Preventive interventions for pressure ulcers in long-term older people care facilities: A systematic review

Abstract

Aims and objectives: To explore the effectiveness of interventions aimed at pressure ulcer (PU) prevention in long-term older people care facilities (LOPC).

Background: Pressure ulcers cause suffering for patients and constitute a major financial burden. Although most PUs could be prevented, their number has remained high. To avoid unnecessary suffering and costs, PU prevention must be effective.

Design: A systematic review.

Methods: A systematic search was conducted in six electronic databases PubMed (MEDLINE), CINAHL, Web of Science Core Collection, Scopus, Cochrane Wounds Group Specialized Register and Cochrane Central Register of Controlled Trials. The inclusion criteria were: (a) study published in 2005-2017, (b) intervention with pre- and post-tests, focusing on PU prevention, (c) implemented in LOPC facilities, (d) persons >65 years as study population, and (e) outcomes reported as PU incidence or prevalence or healing time. The PRISMA guidelines were followed. The methodological quality of the studies was evaluated using the Joanna Briggs Institute's MAStARI critical appraisal checklist. The data were analysed with narrative synthesis.

Results: The review included eighteen studies. The study designs were RCTs (n = 10), comparable cohort or case-control studies (n = 3), and descriptive or case series (n = 5). PU incidence in LOPC facilities decreased by using computerised decision-making support systems, PU prevention programmes, repositioning or advanced cushions. PU prevalence decreased with PU prevention programmes, by using advanced mattresses and overlays, or by adding protein and energy supplements to diet.

Conclusions: There are many ways to prevent PUs in LOPC facilities; no single effective way can be identified. One-third of the preventive interventions in LOPC facilities were effective. However, systematic evidence from randomised trials on preventive interventions of PUs in LOPC settings is still lacking.

Relevance to clinical practice: The findings can be used in practice for selecting and in research for developing effective preventive interventions of PUs in LOPC facilities.

Keywords: aged care; evidence-based practice; implementation; intervention; long-term care; nursing homes; older people; pressure ulcer; quality of care; systematic review.