Bedsore prevention practices could constitute ‘abuse’

The mandated practice of two-hourly repositioning of aged care residents to prevent bedsores is ineffective and could be causing more problems than it solves, according to a UNSW study.

The accepted practice was not only ineffective at preventing pressure ulcers, but was suspected of causing behavioural problems by interfering with residents’ sleep patterns, the researchers said in a paper published in Bioethical Enquiry.

The paper, which has been included in a submission to the Royal Commission into Aged Care made by author Professor Mary-Louise McLaws, concluded that the ritualised two-hourly repositioning of residents could be a form of unintentional institutional abuse.

The study examined the medical and nursing records of 80 deceased residents from eight Registered Aged Care Facilities (RACFs) in Australia to determine the number of residents who were assessed as being at risk of developing pressure ulcers, how the two-hourly repositioning impacted them, and whether the residents had the ulcers in the last week of life.

It found that despite 91% of residents deemed at risk of developing pressure ulcers being repositioned in their beds every two hours, 24/7, more than a third had one or more of the excruciating bedsores when they died.


Pressure ulcers can occur on bony areas of the body such as the heels in people who are bed-ridden or confined to a chair or wheelchair. A 1994 study found they can develop after only half an hour of unrelieved pressure from immobility.

Professor McLaws, of UNSW’s School of Public Health and Community Medicine, said while RACFs were required to practice two-hourly repositioning and did so with the best of intentions, the practice was ineffective and ultimately harmful to elderly residents.

“My first thought was the practice would cause sleep deprivation and that it is simply torturous,” Prof. McLaws said.

The solution

Prof. McLaws and her co-authors said the best proven method of preventing bedsores was the use of alternating pressure air mattresses (APAMs).

“These mattresses relieve pressure all over the body every few minutes, continuously and gently, so as not to wake or disturb the sleeper, at a frequency that human repositioning cannot match,” Prof. McLaws said.

The issue of APAMs to at-risk residents had been minimal to non-existent, however, the study found the cost to be around $1.40 a day per resident and that they were available on government contract.

The study authors recommended the practice of two-hourly 24/7 repositioning stop immediately and that APAMs be allocated to every RACF bed, or at least at-risk residents, without delay.

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