Non-pharmacological interventions to prevent or treat pressure ulcers in older patients: Clinical practice recommendations. The SENATOR-ONTOP series

Introduction: The objective is to develop explicit and transparent recommendations for non-pharmacological interventions for older subjects at risk of developing pressure ulcers, as well as for older subjects with pressure ulcers, based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to rating the quality of evidence and the strength of recommendations. Material and methods: A multidisciplinary panel was constituted. The results of the evidence retrieved were published in a systematic overview. The GRADE approach was used to rate the evidence and to formulate recommendations in older subjects in hospitals or nursing homes. Results: The critical outcomes were incidence of new pressure ulcers and rate of healing. Non- pharmacological interventions were identified. Strong recommendations in favour of the use of alternating pressure and constant low pressure devices in hospitalised (medical or surgical) and nursing home patients at high risk of developing pressure ulcers for ulcer prevention were formulated. In addition, strong recommendations were formulated in favour of regular repositioning to prevent pressure ulcers in older hospitalised patients. Weak recommendations support the use of nutritional intervention to prevent pressure ulcers and of either clinical judgment or assessment scales to detect individuals at risk. For healing of pressure ulcers, weak recommendations support the use of electrotherapy but not of mixed nutritional supplements. Preventive interventions have to be considered also in patients with pre-existing ulcers to reduce the risk of new pressure ulcers. Conclusions: Overall, the panel developed 9 recommendations for the delivery of non-pharmacological interventions to older patients with, or at risk of developing, pressure ulcers.