How to prevent pressure ulcers (bedsores): a home care guide

A pressure ulcer (often called a bedsore) forms when skin and the tissue beneath it are under pressure at the same spot for a long time. The risk is high for people with limited movement, those confined to a bed or wheelchair, people who are poorly nourished and those with incontinence. The good news: most pressure ulcers can be prevented with simple, regular measures.

Highest-risk areas

• Tailbone and buttocks
• Heels and ankles
• Outer hips (when lying on the side)
• Shoulder blades and elbows
• Back of the head and ears

Check the skin every day

Check the at-risk areas at least once a day in good light. Early signs: redness that does not fade when pressed (on darker skin, a purple-blue discolouration), warmth, hardness, swelling or pain. Do not massage or rub the area; relieve the pressure at once and tell the GP or community nursing team. If you see a blister, open wound, discharge, a bad smell or fever, contact a health professional without delay.

Relieving pressure: repositioning

• Change position regularly; ask the care team how often and keep a chart.
• When lying on the side, support the back with a pillow at a slight tilt (about 30 degrees) rather than fully on the side.
• Float the heels just off the mattress with a pillow under the calves.
• Put a pillow between the knees and ankles so bone does not rest on bone.
• Do not raise the head of the bed more than necessary; it increases sliding and friction.
• Encourage someone who sits for long periods to shift their weight at short intervals.

Avoid friction when moving them

When moving someone up the bed, use a slide sheet or two people lifting rather than dragging on the bedsheet. Friction can damage skin before any mark is visible. Discuss an air or pressure-relieving mattress and cushion with the doctor or nurse; ring-shaped cushions are generally not recommended because they can concentrate pressure elsewhere.

Moisture and skin care

Urine and sweat soften the skin and make it vulnerable. Change wet pads and bed protectors promptly, clean the skin gently with a pH-balanced cleanser, pat dry without rubbing and use the recommended barrier cream. Wrinkled sheets, crumbs and seams also create pressure points.

Nutrition and fluids

Too little protein and fluid makes ulcers more likely and slows healing. If appetite is poor, plan small, frequent meals, protein-rich foods (eggs, yoghurt, pulses, meat, chicken, fish) and regular drinks; if there is weight loss, talk to the doctor or a dietitian.