What is a pressure sore?

Pressure sore damage to the skin and underlying tissue can be caused by pressure, shear or friction. Too much pressure put on an area of skin will cause it to crack and break.The risk of pressure sores can be caused by any of the following:

Having to stay in bed for long periods of time
Being seated in a wheelchair for long periods of time
Long periods of time sitting in the same arm chair
Difficult in being able to move about generally
Being elderly or infirm
Having a chronic illness that affects mobility
Being incontinent
Suffering from diabetes
Suffering a stroke
Having poor circulation
Poor nutrition and hydration
Being less mentally aware, either due to sedation or mental disability

How do pressure sores occur?

Pressure on an area of skin will restrict blood flow to that particular area of skin. Overtime, if there is no movement, a pressure sore will start form. To begin with, it will be a small red patch that will not go away. This is often the first sign to look out for.

Pressure damage

The weigh to an elderly person who is lying on a mattress or sitting in a chair for long periods of time causes the blood vessels to close. If the blood supply is not restored, tissue can die within an hour. Tissue covering bone that is close to the surface is at greater risk due to compression against the hard surface of the bone. Sitting for long periods of time creates a high risk of sores on the buttocks as all the weigh of the body is concentrated on this area.

Shear damage to the skin and tissue

Shear damage occurs when attempts are made to slide a body along a surface. Often the body does not move, but due to friction, the tissue between the skin and bones rubs together and gets distorted and mangles which can result in sores.

Friction damage to the skin and tissues

Friction damage can occur when an elderly person is being moved on a surface (moved up a bed for example). The skin and tissue rubs against the hard surface and can cause sores due to the underlying vascular damage cause by the pressure and rubbing.

Sweat and Urine

The presence of excessive perspiration or urine can result increate the chances of pressure sores dramatically.

Skin breakdown

The skin of elderly people can become very fragile. When the skin begins to break down, bacteria and infection can enter the body causing painful infected sores. Areas of the body which take pressure when an elderly person is seated or in bed are most at risk and include the lower sacrum, spine, the buttocks, hips, heels and ankles. In fact any area where the bone protrudes and rubs against the seat or mattress.

Prevention of pressure sores in the elderly

Keeping the skin dry and clean - moisture from sweating, and acid from urine and faeces can rapidly cause sores. When bathing, areas should be patted, no rubbed and barrier cream should be applied afterwards. It is best to avoid talc in the elderly. It is important to wash the elderly person as soon as possible after soiling has occurred. Cotton underwear is better than synthetic because it is cooler and more absorbent. Avoid using plastic mattress covers and synthetic sheets as they encourage sweating. See our article on washing an elderly person.

Changing position - people who are in bed, or in a chair for long periods of time should be moved every 2 hours.

Use pressure pads - use pillows or pressure pads should be used stop the knees and ankles rubbing against each other.

Be careful when moving people - avoid dragging an elderly person up the bed. Turing is good practice as it will allow the blood to flow again under the sore area and encourage healing - but you need to be careful you do not cause more damage in the process. Whilst it may seem harsh to move an elderly person when he or she is comfortable, this is better than leaving the person so that a sore develops.

Bedding and seating - avoid creases in sheets or biscuit crumbs in the bed these can imprint on the skin and cause sores. Avoid using plastic mattress covers and synthetic sheets if possible as they encourage sweating. Do not tuck sheets in tightly. If the person is sitting in a wheelchair or armchair for long periods of time, use special load-spreading gel cushions or air filled cushions that deflate and inflate regularly.

Check for sores regularly - Every morning and evening check for areas red skin. If you identify an area of red skin that could be a sore, do not lie the person on that area and seek medical advice as soon as possible.

Whilst it is slightly cruel to move an elderly person when he or she is comfortable, it is actually worse and a lot more cruel to leave the sore to develop.

Treating pressure sores

If the elderly person in your care develops a pressure sore, you should seek advice professional advice immediately. If left, the sore will eat away at the flesh, eventually forming a hole. The sore will smell like rotting flesh, will ooze green and yellow pus.

- Sores can be bathed in salt water and dressings changed at least twice a day
- Dead tissue delay healing and lead to infection and should be removed