Anyone who cares for an older person needs to be aware that they are likely to be susceptible to pressure sores, particularly if they are immobile a lot of the time. Dan Parton reports.

In this article:

  1. What is a pressure sore?
  2. Who gets pressure sores?
  3. Why do sores develop?
  4. Prevention is better than cure

What is a pressure sore?

Pressure sores, often known as bedsores or pressure ulcers, are areas of damaged skin and tissue. They develop when pressure cuts off the blood supply, damaging the skin. Sores are usually caused when someone sits or lies in one position for too long.

A sore may initially appear as just a small area of red skin that doesn’t disappear after a few hours. The area may become painful and purple in colour and feel warmer than the surrounding skin. Continued pressure and poor circulation causes the skin and tissue to break down because it is starved of nutrients and oxygen. Eventually a wound opens that exposes underlying muscle or bone.

Who gets pressure sores?

Anyone can get a pressure sore, but those most at risk are:

  • Those who have trouble moving and cannot change position themselves
  • Those with type 2 diabetes or any other condition which affects the flow of blood through the body
  • Those who cannot feel pain over part or all of their body
  • Those who are incontinent
  • Those who are seriously ill or have had surgery
  • Those who have a poor diet and don’t drink enough water
  • The very young or those over 70
  • Those who are above or below average weight
  • Those who have damaged their spinal cord and can neither move nor feel their bottom and legs
  • Older people who are ill or have suffered an injury such as a broken hip

Pressure sores often develop in the hips, buttocks, back of the head, base of the spine, backs and sides of the knees, heels, ankles and shoulders, where bony prominences are not protected by much fat.

Why do sores develop?

A pressure sore can be caused through a variety of factors including unrelieved pressure, friction, shearing and maceration.

  • Unrelieved pressure – this occurs when a person has been lying or sitting in the same position for a long time; the area starts to hurt and then begins to feel numb. The weight of the body against a surface causes blood vessels to be squeezed together stopping the supply of oxygen and nutrients.
  • Friction – this occurs when a person is dragged instead of being lifted over a surface. This causes damage to the top layer of skin and feels as if the skin has been grazed or burnt.
  • Shearing – this occurs through sliding, for example, when a person slides down the bed. Blood vessels in the skin and muscle are torn and this feels as if the skin has been rubbed very hard and may burn.
  • Maceration – this is when the skin becomes puffy or waterlogged and softens. This can happen in some illnesses or when there is prolonged contact with urine, faeces or sweat.

For most people, pressure sores cause some pain or discomfort. But if a person is confused or their nerve endings have been damaged, they may not know when their body is being injured. So it is vital to be observant and spot any warning signs of skin damage.

Prevention is better than cure

Research shows that at least 98% of pressure sores are avoidable and so prevention is the best strategy.

In most cases, pressure sores can be prevented by meticulous attention and alertness to any changes to skin condition. Close daily inspection of a bedridden or chair-bound person’s skin can detect early redness or discoloration, which is a signal that the person needs to be repositioned and kept from lying or sitting on the discoloured area until it returns to normal.

People who cannot move themselves should be repositioned at least every two hours – more often if possible. The skin must be kept clean and dry, because moisture increases the risk of developing pressure sores. Dry skin is less likely to stick to fabrics and cause traction.

Special beds, mattresses and seat cushions can be used to reduce pressure in people who are wheelchair-bound or bedridden. These products can reduce pressure and offer extra relief. A doctor or nurse can recommend the most appropriate mattress surface or seat cushion, but none of these devices eliminate pressure completely or are a substitute for frequent repositioning.

You can find more advice and information on how to minimise the risk of someone developing a pressure sore at along with downloadable information leaflets.