White Paper on Pressure Management

Introduction Unrelieved pressure upon weight-bearing tissues can produce lesions, identified by their etiology as pressure ulcers (AHCPR, 1992). The prevalence of pressure ulcers for elderly nursing home residents has been estimated between 2.3% and 28%. (AHCPR, 1992; Brandeis, Ooi, Hossain, Morris, & Lipsitz, 1994; Smith, 1995; Young & Burns, 1981). The prevalence rate among other populations with mobility impairments is even higher; it has been estimated that between 50% and 80% of persons with spinal cord injury will develop a pressure ulcer (Gosnell, 1973; Richardson & Meyer, 1981; Rodriguez & Garber, 1994; Salzberg et al., 1996). Even the lowest of these estimates aptly demonstrates that pressure ulcers are a significant health care problem. According to 1999 Health Care Financing Administration (HCFA) data, inadequate attention to prevent pressure ulcers was the most frequently cited quality of care deficiency in the long-term care setting (Lyder 2000). The costs associated with the management of U.S. pressure ulcers exceed $6.4 billion annually (Marwick, 1992). This burden is reflected in health policy as Healthy People 2010 includes the measurable prevention objective of decreasing pressure ulcer prevalence 50% by the year 2010 (NPUAP, 2000). Sitting-acquired pressure ulcers are a particularly significant problem for wheelchair users. The percentage of pressure ulcers caused by sitting in wheelchairs is difficult to ascertain, but estimates in the literature suggest that it is between 36% and 50% for the at-risk elderly population (Zacharkow, 1984). The inadequacy of wheelchair fit contributes to the development of pressure ulcers (Zacharkow, 1984; Lim, 1988). In assessing risk, individuals with mobility impairments that prevent independent repositioning, as well as those that are bed and chairbound, tend to be at the greatest risk for pressure ulcer development (Allman, 1997). Several studies have indicated that the use of pressure-reducing wheelchair seat cushions designed to maintain tissue integrity will reduce the incidence of sitting-induced pressure ulcers (Bardsley, 1984; Shaw, 1993; Lim, 1988; Shaw, 1996; Conine, 1994; Geyer, 2001). Tissue integrity is maintained by reducing pressures near bony prominences, accommodating orthopedic deformities through immersion, enveloping irregularities at the seating interface to reduce high pressure gradients, and controlling heat and moisture.