent of participants were classified as at risk of developing pressure wounds, with 96 per cent of this group receiving two-hourly repositioning.

According to the findings, one-third of residents who were repositioned had one or more pressure ulcers at the time of death.

Residents can begin to develop a pressure ulcer between 30 minutes and six hours when unrelieved pressure releases an inflammatory response, said Professor McLaws said, a professor of epidemiology, hospital infection prevention and control and disease control at University of New South Wales.

The idea of repositioning a resident every two hours may not be right and the constant disruption of a resident’s sleep could be regarded as elder abuse, she said.

“The standard was developed and it is practiced with the intention of preventing pressure ulcers. However, we have also identified that from a patient’s rights perspective, it could be perceived to be abuse,” Professor McLaws said.

Elsewhere, the study found that 70 per cent of participants had notes of an issue or behavioural concerns.

A lack of sleep could be linked to behaviours of concern among some residents, Professor McLaws said.

“For most humans who don’t get enough sleep or have broken sleep for a few nights or months … it can alter your happiness, your level of ability to focus and communicate well. But if you’re elderly or you have dementia, then it could increase that,” she said.

There needs to be further discussion and research to develop a better prevention method of bed ulcers that does not have adverse consequences such as continuous sleep deprivation, Professor McLaws said.

“I think they failed to understand that disturbing a frail and vulnerable resident has some serious consequences,” she said.

While some residents have access to alternating air pressure mattresses, many may not be able to tolerate it, Professor McLaws said.

She said a trial involving residents to investigate tolerance levels and working with industry to develop technological solutions  could help come up with new methods.

“We need to be thinking about how we can get the industry to improve products or how we can provide access for a trial of tolerance for an alternating air pressure mattress.”

Access the research paper Two-hourly repositioning for prevention of pressure ulcers in the elderly: patient safety ore elder abuse? here.