Pressure sores (bedsores): signs, prevention and care at home

Pressure sores can affect people who spend long periods in a bed or chair, and they can often be prevented. This article explains what they are, who is at risk and how to lower the risk, using information from the NHS and MedlinePlus.

1. Introduction

The NHS describes pressure ulcers, also called pressure sores or bedsores, as areas of damage to the skin and the tissue underneath. Anyone can get one, but people who have difficulty moving are at higher risk ^[1]. MedlinePlus explains that they are caused by staying in one position too long and often form where bones sit close to the skin ^[2]. The World Health Organization lists pressure ulcers among the common health problems of older age, known as geriatric syndromes ^[4].

2. Causes and risk factors

The cause is sustained pressure on, or rubbing of, the skin. The pressure reduces blood flow, which can damage and eventually kill skin tissue ^[3]. The NHS says risk is higher if a person ^[1]:

• Has mobility problems.
• Has had a pressure ulcer before.
• Has been seriously ill in intensive care or has recently had surgery.
• Is underweight.
• Has swollen, sweaty or broken skin.
• Has poor circulation or fragile skin.
• Has reduced sensation or reduced sense of pain.

MedlinePlus adds older age, conditions such as diabetes or vascular disease, cognitive conditions such as Alzheimer's disease, bladder or bowel incontinence (loss of control) and poor nutrition ^[3]. MedlinePlus notes that pressure sores can be a problem in nursing homes ^[2].

3. Signs and symptoms

Pressure sores usually form over bony areas such as the heels, elbows, hips and tailbone ^[1]. MedlinePlus adds the ankles, shoulders, back and the back of the head ^[3].

The NHS lists early signs ^[1]:

• Skin that is discoloured and stays discoloured when pressed. It looks red on white skin and purple or blue on black or brown skin.
• Skin that feels warm, spongy or hard.
• Pain or itching in the area.

An ulcer can become a blister or an open wound and, if untreated, can reach deeper layers of skin, muscle and bone. Sores usually develop gradually but can appear within a few hours ^[1].

MedlinePlus describes four stages. Stage 1 is reddened, painful skin that does not turn white when pressed. Stage 2 is blistering or an open sore. Stage 3 is a deeper crater with damaged tissue beneath the skin. Stage 4 is damage reaching muscle, bone, tendons or joints. Some sores are covered by dead tissue, and deep tissue injuries can look dark purple or maroon and worsen quickly ^[3].

4. Prevention and daily care

The NHS and MedlinePlus describe these steps for people cared for at home ^{[1, 2, 3]}:

• Change position regularly. MedlinePlus suggests about every 2 hours in bed and about every 15 minutes in a wheelchair ^[3].
• Use specially designed mattresses and cushions, or pillows and foam, to relieve pressure. Ask a health professional which type suits the person. MedlinePlus advises against donut-shaped or ring-shaped cushions because they can reduce blood flow ^[3].
• Check the skin every day, with help from a caregiver for areas that are hard to see ^{[1, 3]}.
• Keep skin clean and dry, and avoid sliding across surfaces when moving, which causes rubbing ^{[2, 3]}.
• Eat a balanced diet, stay active where possible and do not smoke ^{[1, 3]}.

Someone at risk can ask a doctor for a risk assessment, so the care team can make a prevention plan ^[1].

Family caregivers can help in practical ways. Look at the skin at every change of clothes or position, especially over the heels, hips and tailbone. Support the person to eat a healthy, balanced diet, because poor nutrition raises the risk ^[3]. Tell the doctor or nurse about any new area of redness that does not fade, and ask them to show you the safest way to move and turn the person so that skin is not dragged across the bed or chair ^{[2, 3]}.

5. Treatment

Treatment depends on how severe the sore is, and the doctor or nurse decides the plan. The NHS says the right treatment depends on how severe the ulcer is. Options include regular repositioning, specialist mattresses and cushions, protective dressings, creams and ointments, antibiotics for infection and wound cleaning. Surgery may be needed if a sore is severe or other treatments have not worked ^[1]. MedlinePlus explains that early sores can be gently washed and covered with a protective dressing, but later stages are usually managed by a health professional, and you should not massage the skin on or near a sore ^[3]. MedlinePlus also notes that advanced sores heal slowly, so early treatment is best ^[2].

6. When to see a doctor

See a doctor or nurse if you think you or someone you care for has a pressure sore ^[1]. Seek urgent advice if there is hot, swollen or red skin, pus, a foul smell, spreading redness, a high temperature or severe or worsening pain ^{[1, 3]}. The NHS describes severe pain as constant pain that is hard to think or talk through, that prevents sleep and that makes moving or self-care very difficult ^[1]. Report any change in an existing sore, or the appearance of a new one, even if it seems small ^[3]. Pressure sores can lead to serious infections, some of which can be life-threatening ^[2].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

7. Conclusion

Pressure sores develop when pressure or rubbing continues on one area of skin, and people who cannot move easily are most at risk. Regular repositioning, pressure-relieving equipment, daily skin checks and good nutrition are the main ways to prevent them. Early medical advice limits harm, and the care team decides the right treatment.