Painful bedsores or pressure ulcers cost billions of dollars to treat each year, but little is known about how to prevent them, Canadian researchers say.

Pressure ulcers range from a slight discolouration of the skin to open sores that expose the bone.

The sores often develop in the tailbone area, hip and heel, caused by friction and long periods of immobilization in a bed or a wheelchair. Some people can develop the sores within three hours of lying on a stretcher in the emergency room. 

"There seems to be a huge mismatch between the billions of dollars we're spending on treating this condition, including an incredible amount of nursing time, and the relatively little effort in determining best practices for prevention," said the study's senior author, Dr. Paula Rochon, a geriatrician and researcher at Baycrest Geriatric Health Care System in Toronto.

The late actor Christopher Reeve, best known for playing Superman, died from complications reportedly linked to an infected pressure sore after he was paralyzed in a horseback riding accident.

Elderly people living in long-term care facilities, especially those who are immobile, incontinent or have dementia, are at risk for the sores, which can prolong hospital stays.

Rochon and her colleagues reviewed randomized clinical trials on preventing pressure ulcers over the last 30 years. Their study appears in Wednesday's issue of the Journal of the American Medical Association.

Prevention strategies

Repositioning people by turning them over is important, but the research doesn't offer tips on how often or the best method, the team found.

Other ideas may help, but need to be tested more rigorously, the researchers said. The steps include:

• Using support surfaces such as mattresses on operating tables.
• Adding foam or sheepskin to beds and wheelchairs.
• Eating nutritious foods.
• Moisturizing the skin on the tailbone.

The study's authors recommend that nurses, doctors, occupational therapists and dietitians work together to prevent ulcers as in other geriatric conditions.

The study was sponsored by the Canadian Institutes of Health Research.