How are pressure injuries managed at the end of life?

An article written by Dr Pauline Gillan, Charles Sturt University (CSU) and Professor Christina Parker, Queensland University of Technology (QUT)

Pressure injuries, localised damage to skin and surrounding tissue as a result of pressure, might not be the first thing that comes to mind when we talk about end-of-life care, but they’re a big issue, both here in Australia and around the world. In fact, some places report rates as high as 58%! [1] These injuries don’t just cause physical harm - they add unnecessary pain, reduce quality of life, and can even shorten life expectancy. [2]

There are lots of reasons why people in palliative care are at risk of pressure injuries including: limited mobility, poor nutrition, declining health, slower healing, and poor blood flow. [3] All of these make them more vulnerable. Despite this, there’s still no clear agreement on the best way to manage these injuries at the end of life.

What we did

To dig deeper, we did a scoping review. We looked at 16 research papers published between 2003 and 2021. These studies came from countries including Italy, the U.S., Australia, Canada, Sweden, Brazil, Taiwan, and Turkey. [4]

What we found

From our scoping review we found four main strategies for managing pressure injuries:

• Turning or repositioning patients every two hours – this was the most common approach; however, it was often done less frequently to keep patients comfortable. For people at the end of life, major guidelines recommend tailoring repositioning to each patient’s comfort and dignity rather than sticking to a strict schedule. [5]
• Wound debridement - this was also inconsistent and often depended on staff availability and skill levels. For patients where healing isn’t the main goal, techniques for removal of damaged tissue should be gentle and the least painful. [5] Comfort and quality of life should always come first.
• Wound assessment was another area where practice fell short. Many clinicians weren’t using validated tools like the European Pressure Ulcer Advisor Panel and the National Pressure Injury Advisory Panel staging scale, which is essential for accurate diagnosis and treatment planning. [5]
• Finally, using different types of dressings - especially moisture-retentive ones - are key for managing partial or full-thickness injuries. [6] But again, use was inconsistent. In aged care settings, cost and lack of knowledge about wound healing often got in the way.

Looking ahead

Managing pressure injuries at the end of life isn’t straightforward. It’s a balancing act between clinical best practice and what really matters - comfort, dignity, and quality of life. Our review shows that while guidelines exist, real-world practice often falls short due to resource limitations, knowledge gaps, and the need to prioritise patient comfort. There’s still work to do to make sure care is both compassionate and evidence-based.

Useful link

National Pressure Injury Advisory Panel – International Guidelines https://www.internationalguideline.com/

References:

1.          Li HL, Lin SW, Hwang YT. Using nursing information and data mining to explore the factors that predict pressure injuries for patients at the end of life. Comput Inform Nurs. 2019;37(3):133-141.

2.           Gupta P, Shiju S, Chacko G, Thomas M, Abas A, Savarimuthu I, et al. A quality improvement programme to reduce hospital-acquired pressure injuries. BMJ Open Qual. 2020;9(3).

3.           Raine G. Is it time to re-evaluate the inevitability of ulcers at the end of life? Int J Palliat Nurs. 2021;27(9):440-448.

4.           Gillan PC, Parker C. Factors associated with the management of pressure injuries at the end of life: A scoping review. J Hosp Palliat Nurs. 2025;27(4):E144-E151.

5.           National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers/injuries: Clinical practice guideline [Internet]. 2025 [cited 2025 Dec 09]. Available from: https://internationalguideline.com

6.           Nuutila K, Eriksson E. Moist wound healing with commonly available dressings. Adv Wound Care (New Rochelle). 2021;10(12):685-698.

Authors

Dr Pauline Gillan

Senior Lecturer in Nursing, Head of Discipline (Postgraduate Nursing)

School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University (CSU)

Professor Christina Parker

Academic Lead, Postgraduate Research

School of Nursing, Queensland University of Technology (QUT)