Prevention Before Cure Is Key For Battle with Pressure Injuries In Care Homes, Says Sleep Expert

When it comes to choosing an appropriate lying surface for residents in care, pressure relief, and specifically the pre- vention of pressure injuries, trumps comfort and sleep quality every time.

In 2018, NHS Improvement described pressure injuries as a ‘concerning and avoidable harm’ with the costs to the NHS of treating the condition running at more than £3.8 mil- lion every day.

Pressure injuries are a major complication faced by people who are bed bound or immobile. The pressure that builds on soft tissue causes distortion to the tissues and/or an interruption to the blood supply – and that kills or damages skin leading to painful ulcers.

Last year, The University of Leeds’ Institute of Clinical Trials led the first ever independent evaluation of pressure relieving mattresses of its kind, and evidenced that the dynamic airflow mattress, commonly found in residential care, was found to offer marginal benefit over Hi Spec polyurethane foam mattresses.

Also known as alternating-pressure mattresses, airflow mattresses contain air pockets which inflate and deflate to constantly change pres- sure points on the skin.

Professor Jane Nixon, who led the study into them, also highlighted that: “Some patients find the air mattress unsettling. They are kept awake by the noise of the pump, feel unsafe because the mattress is moving, or just find them uncomfortable. Rehabilitating patients also complain that they can’t move around themselves or get in and out of bed – and that exacerbates already limited mobility.”

As long as pressure injuries are treated as a problem in their own right rather than a symptom of poor care, then the problem in my opinion will only worsen. Neuroscientist Mathew Walker wrote in 2017 that; ‘Sleep is the single most effective thing we can do to reset our brain and body each day – Mother Nature’s best effort yet to contra death.’ However, the UK Sleep Council published a poll that showed being uncomfortable in bed as the main factor in disturbing sleep.

Poor sleep posture can also create a vicious cycle – people work all day in positions that cause neck and back pain, and then sleep in ways that don’t treat this, or even make it worse. They wake up the next day in even more pain because of their sleep posture, become frustrated, and go into a routine of bad days and nights.

10 per cent of hospital beds have air flow mattress, and yet until 2019, no one had carried out research on the effects of sleeping on them. Now, these clinical studies, and even our own independent research carried out by The University of Salford and The University of Central Lancashire (Uclan) have demonstrated how important sleeping on the right surface is, so surely comfort should be a given rather than an optional extra, whether it’s in healthcare or a domestic setting.

One of the best kept secrets in healthcare and particularly elderly care is the impact of good posture in bed. There are a range of aims that can be related to postural care, which include:

• Improved quality of sleep
• Increase in amount of sleep
• Improve function and communication lying • To maximise comfort and reduce pain
• Uphold and progress quality of life

• Ease physical care required
• Protect body shape
• Maintain or improve muscle tone
• Support in repositioning and moving and handling needs

Postural care may also have significant impact on the health status of individuals and therefore impacts on services and the ongoing cost of health care needed, for example:

• The musculoskeletal system – to prevent or reduce contractures and body shape distortion

• The neurological system – to provide proprioceptive feedback to aid maintenance of, or improve, muscle tone

• Respiratory function – to maintain a good airway and to prevent body shape distortion from impeding the respiratory system

• Digestion – to prevent body shape distortion from impeding the digestive system

• Pressure care – by improving the body shape and positioning, pressure can be more effectively distributed therefore supporting good pressure care, preventing pressure injuries

• Personal hygiene

Perhaps, a starting point for better posture in residential care would be prescribing the right pillow and mattress, backed by independent research from recognised institutions to ensure a legitimate benefit for patients.

All of our work in healthcare is assessment led, so we get to see at first-hand the damage and body shape deformity patients suffer due to a lack of knowledge or consideration of their posture. Many local authorities have little or no provision for the postural needs of patients in their community, regardless of it being for sitting (specialist seating) or lying down.

The sooner posture is a priority in care homes, the better chance we have in preventing pressure injuries at their root cause.