Older people in hospital - Skin care and preventing pressure sores

Skin thins with age and can become very weak. Older skin may injure easily and take longer to heal. Not eating and drinking enough, not being active, memory and thinking problems, pain and incontinence can lead to skin damage or sores.

Pressure sores (sometimes called bed sores or pressure ulcers) can be caused by lying or sitting in one position for too long and are most likely to occur on the bony parts of the body, such as elbows, hips, ankles and the tailbone (sacrum, at the base of the spine).

Pressure sores and skin tears are very painful and can take a long time to heal. They can cause other, sometimes severe, problems such as infections or permanent muscle or bone loss. Having a wound can mean your stay in hospital is longer. It can also reduce your independence and your ability to look after yourself once you leave hospital.

Skin care in hospital

During a stay in hospital, your skin may be affected by the hospital environment, staying in bed or sitting in one position for too long, whether you are eating and drinking enough and your physical condition. Ask hospital staff to regularly check your skin, particularly if you feel any pain.

There are some things that you can do to look after your skin, including:

• Keep your skin clean and dry.
• Avoid any products that dry out your skin. This includes many soaps, body washes and talcum powder. Ask for skin cleansers that are non-drying. Ask nursing staff or your pharmacist to give you options.
• Use a water-based moisturiser daily. Be careful of bony areas and don’t rub or massage them. Ask staff for help if you need it.
• Check your skin every day or ask for help if you are concerned. Let a doctor or nurse know if there are any changes in your skin, especially redness, swelling or soreness.
• If you are at risk of pressure sores, a nurse will change your position often, including during the night.
• Always use any devices given to you to protect your skin from tearing and pressure sores. These may include protective mattresses, seat cushions, heel wedges and limb protectors.
• Drink plenty of water (unless the doctor has told you not to).
• Eat regular main meals and snacks. Sit out of bed to eat if you can.
• Try to maintain your regular toilet routine.
• If you have a wound, a plan will be developed with you and your family or carers before you leave hospital. It will tell you how to dress and care for the wound.

Risks of pressure sores in hospital

A pressure sore (also called a ‘bed sore’ or ‘pressure ulcer’) is a painful wound that affects the skin and the flesh under it. If you sit in a chair or lie in a bed a lot, over time, the weight on the bony parts of your body stops blood from flowing.

Pressure sores can particularly occur over bony areas such as:

• hips
• knees
• tailbone (sacrum)
• heels.

Pressure sores can begin to form in as short a time as two hours and can be serious, potentially leading to infection that spreads to the bloodstream, if untreated.

Pressure sores are more likely to develop in people who are undernourished or who leak urine or faeces involuntarily (are incontinent). Being undernourished makes the skin thin, dry, rigid, and more likely to tear or break. Being incontinent exposes the skin to moisture from urine and faeces, which can lead to irritation and pressure sores.

Reducing your risk of pressure sores in hospital

Keeping mobile and moving is important for your skin. Movement increases blood supply to tissue and means you are not staying in bed in one position for too long. To avoid pressure sores, try to move regularly and check your skin.

Try to:

• Do what you can for yourself, as long as you can do it safely, such as showering, dressing and walking to the toilet.
• Walk around the ward every few hours if you can. If you have been advised not to walk by yourself, change your position every one to two hours, particularly moving your legs and ankles.
• Whenever possible, sit out of bed rather than sitting up in bed, as this puts pressure on your tailbone.
• Move as frequently as possible. Even small changes in how you sit or lie make a difference.
• Ask staff if you need an air mattress, cushions, pillows or booties to ease sore spots.
• Staff will help if you if can’t do these things yourself.

Check your skin regularly for signs such as:

• Is your skin red, blistered, or broken?
• Do you have any pain near a bony area?
• Are your bed or clothes damp?

Let staff know if you see any changes to your skin that could lead to pressure sores.

Eating healthy food and drinking enough water are also important in maintaining healthy skin and play a key role in wound healing. Make sure you eat regular main meals and snacks, and drink plenty of water (unless your doctor has told you not to).

Where to get help

• Your GP (doctor)
• Allied health staff
• Nursing staff
• Patient liaison officer