What is a pressure sore?
A pressure sore is a broken area on the skin caused by a loss of blood supply that occurs as a result of sustained pressure. It can rapidly become an ulcer which can be difficult and slow to heal. Pressure sores occur most frequently at pressure points where skin covers bone, for example on the:
- Heels and ankles.
- Sacrum, an area at the base of the spine just above the cleft of the buttocks.
- Shoulder blades and shoulders.
What causes pressure sores?
Prolonged pressure such as sitting or lying in the same position for extended periods without moving can obstruct the blood supply to that part of the skin. This reduces the supply of nutrients and oxygen to the skin, causing it to break down and a sore to develop.
Because they tend to be less mobile, older people are at increased risk of developing pressure sores. Those most at risk are the immobile, the unconscious and the paralysed, who cannot move themselves to relieve the pressure.
Moisture on the skin, due to incontinence or perspiration, also contributes to the development of pressure sores because the skin is more likely to break down.
Friction or dragging on the skin can also cause it to break down. This may happen when the older person is being helped to sit up in bed, for example. Crumpled sheets underneath the skin are also a source of increased pressure.
Older people who are either underweight or overweight are also at risk of developing pressure sores, due to increased pressure over the bony parts of their body.
How can pressure sores be prevented?
Carers are likely to have a major role in prevention of pressure sores in older people who are confined to bed for long periods of time. Some key points to remember are:
An older person should remain active and mobile if pressure sores are to be avoided. Remind them to turn regularly when they are in bed and to stand up if they have been sitting for a long time.
Relieve pressure every two hours
Those who are unable to move themselves need to have their pressure areas relieved at least every two hours. This may prove difficult if there is only one carer. It may help to carefully roll the older person from side to side. Avoid dragging the person along the bed.
Deep breathing and passive exercises such as guiding the person's arms and legs through their full range of movements can also help to promote the circulation of blood around the body and to the skin.
If the older person is incontinent, it is important that they are kept as dry and clean as possible. Episodes of incontinence should be attended to as soon as possible. Avoid rubbing the skin too hard when drying it as this may cause friction.
It may help to apply a waterproof cream to the buttocks to keep urine and faeces away from the skin. If urinary incontinence is uncontrollable, it may be necessary for the elderly person to have a catheter or drainage tube inserted into the bladder to drain the urine away.
People who perspire excessively should be helped to wash regularly and body talc can be applied to the intact skin if tolerated.
Cushion high risk areas such as the ankles and the sacrum with soft pillows or sheepskin bootees and pads. Soft mattresses filled with air, water or foam can also be used.
A healthy, well-balanced, high protein diet is also important if the older person is to avoid a pressure sore. It is a good idea to talk to your doctor or public health nurse about this, as the person might have other medical conditions that restrict what they are allowed to eat. In this case they may refer you to a dietitian for advice.
Avoid scratches and cuts
It is important to keep your fingernails trimmed and remove rings and watches when turning or assisting the older person so as to avoid scratching their skin, as this can lead to a pressure sore. Equally important is the need to keep the older person's fingernails short, especially if they are inclined to scratch themselves a lot. It may help to place cloth mittens on their hands if they are confused and unable to stop themselves scratching.
Check skin regularly
Skin should be checked regularly, keeping an eye out for redness over bony pressure areas, which is the first sign that a pressure sore could develop.
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