- Pressure ulcers or bed sores most often occur
over bony areas such as the tailbone (the #1 location), hip, ankle,
- More than 25% of older people in healthcare
institutions and 15% of those living in the community develop
- Pressure ulcers are most likely to happen to
older people who are not mobile, who are severely ill, and/or who
have mental conditions.
- Prevention includes maintaining activity,
changing position, avoiding friction, and maintaining proper skin
moisture. Special devices and equipment are also available.
- Areas of skin redness and open sores should
be reported to a health care provider.
- A pressure ulcer (also known as a bed sore or
decubitus ulcer) is a change or break in the skin caused by constant
- It often occurs over a bony area such as the
ankle, tailbone, hip, or elbow.
- Pressure ulcers decrease quality of life,
may be painful, and require dressing changes.
- Pressure ulcers are most likely to happen to
older people, especially those who are not mobile, who are severely
ill, and/or who have mental conditions.
- The number of people with pressure ulcers is
- In the community, 15% of people will develop
a pressure ulcer.
- More than 25% of those in healthcare
institutions will do so.
- Clearly, pressure ulcers are a big concern in
healthcare, especially considering that 60% of all pressure
ulcers can be prevented.
pressure ulcer can appear as a red or discoloured area on the skin,
as a blister, or as an open sore. It can develop quickly, especially
over bony areas like the buttocks and heels.
- Pressure ulcers can develop in
often-overlooked areas, such as the back of the head, behind the
ears (where oxygen tubing rubs), or on the ears (from lying in bed).
People who can't move themselves or who
have decreased mobility are at high risk for developing pressure
- Staying in one spot for longer than two hours
without changing position causes reduced blood flow to that area and
the tissue becomes starved of nutrients, blood, and oxygen.
- A low level of pressure sustained over a long
period can be just as damaging to tissue as a high level of pressure
for a shorter period.
Watch for pressure ulcers if your family member is
- If the pain is not controlled, they may not
feel like moving around or changing position.
- If they have too much pain medication, they
may not have the capacity to move.
Your family member may not be able to feel or
sense the discomfort that happens when pressure ulcers begin.
- If they cannot respond to the touch of a hand
or to stronger stimuli, they are at much higher risk for developing
- If they are confused, they may not be aware
of discomfort from being in one position for prolonged periods.
Staying active is important. Go for walks
regularly, if possible, or change position frequently. If your family
member can only sit in a chair, remind them to make small shifts from
hour to hour.
A family member who is bedridden may be unable to
change position and take pressure off the bony areas. They need help
to move and redistribute the pressure.
- Place pillows behind their back when turning
from side to side.
- Pillows are also effective when placed under
the heels to reduce the pressure in those areas.
- Don't overlook the pressure that occurs
when the knees are close together. Place a folded blanket or sheet
to separate the knees.
Sitting upright in bed or in a chair puts extra
pressure on the tailbone – the #1 location where pressure
ulcers occur. Rule of thumb: Never raise the head of the bed past 30
degrees (unless there are swallowing problems).
beds and mattresses are available to help reduce pressure ulcers and
- Special cushions are available that you can
put on a chair to redistribute the pressure on the backside. An
Occupational Therapist can help you obtain these devices.
- Do NOT use doughnut devices as these localize
pressure to other areas.
Nutrition plays an important part in
preventing pressure ulcers.
- It is important that your family member eat
enough protein, vitamins, and minerals and drink enough water.
- Eating well is important to rebuild cells
when they break down.
- Protein supplements are a great way to
If help is required, you should seek advice from a
If your family member is incontinent, the
moisture from urine and waste products can cause the surface of the
skin to become red or irritated. It is very important to:
- remove the waste as soon as possible
- clean the skin gently with water and mild
- dry the area well.
pads and barrier creams can help keep the moisture away from the
- Moisture on the skin encourages pressure
ulcers to develop. This is also true if the skin is too dry, as it
causes skin to break down.
- Skin moisturizers and barrier creams can be
and shear from movement can contribute to pressure ulcers.
- Dragging the heels on the bed or sliding the
buttocks against the bed or chair can remove the first layer of
- Shear happens when the deeper tissues are
pulled and torn from these shifts as well.
When sliding up in bed, the feet should be placed
flat and used to help push.
When sitting upright in bed, all of the pressure
is on the buttocks. Sliding down can result in friction and shear
that harms the skin.
rub red areas on the skin, as this
causes shearing of the tissues below the skin surface.
- Check skin daily. Watch for skin changes such
as redness that will not go away, as this may be a pressure ulcer.
- Home visits from a health care professional
should include a head-to-toe skin assessment to identify problems
- Stay active. Activity stimulates the blood
flow and reduces the risk of pressure sores.
- Keep skin moisture in balance. Not too wet,
not too dry. Use barrier creams and moisturizers as necessary.
- Change position at least every two hours. Use
a clock as a reminder, or change positions on even or odd hours.
- Eat well and drink plenty of fluids unless
otherwise told. If necessary, talk to a Dietitian.
- If there is an area of skin redness or an
open area, seek help from a health care professional.
Association of Wound Care
- The Canadian Association of Wound Care has
designed a pressure ulcer awareness and prevention program that
includes the tools necessary to reduce the number of pressure ulcers
in all types of settings across Canada.
Pressure Ulcer Advisory Panel
- Spinal Cord Injury is another Caregiver
College project. Use the menu to go to the section on pressure
sores. This section includes photographs and detailed descriptions
of the various signs and stages of pressure sores as well as
prevention tips, although from a spinal cord injury perspective.
Clinic – Bedsores (pressure sores)
- According to the website, it "serves as
the authoritative voice for improved patient outcomes in pressure
ulcer prevention and treatment through public policy, education and
Academy of Family Physicians
- Mayo Clinic website includes a wealth of
information about bedsores and recounts the story of Christopher
Reeve, who died of complications of a bedsore.
Academy of Family Physicians website offers comprehensive
information about pressure sores.