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Pressure Sores

• Pressure ulcers or bed sores most often occur over bony areas such as the tailbone (the #1 location), hip, ankle, or elbow.
• More than 25% of older people in healthcare institutions and 15% of those living in the community develop pressure ulcers.
• 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 pressure.
• 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 startling.
• 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.

• A 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 ulcers.

• 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 experiencing pain.

• 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 pressure ulcers.
• 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).

• Specialized beds and mattresses are available to help reduce pressure ulcers and increase comfort.
• 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 improve nutrition.

If help is required, you should seek advice from a Dietitian.
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 soap, and
• dry the area well.

Control pads and barrier creams can help keep the moisture away from the skin.

• 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 helpful.

Friction 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 skin.
• 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.

Do not 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 early.
• 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.

Canadian 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.

Spinal Cord Injury

• 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.

National Pressure Ulcer Advisory Panel

• 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 research."

Mayo Clinic – Bedsores (pressure sores)

• Mayo Clinic website includes a wealth of information about bedsores and recounts the story of Christopher Reeve, who died of complications of a bedsore.

American Academy of Family Physicians

• American Academy of Family Physicians website offers comprehensive information about pressure sores.