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Pressure injuries pose a significant challenge to at-risk populations and have deep impacts on quality of life, mobility, comfort, and financial considerations. These and other factors make prevention a core need, and strategies need to be as effective as possible. Authors of a recent scoping review in the International Wound Journal point out that prevention training has traditionally focused on hospital and long-term residential care environments. However, this same training may not serve older, at-risk adults living in the community, nor their caregivers. They note that the National Pressure Injury Advisory Panel (NPIAP), the European Pressure Ulcer Advisory Panel (EPUAP), and the Pan Pacific Pressure Injury Alliance (PPPIA) recommendations suggest that education should ideally have several different results that indicate success, including:¹

• improving knowledge of preventing and managing PI for patients and caregivers;
• patient behavioral changes supporting PI prevention;
• improvement in quality of life; and
• evidence of PI prevention or reduction.

They contend that a key to achieving success in these metrics is participant engagement, since educational approaches may be didactically sound but may not resonate with patients and their loved ones.

In their review, the authors sought to describe features of various PI education programs that exist for older adults living in a community-based setting and those who care for them. They searched CINAHL, Medline, Scopus, Cochrane Library, and ProQuest from 2009 to August 2023 using Arksey and O'Malley's 6-step framework and PRISMA-ScR guidelines for peer-reviewed papers in English.¹ They found 136 papers and included 4 in their review. The authors stated that educational materials did take literacy levels and cognitive status into consideration in their design. Programs consisted of printed materials such as brochures or handouts, in-person training, or a combination thereof. Of note, however, is the duration of the programs outlined. Some were a few weeks long, while others took place over nearly a year. The review identified some improvements in knowledge of PIs related to treatment, nutrition, and mobility issues. Long-term impact on behavior, though, remained in question.¹

The authors shared that they recommend a multi-pronged approach to education on PIs for this patient population. They feel the education should be continuous, providing support over extended periods of time. Additionally, they recommended that these efforts begin at the level of primary care providers as part of a comprehensive approach to their overall health. Agreeing that literacy and cognition must be considered in designing these programs, they added that understanding cultural needs may enhance implementation. Overall, the authors advocated for “accessible, relatable, and effective” outreaches focused on long-term sharing of information and behavior modification, along with a collaborative approach with caregivers and patients themselves.¹

Reference

1. Sahay A, Willis E, Yu S. Pressure injury education for older adults and carers living in community settings: A scoping review. Int Wound J. 2024 May;21(5):e14894. doi: 10.1111/iwj.14894. PMID: 38772749; PMCID: PMC11108764.