A Randomized Control Trial Investigating the Impact of Individualized Seating Provision for Older Adults in Long-Term Care

SIGNIFICANCE: As people age, many are affected with physical illnesses and neurological conditions that are associated with deterioration in physical ability, function, and well-being; therefore, it is not unusual for seating needs to emerge. In this research, we aim to examine the effectiveness of individualized seating provision within long-term care facilities and how it can significantly have an impact on the health and well-being of patients and their caregivers.

INNOVATION: Much of the seating provided in long-term care is not specific to patient need. Individualized seating assessment—identifying the person’s joint range of motion, identifying postural support, and providing a prescribed seating system that best positions and supports the person for comfort and function—could serve in meeting the needs of older adults in long-term care and could prevent pressure ulcers and postural-related difficulties.

APPROACH: The principle aim is to identify the impact of individualized seating in reducing postural and pressure care difficulties for older adults in long-term care. Clinical evidence and experience are suggestive that current wheelchair provision does not meet the needs of older adult patients. Clinically unsuitable seating may lead to the development of pressure ulcers, which are a concern due to the cost involvement and the impact on the person. In this research, we aim to examine the impact of individualized seating on the incidence of pressure ulcers, among other variables.

METHOD: A quasi-experimental design using a mixed approach of standardized tools and those designed by the research team was ethically approved and utilized in three long-term care facilities in northern Ireland.

Forty eligible patients were recruited using purposive sampling. Participants were aged more than 65 yr and were identified by the staff as requiring seating intervention. Informed consent was gained. Participants were subject to baseline assessment before being randomly allocated to either the control group (who continued to use their existing seating) or the intervention group (who were provided with individualized seating). Participants were observed for pressure care, posture, medical presentation, functional ability, and comfort. After 12 wk, baseline assessments were repeated. The outcome measures included demographics, seating assessment, digital photographs, Braden Scale, pulse oximetry, and caregiver questionnaires.

Descriptive analysis was used to interrogate the qualitative data. Analysis of qualitative data responses (caregiver questionnaires) would give an insight into the complex issues associated with caring for adults with seating needs and whether the provision of individualized seating positively affected their workload.

RESULTS: The results indicate that specialized seating can contribute to a reduction in pressure ulcer incidence and postural correction as well as increased saturated oxygen levels, functional ability, and social interaction. Many of the caregivers reported that suitable seating made it easier to feed patients and noted an increase in social interaction when using the wheelchairs. Many of the caregivers reported that the experience of individualized seating was a positive one for both the patients and the caregivers.

CONCLUSION: The key findings indicate that an individually assessed seating system improves skin integrity, quality of life, and ease of completing activities of daily living. It is known that seating needs among this population group are great, and it is vital that occupational therapists complete individualized assessments and that suitable seating is identified and provided.