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
- Heels and ankles.
- Sacrum, an area at the base of the spine just
above the cleft of the buttocks.
- Shoulder blades and shoulders.
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
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.
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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