Pressure sores

If you are looking after someone with dementia you will want to take particular care to ensure that they do not develop pressure sores. Older people who are not very mobile are particularly vulnerable. Pressure sores are usually easy to treat at an early stage. However, if left untreated, they will get worse and can be dangerous.

What is a pressure sore?

A pressure sore is a damaged area of skin which occurs when pressure reduces or cuts off the blood supply to a part of the body over a period of time. If you notice any red patches on the person's skin which do not disappear after a few hours, these may well be pressure sores.

Whenever you help the person to wash or dress or if they seem to be in discomfort be alert to the possibility of pressure sores. You should contact the district nurse straight away as pressure sores need immediate attention. If the person with dementia does not have a district nurse the GP will put you in touch.

Lying in bed

People normally move around in bed, even during sleep. However, people with dementia may not move for long periods because of apathy associated with their illness or a physical disability. This can lead to pressure sores.

If the person lies on their back pressure sores may occur on the heels and the buttocks or any area of the body which presses against the bed for a prolonged period. Areas such as the shoulders, shoulder blades, hips and ankles where there is less protective tissue are at risk.

• Try to ensure that the person does not remain for too long in one position in bed. Ask the district nurse for advice on how to help them to move.
• Encourage the person to get up during the day and to move around as much as possible either on their own or with help.

Sitting in a chair

Most people move around naturally when they are sitting down. However, people with dementia may remain seated for long periods in one position due to apathy or lack of motivation and pressure sores may occur.

• Encourage the person to rock from side to side in the chair from time to time or change their position while they are sitting.
• Help them to stand at least every couple of hours and walk around.

Friction

As people age their skin becomes increasingly delicate and even quite mild friction can help to produce pressure sores.

• Be careful not to drag the person when helping them to move.
• Ensure there are no rough seams in clothes or objects left in pockets that could cause friction.
• Check that bedding is smooth. Even wrinkles in the sheets can contribute to pressure sores.

Treatment

If you can catch a sore at an early enough stage the district nurse may only advise common sense measures such as removing the cause of the friction and helping the person to move frequently. The nurse can also advise on aids to protect the body such as fleecy pads, special cushions or mattresses.

If the skin has broken it will need dressing by a district nurse. Pressure sores which have become infected can make the person ill and may be dangerous.

Precautions

• Try to make sure the person eats a good balanced diet. Good nutrition means the skin will be healthier and more resistant to sores developing.
• Help the person exercise regularly. Exercise improves the circulation and helps relieve any pressure which has built up.
• Make sure the person does not remain in wet clothes or a wet bed if they are incontinent. If urine remains in contact with the skin for any length of time it will make it spongy and less resistant to sores.
• Avoid tight clothing or tight bedding, especially over the feet.
• Excessive heat and moisture can also contribute to pressure sores so try to prevent the person becoming hot and sweaty.
• Make sure the person is thoroughly dry after a bath or wash, particularly in the skin folds. Pat rather than rub dry.
• Never rub or massage any places where the skin has reddened as this could cause further damage.
• Encourage the person or help them to move their position when they are lying or sitting for any length or time.

We would like to thank AGILE, Physiotherapy with Older People, for their help in preparing this advice sheet.

March 1997

Page Text supplied by The Alzheimer's Disease Society of Great Britain