Nonpharmacologic Interventions to Heal Pressure Ulcers in Older Patients: An Overview of Systematic Reviews (The SENATOR-ONTOP Series).
BACKGROUND
Pressure ulcers (PUs) are more frequent in older patients, and the healing process is usually challenging. Nonpharmacologic interventions may play a role in the treatment of older people with PUs, but most systematic reviews (SRs) have not addressed this specific population using convincing outcome measures.


OBJECTIVE
To summarize and critically appraise the evidence from SRs of the primary studies on nonpharmacologic interventions to treat PUs in older patients.


METHODS
SR and meta-analysis of comparative studies.


METHODS
PubMed, Cochrane Database of Systematic Reviews, EMBASE, and CINHAL (from inception to October 2013) were searched. A new search for updates in the Cochrane Database was launched in July 2014. SRs that included at least 1 comparative study evaluating any nonpharmacologic intervention to treat PUs in older patients, in any health care setting, were included. Any primary study with experimental design was then identified and included. From each primary study, quality assessment was undertaken as specified by the Cochrane Collaboration and the Grading of Recommendations Assessment, Development and Evaluation working group. Interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis, using complete ulcer healing as the outcome measure.


RESULTS
One hundred ten SRs with 45 primary studies satisfied the inclusion criteria. The most frequent interventions explored in these trials were support surfaces (13 studies), nutrition (8), and electrotherapy (6). High or moderate quality of evidence was found in none of the interventions, mainly because of the very serious risk of bias of most studies and imprecision in the treatment effect. Evidence grade is very low or insufficient to support the use of any support surface, nutrition intervention, multicomponent interventions, repositioning or other adjunctive therapy (ultrasound, negative pressure, laser, electromagnetic, light, shock wave, hydrotherapy, radiofrequency, or vibration therapy) to increase the rates of PU healing in older patients. Electrotherapy showed some beneficial effect in the treatment of PUs, although the quality of evidence is low.


CONCLUSIONS
In older patients with PUs, evidence to use any nonpharmacologic therapy to increase the rates of wound healing is inconclusive, except for low quality evidence that supports the use of electrotherapy. This situation is especially alarming for interventions that are usually standard clinical practice (repositioning, support surfaces). Although there is some evidence in younger populations and other types of ulcers, studies in older populations with PUs using sound methodology are needed.
Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, Spain. Electronic address: mvelez.hrc@salud.madrid.org.
Manuel
M
Vélez-Díaz-Pallarés
Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Isabel
I
Lozano-Montoya
Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy.
Iosief
I
Abraha
Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy.
Antonio
A
Cherubini
Department of Medicine for the Elderly, NHS Grampian, Aberdeen, United Kingdom.
Roy L
RL
Soiza
Department of Medicine, University College Cork, Cork, Ireland.
Denis
D
O'Mahony
Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Beatriz
B
Montero-Errasquín
Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Alfonso J
AJ
Cruz-Jentoft
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D003668:Pressure Ulcer / Q000628:therapy*; D014945:Wound Healing
Overview of reviews; meta-analysis; pressure ulcer treatment; pressure ulcers; systematic reviews