Nursing Challenges in Pressure Injury Prevention and Management: A Meta Analysis of Global Prevalence Trends and Future Care Demands in Geriatric Populations

Abstract

Pressure injuries (PIs), also known as pressure ulcers or bedsores, represent a major challenge in geriatric care worldwide and are widely considered indicators of healthcare quality and patient safety. Older adults are particularly vulnerable due to multimorbidity, frailty, immobility, malnutrition, incontinence, and cognitive decline, which increase the risk of skin breakdown and delayed healing. Despite international guidelines, standardized risk assessment tools, and prevention bundles, global prevalence rates remain highly variable, reflecting differences in care settings, documentation, nurse staffing, and implementation fidelity. This meta-analysis systematically reviews and synthesizes evidence on the global prevalence of pressure injuries among adults aged 60 years and above, explores temporal and regional trends, and highlights the nursing challenges associated with prevention and management. Following PRISMA 2020 guidelines, studies reporting prevalence or incidence of PIs in geriatric populations across acute hospitals, long-term care facilities, community, and palliative settings were retrieved from MEDLINE, Embase, CINAHL, Scopus, and Cochrane Library. Pooled prevalence estimates were calculated using random-effects models, with subgroup analyses by region, care setting, and stage of injury. Results demonstrate that while overall prevalence has modestly declined in high-income regions with structured prevention programs, it remains high in resource-limited settings, especially in long-term care, where staffing shortages, limited wound care training, and poor adherence to repositioning and skin care protocols persist. Device-related pressure injuries, moisture-associated skin damage, and inadequate nutritional support are emerging challenges. With global population aging, the demand for complex wound prevention and management will grow substantially, creating additional pressures on healthcare systems. Addressing these challenges requires workforce strengthening, nurse education, digital surveillance, multidisciplinary collaboration, and policy support to ensure equitable, evidence-based pressure injury care for older adults worldwide.