Pressure sores can develop in anyone with reduced mobility, such as being confined to a bed or chair. This type of skin damage is difficult to treat and can lead to serious complications. Other names for this type of damage include bed sores, pressure ulcers and decubitus ('lying down') ulcers. Prevention tips include regular changes of position, good hygiene and skin care, and a healthy diet.
Pressure sores are areas of damage to the skin and underlying tissue caused by constant pressure or friction. This type of skin damage can develop quickly in anyone with reduced mobility, such as older people or those confined to a bed or chair.
Pressure sores can be difficult to treat and can lead to serious complications. Prevention includes regular position changes, good hygiene and skin care, and a healthy diet.
Other names for this type of damage include bed sores, pressure ulcers and decubiti (‘lying down’) ulcers.
The skin over bony areas such as the heels, elbows, the back of the head and the tailbone (coccyx) is particularly at risk. Lack of adequate blood flow can cause the affected tissue to die if left untreated.
Grades of pressure sores
If a person is bedridden for long enough, the areas of skin constantly in contact with the mattress or chair will start to discolour. This shows that the skin is in danger of ulcerating.
Pressure sores are graded to four levels, including:
- Grade I – skin discolouration, usually red, blue, purple or black
- Grade II – some skin loss or damage involving the top-most skin layers
- Grade III – necrosis (death) or damage to the skin patch, limited to the skin layers
- Grade IV – necrosis (death) or damage to the skin patch and underlying structures, such as tendon, joint or bone.
Complications of pressure sores
Untreated pressure sores can lead to a wide variety of secondary conditions, including:
- Sepsis (bacteria entering the bloodstream)
- Cellulitis (inflammation of body tissue, causing swelling and redness)
- Bone and joint infections
- Abscess (a collection of pus)
- Cancer (squamous cell carcinoma).
Risk factors for pressure sores
A pressure sore is caused by constant pressure applied to the skin over a period of time. The skin of older people tends to be thinner and more delicate, which means an older person has an increased risk of developing a pressure sore during a prolonged stay in bed.
Other risk factors for a pressure sore include:
- Poor physical condition
- Poor mental condition
- Immobility and paralysis
- Being restricted to either sitting or lying down
- Urinary and faecal incontinence
- Malnutrition and obesity
- Advanced age
When a person is bedridden, pressure sores can occur in a number of areas, including:
- Back or sides of the head
- Rims of the ears
- Shoulders or shoulder blades
- Lower back or tailbone
- Backs or sides of the knees
- Heels, ankles and toes.
Prevention of pressure sores
If you are caring for someone confined to a bed or chair for any period of time, it’s important to be mindful of the risk of pressure sores. To prevent skin damage, you need to relieve the pressure, reduce the time that pressure is applied and improve skin quality.
Develop a plan that the person under your care, and any other caregivers, can follow. This plan will include position changes, supportive devices, daily skin care, a nutritious diet and supportive lifestyle changes.
A routine nursing assessment is required for people at high risk of pressure sores.
Position changes and supportive devices for preventing pressure sores
People who use a wheelchair are advised to shift position within their chair about every 15 minutes.
People who spend most of their time in bed are advised to change position at least once every two hours, even during the night, and to avoid lying directly on their hipbones.
Pillows may be used as soft buffers between the skin and the bed or chair.
Daily skin care for preventing pressure sores
- Check the skin at least daily for redness or signs of discolouration.
- Keep the skin at the right moisture level, as damage is more likely to occur if skin is either too dry or too moist.
- Use moisturising products to keep skin supple and prevent dryness.
- Never massage bony areas because the skin is too delicate.
Diet and lifestyle for avoiding pressure sores
- Make sure the person eats a healthy and nutritious diet.
- Be aware of using good hygiene practices.
- Maintain activity levels, where appropriate.
- Make sure the person quits smoking.
Warning signs of pressure sores
Daily checks are needed to look for the following early warning signs:
- Red/purple/blue, torn or swollen skin, especially over bony areas
- Signs of infection, such as skin warmth, swelling, cracks, calluses, and wrinkles.
Treating pressure sores
There is a variety of treatments available to manage pressure sores and promote healing, depending on the severity of the pressure sore. These include:
- Regular position changes
- Special mattresses and beds that reduce pressure
- Dressings to keep the sore moist and the surrounding skin dry
- Light packing of any empty skin spaces with dressings to help prevent infection
- Regular cleaning with appropriate solutions, depending on what stage the sore is at
- Specific drugs and chemicals applied to the area, if an infection persists
- Surgery to remove the damaged tissue
- Operations to close the wound, using skin grafts if necessary
- Continuing supportive lifestyle habits such as eating a healthy and nutritious diet.
Where to get help
- Your doctor
- Hospital staff
- Domiciliary care staff
- NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
Things to remember
- Anyone confined to a bed or chair for a long time is at risk of developing a pressure sore.
- Pressure sores can be difficult to treat.
- Prevention includes regular changes of position, good hygiene and skin care, and a healthy diet.
You might also be interested in:
- Leg ulcers.
- Paraplegia (spinal cord injury).
- Spina bifida.
- Wounds - how to care for them.
- Wounds - lower leg ulcers.
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Joanna Briggs Institute
Last reviewed: February 2013
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