Bed sores (pressure sores)

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Because their skin is subjected to constant pressure and friction, people who are confined to a bed or wheelchair are susceptible to bed sores (also known as pressure sores or decubitus ulcers).

Nails hair and skin

Bed sores develop on parts of the body that are in constant contact with the mattress or chair on which the patient spends most of their time, so commonly affected sites include the bony parts of the body, such as the coccyx (tailbone), heels, elbows, and the back of the head.

Bed sores are graded according to their severity and the likelihood that a skin ulcer will develop. In summary:

Grade 1: The skin has started to discolour, and may appear red in those with white skin, or blue-purple in people with darker skin tones. There is no damage to the surface of the skin, but the area may feel warm or spongy.
Grade 2: The top layers of the skin display damage, and an open sore is visible. The area may appear blistered or grazed, with red or purple discolouration of the adjacent skin.
Grade 3: The deeper layers of the skin are dead (necrotic), and the sore may have a crater-like appearance.
Grade 4: The damage or necrosis penetrates beyond the skin layers into the underlying tissues such as muscle and bone.

Bed sores and their complications can be extremely serious. Every care should be taken to prevent them occurring, and any sign of discoloured tissue in a susceptible person should be discussed with your doctor and monitored very closely.

Bed sores are caused by the loss of blood supply to the skin due to continuous pressure on the affected parts. Over time, the skin and underlying tissues can die from the lack of blood flow.

Those who are most prone to bed sores include people who are bedridden (even for a short time), and those who use a wheelchair.

Older people are more vulnerable to bed sores than young people, as the skin becomes more delicate as we get older and the efficiency of wound healing declines. Additionally, older people are more likely to be underweight, reducing the amount of padding over their bones.

Other risk factors include:

Needing a high level of care
Being immobile, or being able to sit or lie in only limited positions
Being unable to perceive pain
Being in poor physical or mental health
The skin being either too dry or too moist
Being incontinent (because of the presence of moisture on the skin)

Having a poor diet is associated with more frequent bed sores, and increases both the likelihood they’ll become infected and the amount of time it takes them to heal. People with inadequate levels of protein, vitamin C or zinc are considered particularly vulnerable.

The skin should be checked for redness or other changes at least once a day. Consult your healthcare professional if any changes are detected, and follow their advice for cleaning and treating the wound.
Work with your healthcare team to develop a prevention plan against bed sores. The plan will likely include regular position changes, the use of supportive devices, a healthy diet, and a regular skin care regime.
It is recommended that patients who are restricted to bed are moved every two hours throughout the day and night. For those in a wheelchair, movement should occur every 15 minutes.
Avoid lying on your hip bones.
Lying on soft pillows may help to relieve areas of pressure.
Use moisturisers to keep skin supple.
Follow good hygiene practices.
Ensure that both the patient and their bedding are clean and dry, as damp skin is more vulnerable to damage. A light sprinkling of powder on the sheets may help to reduce friction.
Stop smoking. It increases your risk of developing pressure sores, increases their severity, and delays their healing.
Work with your healthcare team to ensure that any additional health problems that may affect your circulatory health are well managed (for example diabetes).
Include some protein in your diet every day, as protein malnutrition is associated with an increased risk of bed sores. Protein powders or liquids may be suitable for those with impaired digestion.
Vitamin C and zinc are also particularly important for the prevention of bed sores. Vitamin C is present in a wide range of fresh fruit and vegetables, while the best sources of zinc are animal foods such as meat, eggs and seafood.

Bed sores can be extremely serious. Check the skin for discolouration regularly, and discuss any concerns with your doctor or healthcare team as quickly as possible
Don’t massage the bony parts of the body, as the skin in these regions is extremely delicate and prone to damage.