TORONTO — Pressure ulcers, or bedsores, are a "big problem" but not much effort has been made to scientifically assess methods of prevention, says the lead author of a new study.

"It's much cheaper to prevent a pressure ulcer than to treat one," said Dr. Madhuri Reddy, a geriatrician and chronic wound specialist who conducted the study at Women's College Hospital in Toronto in collaboration with Baycrest Geriatric Health Care System.

"And there seems to be a huge mismatch between the large amount of money we're spending on treating this condition, including an enormous amount of nursing time and efforts, and a relatively little effort in determining the best practices for prevention."

Reddy, who spoke from Boston where she's taken a new job at Hebrew Rehabilitation Centre, explained that pressure ulcers are damage done to the skin, often due to friction or long periods without movement on a bed or in a wheelchair.

The late actor Christopher Reeve, who was paralyzed after a horseback riding accident, died in 2004 of complications from an infection caused by a bedsore.

"(Pressure ulcers) occur most commonly in people that are immobile such a spinal cord injury, people with severe multiple sclerosis, and of course older adults who also may be immobile," Reddy said.

"They can occur quite quickly over a few short hours on a hospital room stretcher. They occur commonly in people at risk in acute-care hospitals and also in long-term care."

They begin as redness that doesn't go away. After a break in the skin the sores can erode and go very deep - sometimes leading to bone infections, she said.

Reddy and her colleagues found 59 studies over the last 30 years that were randomized control trials of bedsore prevention. The majority of the studies were "inadequate in their design" and haven't yielded "robust scientific evidence" from which to develop comprehensive best practice guidelines.

The findings are published in the current issue of the Journal of the American Medical Association.

"Very few studies had any information really about simple things like 'how often should you be turning patients who can't move themselves and who are at risk for developing pressure ulcers,' " said Dr. Paula Rochon, a geriatrician at Baycrest and a senior author on the study.

A multi-disciplinary approach is needed that involves nurses, occupational therapists and dietitians, Rochon said.

Reddy said promising interventions include the use of appropriate support surfaces such as mattresses on operating tables, and specialized foam or sheepskin on beds and wheelchairs. She also cited proper nutrition and moisturizing the skin on the tailbone.

Dr. Howard Bergman, who was not connected with the study, said the findings show there are not a lot of data and "we need to do more research on this."

Bergman, head of geriatric medicine at McGill University and Jewish General Hospital in Montreal, said there is more awareness in recent years, and staff in hospitals and long-term care facilities know what to do to prevent bedsores.

There are fewer "horror stories" than in the past, he said.

"We're all working at the limit in terms of manpower, people power in hospitals and nursing homes, and this is labour intensive," he said.

"It takes time to turn somebody. It takes time to make sure somebody's toilet is not simply peeing into the bed or into diaper."

"And I suppose that's when things slip between the cracks."

A 2004 study found that an average of one in four patients in Canadian health-care settings suffers from a bedsore. In the U.S., the cost of treating one pressure ulcer has been found to range from $500 to $40,000, depending on the severity of the wound.

Dr. Irene Turpie, a geriatrician and professor emeritus at McMaster University in Hamilton, Ont., noted that elderly people are at risk of getting inadequate nutrition in hospital.

They're often given food they're not accustomed to, and it's in containers that are difficult to open, she said. They may miss meals because of surgeries and other appointments and sometimes arrive in hospital malnourished.

"If you don't have enough protein in your system, you're not going to be able to heal up ulcers in your back," she said.

Registered nurse Susan Selinger, a skin wound clinician at Hamilton Health Sciences Centre, said the Registered Nurses' Association of Ontario has established good nursing practice guidelines for risk assessment and prevention of pressure ulcers.

The guidelines are currently being implemented and will be evaluated at her hospital, Selinger said.