Two-Hourly Repositioning for Prevention of Pressure Ulcers in the Elderly: Patient Safety or Elder Abuse?

J Bioeth Inq. 2019 Mar;16(1):17-34. doi: 10.1007/s11673-018-9892-3. Epub 2019 Jan 22.


For decades, aged care facility residents at risk of pressure ulcers (PUs) have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week (24/7). Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities (RACFs) to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent (73/80) of residents identified as being at risk of PUs and repositioned two-hourly 24/7, 34 per cent (25/73) died with one or more PUs. Behaviours of concern were noted in 72 per cent (58/80) of residents of whom 38 per cent (22/58) were restrained. Dementia was diagnosed in 70 per cent (56/80) of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia (82 per cent v 50 per cent, p = 0.028). The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress.

Keywords: Aged care; Dementia; Guidelines; Law; Restraints.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Australia / epidemiology
  • Cross-Sectional Studies
  • Dementia / epidemiology
  • Dementia / mortality
  • Dementia / therapy
  • Elder Abuse*
  • Female
  • Humans
  • Male
  • Patient Safety*
  • Pressure Ulcer / epidemiology
  • Pressure Ulcer / mortality
  • Pressure Ulcer / prevention & control*
  • Prevalence
  • Residential Facilities / statistics & numerical data*
  • Restraint, Physical / adverse effects
  • Restraint, Physical / statistics & numerical data
  • Surveys and Questionnaires