Pressure Sore Prophylaxis in Elderly Patients Using Slab Foam or Customized Contoured Foam Wheelchair Cushions

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Abstract
In a modified sequential trial, we randomly assigned 288 elderly patients, who were assessed to be at high risk of pressure sores (Norton score ≤14), to use slab foam or customized contoured foam cushions in their wheelchairs for 3 months. A total of 359 sores developed in 169 (68%) of the 248 at-risk patients who completed the study. The sores were mostly of the persistent erythema level (57%) in severity and took an average of 28 days to heal. No significant differences were found in the overall incidence, severity, or healing time of the sores in the patients who developed sores and used the slab (n=85) or the contoured (n=84) cushions. Significantly more sores developed in the area of ischial tuberosities in the slab cushion group, and in the sacrococcygeal area of the contoured cushion group. Age and severe malnourishment were found to be associated with the incidence of sores but the number of hours seated daily and other patient characteristics were not related. We concluded that customized cushions should be offered only to those elderly patients who do not have a tendency to slide in the chair. Implications of the findings for prophylactic practice in extended care facilities are identified.

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