Pressure Injury Prevalence in Long-Term Care: What the International Evidence Tells Us

Pressure injuries (PIs) remain a key indicator of care quality in long-term care (LTC) and residential aged care worldwide. Older adults are particularly vulnerable due to frailty, reduced mobility, cognitive impairment, chronic illness, and reliance on staff for repositioning and skin surveillance.

🌍 What does international evidence show?

International literature demonstrates significant variation in reported pressure injury prevalence across long-term care settings. This variability is largely influenced by:

• Differences in study design and data collection

• Resident acuity and case-mix

• Inclusion or exclusion of Stage I injuries

• Consistency of skin assessment practices

A recent high-quality systematic review and meta-analysis by Sugathapala et al. (2023) synthesised data from 47 international nursing-home studies and reported:

• 11.6% pooled point prevalence (all stages)

• 7.2% prevalence when Stage I injuries were excluded

• 14.3% cumulative incidence of new pressure injuries

• 8.5% nursing-home-acquired pressure injury rate

Earlier reviews echo this variability. Anthony et al. (2019) identified prevalence ranging from 3.4% to 32.4%, with higher rates often seen in high-risk populations or under-resourced settings.

🦶 Common injury sites and severity

Across international studies:

• The heel and sacrum are the most frequently affected sites

• Stage I and II injuries are most common This highlights a critical opportunity for early identification and prevention before injury progression.

🇦🇺 How does this compare to Australian aged care?

The Australian National Aged Care Safety and Quality Commission reports pressure injury prevalence between 8% and 42% across residential aged care services.

When compared with international pooled estimates (~7–12%), Australian data:

• Falls within the global range

• Extends toward the higher end, likely reflecting:

🛠️ Implications for practice

International evidence consistently shows that most pressure injuries are preventable. Facilities with lower prevalence rates commonly demonstrate:

• Routine, standardized risk assessment

• Timely access to pressure-relieving equipment

• Ongoing workforce education

• Regular skin inspection and early escalation

Higher prevalence is associated with gaps in these systems.

✅ Key takeaway

International evidence suggests pressure injury prevalence in long-term care typically sits between 7% and 15% at a population level. Wide variation reinforces the importance of standardised assessment, proactive prevention, and continuous quality improvement.

Aligning Australian residential aged care practices with international best-practice benchmarks is essential to reducing preventable harm and improving resident dignity and outcomes.

📚 Key references

• Sugathapala, R.D.U.P., et al. (2023). Prevalence and incidence of pressure injuries among older people living in nursing homes: A systematic review and meta-analysis. International Journal of Nursing Studies, 148, 104605.

• Anthony, D., et al. (2019). Pressure ulcer prevalence in long-term care: A systematic review. Journal of Advanced Nursing.

• NPIAP / EPUAP / PPPIA. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline.