news
Sore point
Medical experts question mandated
two‑hourly repositioning.
A
n alternating pressure air mattress (APAM), not two-hourly
repositioning, is the key to preventing bed sores.
What’s more, the constant mandated repositioning of
residents in aged care could be a form of unintentional abuse and
ultimately unlawful.
This is according to a new study from the University of NSW.
Published in the Journal of Bioethical Inquiry, it found that far from
preventing sores, the repositioning practice can cause behavioural
problems because of the sleep interference.
“My first thought was that the practice of two-hourly
repositioning would cause sleep deprivation and that it is simply
torturous,” said study author Professor Mary-Louise McLaws
of UNSW’s School of Public Health and Community Medicine.
“It wasn’t a surprise when residents were classified as having
Diffusing aggression
What do stakeholders think about
resident-to-resident aggression?
M
any people working in aged care see resident-to-
resident aggression (RRA) happen daily but don’t have
access to much evidence surrounding its prevention, a
new study has said.
Led by Dr Briony Jain from Monash University, Victorian
researchers interviewed 15 people working in aged care senior
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agedcareinsite.com.au
‘behaviours of concern’ and then chemically or physically
restrained.”
McLaws and her co-authors suggest that a better and more
cost-effective alternative would be the APAMs.
Originally thought to be an expensive outlay, and without
substantial evidence of the effectiveness of the mattresses, the
new study found the actual cost of these devices to be around
$1.40 a day per resident and pointed out that they are available on
government contract.
“A study carried out decades ago showed that APAMs were
more cost-effective than the practice of repositioning. And when
you look at the costs of prevention, they are substantially lower
than those required to treat severe pressure ulcers.
“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,”
McLaws said.
The authors also recommended the cessation of chemical and
physical restraints, as the resultant inactivity also leads to ulcers.
They also made submissions to the forthcoming royal commission
on the findings of their work.
Co-author Catherine Sharp said: “We are very optimistic that
we will see two-hourly repositioning of residents stopped in
favour of using APAMs. This will not only improve the wellbeing
of our elderly aged care residents and elderly in hospitals and the
community, but it will reduce the costs and levels of unnecessary
stress experienced by residents, facility staff and families alike.” ■
management, policy and external stakeholder roles to find
out what they knew about RRA and how they felt it could
be curbed.
The majority (53.3 per cent) of the participants said they had
witnessed RRA on the job and the same number agreed it was
preventable.
Just under three-quarters of those interviewed said this
aggression occurred monthly, and a fifth said it happened daily.
Interviewees felt that some potential causes of RRA were
maladaptation to nursing home life, and physical environment
and staffing-related issues. Some also believed that the issues
started outside of the nursing home environment and were
transferred over.
While some said that RRA was dangerous and unpredictable,
respondents also considered it expected behaviour in a nursing
home setting.
Most participants believed that the key to tackling the issue was
a person-centred care approach that would encourage and allow
“nursing home staff to really get to know the resident”.
This would include getting a detailed personal history of the
resident and establishing a positive relationship with the family in
order to be aware of previous incidents, conduct risk assessment
and recognise triggers.
“This may help better understand the resident’s journey, develop
a sense of empathy, and combat any stigma associated with
disclosing mental health or behavioural issues,” the paper said.
Its authors advocated for increased reporting of both minor
and major incidents of RRA, saying that would help identify
patterns and inform appropriate responses.
“However, a cultural shift is first required to recognise RRA as a
manageable and preventable healthcare and adult safeguarding
issue,” they added. ■