Two-hourly repositioning is ‘unintentional institutional abuse,’ claims study

The researchers highlight that the chronic sleep deprivation such regular turning causes could constitute “torture”.

James McKay
11 February 2019
elderly man in bed

Two-hourly pressure area care could constitute torture or  “unintentional institutional elder abuse”.

The practice of repositioning patients who are at a ‘high risk’ of developing ulcers may be interrupting their natural sleep rhythms and could be classed as “unintentional institutional elder abuse”, a new study has claimed.


Researchers from the University of New South Wales examined the records of eighty patients living in eight different care homes in Australia. A key limitation of the study is its size and narrow focus.

The controversial study found that despite nearly all of the patients being repositioned every two hours, even through the night, more than one-third of them still had one or more of the “excruciating” pressure ulcers when they died.

‘Chronic sleep deprivation’.

In their paper,  published in Bioethical Enquiry, the researchers Catherine Sharp, Jennifer Schulz Moore and Mary-Louise McLaws write, “For decades, aged care facility residents at risk of pressure ulcers have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week. Yet, pressure ulcers still develop.”

“We concur with others who have shown that the ritualistic practice of waking residents every two hours for the purpose of repositioning contributes to severe sleep deprivation and behaviours of concern”.


“Sleep is a fundamental phenomenon in most organisms and the sleep–wake cycle is a physiological rhythm which modulates endogenous neuronal activity in the brain.”

“Chronic sleep deprivation can cause significant and cumulative physiological deficits and the disruption of normal neurophysiological mechanisms.”

Adding that the chronic sleep deprivation caused by regular turning causes could be in violation of the Optional Protocol to the Convention against Torture.

The team also questioned the ethical implications of repositioning patients who lack the ability to consent to two-hourly repositionings, such as those with severe dementia.


An alternative.

Rather than two-hourly repositioning, the researchers suggest the use of alternating pressure air mattresses (APAMs).

“Pressure relief should be provided in the form of an APAM, not waking residents up for the purpose of repositioning,” the researchers say.

“An APAM provides pressure relief to all parts of the body every few minutes throughout the twenty-four hours without waking residents, whereas repositioning for pressure relief is usually only carried out two-hourly.

While APAMs have been shown to prevent pressure ulcers, the research dates back to 1967.

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