Systematic review of the impact of care bundles on the incidence of pressure ulcers among at-risk older adults

What is it about?

Background Care bundles have been widely studied in the general adult population. However, limited research has focused specifically on individuals aged 65 and older on pressure ulcer prevention. Care bundles are sets of evidence-based interventions and when applied consistently, can improve clinical outcomes. Aim To explore the impact of care bundles on the incidence of pressure ulcers among adults aged 65 and over. Materials and methods Meta-analysis was conducted for studies with comparable methodologies and highly heterogeneous studies were reported narratively. Results The search strategy identified 1,482 citations, of which 11 studies met the inclusion criteria. The mean sample size across studies was 1718 participants (SD ± 3130). Across included studies, care bundles were associated with reductions in pressure ulcer incidence, though findings varied by study design and implementation. Two meta-analyses of randomized controlled trials and quasi experimental studies found no statistically significant differences between care bundles and usual care, with wide confidence intervals and high heterogeneity limiting certainty. In contrast, a third meta-analysis of quasi experimental studies reported that the overall odds ratio for PU development was 0.45 (95% CI: 0.33 to 0.61; p< 0.00001), indicating that patients receiving the care bundle were 55% less likely to develop a PU compared to those receiving usual care. Evidence Based Librarianship (EBL) quality scores ranged from 64% to 96.5%, with the majority (n = 8) scoring ≥75%, reflecting strong methodological quality. Conclusion This systematic review demonstrates that the implementation of care bundles has the potential to lower pressure ulcer incidence in older adult populations. Given the substantial heterogeneity and variation in study designs, the results should be interpreted with caution. Further research is needed to strengthen the evidence base and optimise implementation in among high risk older adults. Clinical implications Care bundles should be considered for pressure ulcer prevention in older adults, thorough ongoing evaluation and adaptation are warranted as further evidence emerges

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