Preventing pressure ulcers

Photo of a young woman in a wheelchair talking to a friend (franz pfluegl / iStock / Thinkstock)

Regularly changing a person’s lying or sitting position is the best way to prevent pressure ulcers. Special mattresses and other aids can help to relieve pressure on at-risk areas of skin.

Most pressure ulcers (bedsores) arise from sitting or lying in the same position for a long time without moving. Most people keep changing their position when they sit for a long time or are asleep, consciously or subconsciously. But people who are very weak, ill, paralyzed or unconscious move much less or not at all. This means that the parts of their body that they are sitting or lying on are constantly under more pressure. How long it takes for pressure ulcers to develop can vary greatly from person to person.

Which interventions are the most important?

Pressure ulcers usually heal very slowly, and may come back. That's why it's so important to make sure they don't develop in the first place. People who are confined to a wheelchair or have to stay in bed for a long time often say that they can feel parts of their body becoming sore. It's important to pay attention to what they say, to quickly reduce pressure on their skin, and regularly change the position they sit or lie in.

Observing which parts of the body are most susceptible to pressure, as well as the positions that put the most pressure on them, can help you get an idea of what sort of relief might be helpful. For example, lying down puts much less pressure on your backside than sitting in a chair. If you use a wheelchair, you can find out what helps to reduce the pressure and then make that your routine.

It's also important to try to move if possible – even if you have to lie in bed or sit in a wheelchair. If you are able to sit up, leave the bed, or even walk a few steps with a bit of help, it’s a good idea to do that as often as possible.

How often is repositioning necessary?

Even though it's often recommended that people be repositioned every two hours, there's no single recommendation that works for everyone. Some people can lie in the same position for quite a long time without getting ulcers, while others need to switch much more often. Research has not yet found out how often someone should change position to get the best preventive effect.

Unnecessarily moving someone too much for no good reason can also have disadvantages. For instance, repositioning every two hours at night may wake the person each time and keep them from getting a good night’s sleep. Changing position can also be very painful for people who have wounds or joint conditions. Frequent repositioning is physically demanding for caregivers or family members too. It's therefore important to observe how often someone’s position really needs to be shifted. It can then help to make a note every time they are repositioned.

What role do diet and skin care play?

Some people who are hardly able to move don't get very hungry or thirsty. In order for them to stay in good physical condition, though, it's important to make sure they get enough to eat and drink. Eating too little or a very unbalanced diet and hardly having anything to drink may weaken their skin even more. Some people take dietary supplements, but there's hardly any research on whether these products can help prevent pressure ulcers.

It's important to keep the skin from getting too dry, but also to prevent it from being exposed to constant moisture – either one increases the likelihood of damage to the skin. There's not yet enough good research to be able to say whether regular use of creams or lotions can prevent pressure ulcers.

Can pressure-relieving mattresses prevent pressure ulcers?

Pressure-relieving mattresses and support surfaces can lower the risk of pressure ulcers. There are now many different products that can be used in hospitals, nursing homes or at home. Most of them offer especially soft surfaces or alternating pressure.

Special foam mattresses can be used to provide a soft surface, for example. These distribute the pressure over a larger surface area, reducing the pressure on especially vulnerable parts of the body. One drawback of very soft mattresses is that they can make it more difficult for people to move themselves. If they sink into the mattress, it can be harder for them to prop themselves up and change positions. This is a problem especially for weaker people who would actually still be able to change their position on their own. So it makes sense to check what kind of mattress is most suitable.

Special mattresses known as alternating pressure mattresses are also commonly used and can help to prevent pressure ulcers. These mattresses have several chambers that are automatically filled with different amounts of air. The air pressure usually changes several times an hour to relieve pressure on different parts of the body. Alternating pressure mattresses are most often used for patients who have an especially high risk of developing pressure ulcers – such as patients in intensive care who are on a ventilator and can't move on their own.

What other kinds of aids are available?

Another thing that can help prevent damage to the skin is sheepskin mattress covers. Some people find sheepskin unpleasant, though, because it can make your skin very warm after a while.

Pressure ulcers often occur on people’s heels. So heels are often elevated using pillows, or special heel protectors made out of animal skin or foam are used. But there is no proof that these actually prevent pressure ulcers. Some people find the heel protectors uncomfortable and choose not to wear them. There are also concerns that they could increase the risk of falling if people get up and walk around while wearing them.

There hasn't been much research on aids such as special positioning cushions or special cushions for people to sit on either.

How can friends and family help?

Caregivers might sometimes provide too much help. For instance, they might turn someone over in bed although the person is actually still capable of turning over in bed themselves, perhaps with just a little assistance. It is better to only help as much as needed, so the person stays as independent as possible, helping to prevent pressure ulcers.

If you are caring for a family member at home or go to visit them in the hospital or at a nursing home, you can help them move short distances, for instance when taking a few steps to the table to sit down and eat.

If someone needs to lie in bed for a long time, a nursing care plan is usually made together with nursing professionals. This may include information such as how many times a day a person needs to be repositioned. It is important for everyone to make sure that the plan is followed properly. This also includes regularly changing diapers or incontinence pads.

You should tell the nurses or doctors immediately about any red or sore areas of skin. They can then take a closer look at the affected area. It is always important to take pressure off that part of your body.

Family members can also learn various positioning techniques in caregiving courses. In Germany and other countries, health insurers or long-term care insurers cover the costs of many of the aids needed at home or may lend things like nursing beds. Many cities also have information centers for caregivers, offering help and advice concerning issues related to pressure ulcer prevention.

Labels: Aging and geriatric care, Bedsores, L89, M70, Pressure ulcers, Prevention, Skin and hair