How to prevent pressure injuries at home
Pressure injuries, also called pressure ulcers, pressure sores or bedsores, are areas of localised damage to the skin and the tissue underneath caused by prolonged pressure. This causes a reduction in blood flow, depriving the tissues of oxygen and nutrients.
Pressure injuries are one of the most common, costly, and preventable health complications affecting people with reduced mobility. They may cause pain, limit participation in daily activities, increase dependency on others, reduce opportunities for social engagement, and lead to prolonged healthcare intervention. They may cause individuals to be unable to sit in their chair, participate in family life, or pursue the activities that are important to them.
Pressure injuries can have a significant impact upon comfort, independence, health, well-being and quality of life.
They can be painful and difficult to treat without the right guidance and equipment.
There are different grades of pressure injury ranging from discolouration of the skin to deep wounds affecting the muscles and bone. Pressure injuries can cause medical complications and in serious cases they could become fatal. .
What causes them
Pressure injuries are caused by sustained pressure, often combined with shear, friction, or moisture, leading to damage of the skin and underlying tissues. The sacrum, the shoulders, the hips, back of the head, and the heels are the most common areas where pressure injuries may occur because of:
- Pressure: Skin and tissue compressed between a bone and a solid surface, such as a chair or a mattress. Blood cannot reach the tissue properly while it is squashed, and if that goes on long enough the tissue begins to break down.
- Friction: Skin rubbing against a surface, such as heels moving against a bed or bedding.
- Shear: Skin and the tissue beneath it are pulled in opposite directions, which happens when someone slides down a bed or a chair, or when moving and handling is completed inappropriately.
Most situations involve more than one of these at once, which is why prevention is rarely a matter of changing a single thing or providing a piece of equipment.
Pressure injuries are also different to moisture lesions which can make the skin more susceptible to breaking down.
Who is most at risk
Anyone can develop a pressure injury, but some people are at greater risk than others. Common risk factors include:
- Reduced mobility: If a person cannot shift their own position, pressure stays in the same place for a long time for example in the chair or in the bed. . Poor positioning and inadequately fitting chairs or beds can increase this pressure due to shear, weight distribution and inadequate pressure relieving properties.
- Neurological conditions: such as stroke, multiple sclerosis, spinal cord injury to mention a few
- Reduced sensation: Discomfort is what normally prompts a person to move before damage is done. Where a medical condition or injury has affected sensation, they may not feel these warning signs.
- Poor nutritional intake or dehydration due to the need for the skin needing adequate nutrients to remain healthy and repair. When these are lacking skin becomes more vulnerable to sheer, pressure and friction.
- Older age and frailty as the skin becomes thinner and less able to tolerate pressure but can often be combined with other risk factors.
- Moisture: Bladder or bowel incontinence keeps the skin damp in exactly the areas already under pressure. Body fluids also contain substances that break skin down faster and raise the risk of infection where skin is already open. The same can be said for increased heat and sweating.
- Circulation problems: lead to reduced blood flow to the tissues and this limits the delivery of nutrients and oxygen and increases vulnerability to skin breakdown
How to reduce the risk
Pressure injuries can occur surprisingly quickly and to prevent and manage them requires a 24 hour approach rather than sitting in one piece of equipment. The right cushion or mattress matters, but it will not do the job on its own.
- Regular repositioning: It is important to encourage regular repositioning where possible. This may mean moving between the bed and chair or shifting weight or small movement in the chair. Pressure needs to come off the areas at risk at regular intervals so that blood can flow back and the tissue can recover. Someone who cannot change position on their own will need help to do it, regularly, throughout the day and night.
- Seating: A chair or bed should support the whole body and spread the load evenly, and it needs to suit the person rather than the room. This is what seating and postural care assessment is for.
- Moving and handling: How someone is moved or handled is important. Dragging a person up a bed or a chair creates exactly the shear that causes damage. Slide sheets and moving and handling equipment can reduce the risks of moving and handling and should be considered in combination with the pressure management needs.
- Pressure relieving equipment: Mattresses, cushions, lying support systems. bed cradles and joint protectors all have a part to play. This is a clinical decision and should be assessed by a professional.
- Checking the skin: Looking at the areas at risk, regularly and in good light, is the cheapest thing on this list and the one most often skipped. It is how a problem gets caught while it is still easy to deal with.
- Good nutrition and hydration
- Managing continence and moisture
- Monitor any changes in weight, health condition and function.
When to get help
Individuals at risk of pressure injury should seek advice from a healthcare professional if they notice any changes to skin integrity, including persistent redness or discolouration, broken skin, pain, swelling, or signs of infection. Advice should also be sought following any significant change in mobility, health status, nutrition, hydration, or equipment needs, as these factors may increase the risk of pressure damage and require a review of pressure-relieving strategies.
Getting an assessment
An Occupational Therapy assessment may be beneficial if you, or someone you support, are experiencing difficulties that affect everyday activities, comfort, safety, or independence. Consider seeking an assessment if:
- You are finding it difficult to move, change position, or remain comfortable when sitting or lying.
- Your current chair, wheelchair, bed, mattress, or cushion no longer feels comfortable or supportive.
- You have experienced a recent change in your health, mobility, strength, weight, or functional abilities.
- You are concerned about falls, pressure damage, or maintaining your independence at home.
- You require advice on equipment, seating, positioning, or pressure-relieving strategies.
- Family members, carers, or healthcare professionals have concerns about your comfort, safety, or risk of skin breakdown.
An occupational therapist can assess your individual needs, identify factors contributing to pressure risk, and provide personalised recommendations to promote comfort, skin integrity, safety, and independence.
Get in touch and tell us a little about the situation, and we will explain what an assessment would involve and what it costs.
For further information on pressure injuries