In 2013, an estimated 475,000 older people lived in residential and nursing homes across the UK (LaingBuisson, 2014). There are about 15,700 private, voluntary and Local Authority care homes in the UK, providing care at an estimated annual value of more than £8 billion per annum (Annexe, 2002).
Approximately half of the residents of nursing home facilities are predominantly wheelchair or seating users.
The standard chairs in nursing homes were never intended for continuous sitting. In some cases, the poor posture and positioning as a result of inadequate seating, results in increased discomfort; skin breakdown; reduced mobility; limits on vision, swallowing, and breathing; and biomechanical problems, such as hips out of normal alignment and poor lower-extremity positioning.
Impact of poor seating
Many people who suffer from long term disabilities, or who are elderly, lack mobility. As a result, they often spend long periods of time sitting, whether in a wheelchair or in an armchair. When people spend prolonged time sitting they can become very uncomfortable and may develop poor posture, pressure ulcers or both. Many nursing home residents do not receive an adequate seating assessment on admission to the nursing home and therefore are provided with unsuitable seating which can be very harmful.
“I feel like we are never going to get one [a chair] to suit her. We have used three from storage but they have not been suitable and her current chair is leaving marks on her skin.”
a nursing home. A professional trained in how to assess and prescribe seating and monitor pressure care should carry this out. The resident should ideally be matched with suitable specialised seating to meet their postural and functional needs.
Current expenditure by the NHS in the UK on pressure ulcers is £2.1bn annually (Bennett, 2004). This equates to approximately £10,500 per sore. Anecdotal evidence suggests that correct seating provision is instrumental in depleting this cost by preventing ulcers through investment in chairs before ulcers develop. As the average retail price of a chair is £1,800 across all seating companies, there is an 82.9% potential saving for the NHS in this area (Bennett, 2004).
Aim of research
Seating Matters have collaborated with leading researchers at Ulster University to try to identify the importance of suita- ble seating provision in reducing the incidence of pressure ulcers and postural dif culties which have an
impact on swallowing, eating, breathing and feeding, in adults in nursing homes. This clinical trial explores the effectiveness of specialist seating provision within a nursing home environment and how it has the potential to impact positively on the health and wellbeing of residents and their caregivers. It will identify the key principles of correct positioning, seating and mobility and the in uence this can have on the health of older people.
This study involved a mixed methods design. We used a range of qualitative and quantitative tools, both standardised and those designed by the research team, based on issues identi ed in the literature.
Participants were recruited from three nursing homes and randomly allocated to one of two groups. The control group continued to use their existing chair while the intervention group were provided with a chair that was compatible with their individual seating and postural needs.
Both groups were monitored by Occupational Therapists from the research team over a 12 week period looking
at their seating and postural abilities, oxygen saturation levels, functional skills, skin integrity, and caregivers’ level of input.
A questionnaire was completed by the caregiver before and after the 12 week trial period. A seating assessment was also completed with each participant before and after the trial period to monitor and record any changes in posture, skin breakdown or medical presentation.
At the beginning of the trial the following assessment tools were administered for participants in both the intervention and control groups.
• Demographics (such as age of client, medical history etc) • Seating assessment (of resident’s sitting balance and postural needs, sitting skills, range of movement for sitting and transferring in/out of the chair)
• Digital Photographs (taken before and after initial assessment with residents sitting in their original chair and in the chair they used during the trial period) Physiological factors:
• Braden Scale to measure risk of developing pressure ulcers
• Pulse Oximeter to measure saturated oxygen levels Quality of life factors:
• Caregiver questionnaire to gather any changes, if any before and after trial period
Pressure Ulcers/Red areas:
The results in this area have been very signi cant with
no participants developing a red area or pressure ulcer whilst using Seating Matters specialised seating. In the Control Group, there was a 5% increase in pressure ulcers. Each existing pressure ulcer in this group remained. Concurrently, the participants in the Intervention Group, using the Seating Matters chairs, had a reduction in pressure ulcers by 88.3%.
Pulse Oximeter-saturated oxygen levels:
Interestingly 95% of the intervention participants were found to have an increase in oxygen saturation levels over the 12 week trial. The rest of the intervention participants maintained their initial results while 45% of the control participants experienced decreased oxygen saturation levels while continuing to use their existing seating which had not been individually tailored to their needs.
Results from the caregiver questionnaires as well as qualitative feedback have shown that both the incidence of sliding and falling to the side in participants in the intervention group have decreased signi cantly. In some cases, carers have reported initially repositioning the participant as a result of poor posture every 20 minutes whereas at the end of the trial, using specialised seating, that has been reduced greatly.
“The chair is fab! We don’t have to reposition him as much anymore as he used to slide down in his chair before every 20 minutes!”
Feedback from carers and family as well as direct observation and assessment from the Occupational Therapists has shown that as a result of seating, many intervention participants have shown increased function and participation in activities of daily living. Participants were more alert, able to sit up for much longer and able to assist with self-care tasks and leisure activities.
“She is so much more comfortable. She doesn’t ask to go to bed anymore and she can even play bingo now!”
“She seems to like the new chair, always sitting comfortably. Family love it and say they nd their mother more responsive when they visit.”
In some cases, participants even regained the ability to feed themselves independently and carers found that assisting with this activity was much easier and safer when positioned correctly in a Seating Matters chair.
“We can now feed her in the chair as they [Seating Matters] provided us with a table that can be tted on. It’s been great.”
“It’s been great. She is much easier to feed now as she doesn’t fall forward anymore. She is very content in her chair.”
Full ethical approval and research governance was sought and obtained from Ulster University lter committee and OREC Northern Ireland
This relevant and current piece of research provides information on strategies and protocols needed for appropriate seating and positioning recommendations. The needs of each patient are different and require individualised assessment to provide appropriate clinical guidance and recommendations for seating. This is a fundamental aspect of patient care which has a direct effect on many wider aspects of an individual’s health and wellbeing.
The Seating Matters chairs have been researched intensively and clinically trialled for those who are elderly or have complex seating needs.
The staggering results have proven what we already believe, that the correct use of specialised seating can lead to;
• A signi cant reduction in pressure ulcer incidence by 88.3%
• Increase in oxygen saturation levels by 95%
• Increased functional ability
• Improved posture and a reduction in the development of postural deformities or sliding/falling from the chair • Improvement in respiration, elimination, digestion and other physiological functions
• Improved quality of life and psychological wellbeing
• Improved communication and interaction
• Improved comfort and reduction in pain levels
• A signi cant reduction in expenditure on staff labour and treatment of pressure ulcers
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