Alzheimer's Society

If you're looking after a person with dementia who has difficulty walking, you need to take particular care that they don't develop pressure sores - especially if they are an older person. Pressure sores are usually easy to treat early on, but if they are left untreated they do get worse, and they can be dangerous.

People tend to develop pressure sores when they become seriously physically or mentally impaired. The difficulty for you as a carer is that someone with this level of impairment may not be able to tell you if an area of their skin is uncomfortable. That's why it's important to be aware of the possibility of pressure sores, and to act quickly if you spot them.

What is a pressure sore?

A pressure sore is an area of skin that becomes damaged over time when the blood supply to a particular part of the body is reduced or cut off. If you notice any red patches that do not disappear after a few hours, these may well be pressure sores.

• Whenever you help the person with dementia to wash or dress, or if they seem to be indiscomfort, be aware of the possibility of pressure sores.
• If you think you have found pressure sores, contact the district nurse (via your GP surgery) straightaway, as they need immediate attention.

What is the treatment?

• If you notice the pressure sore at a very early stage, the district nurse may simply suggest that you remove the cause of the friction and help the person to move around. They can also advise on aids to protect the body, such as fleecy pads, special cushions, or mattresses that can help prevent pressure sores developing. 
• Pressure sores that have become infected are painful and can make the person ill. If the skin has broken, the district nurse will need to dress them.

Pressure sores can be a problem, but there are plenty of things you can do to prevent them developing in the first place. Here are some suggestions.

When lying in bed

When people are in bed, they normally move around - even when they're sleeping. But in the later stages of dementia, people often lose their motivation and can develop physical disabilities, so they may not move for long periods. This lack of movement can lead to pressure sores.

• If they lie on their back, they may get pressure sores on their heels, buttocks or any part of the body that presses against the bed or chair for a prolonged period. Bony areas, such as the shoulders, shoulder blades, hips and ankles are particularly at risk because they have less protective tissue.
• Try to make sure the person you're caring for doesn't stay in one position for too long. 
• Encourage them to get up during the day and move around as much as possible - either independently, or with some help. 
• Ask the district nurse for advice on how to help them move.

Sitting in a chair

Most people shift around naturally when they are sitting down. But in the later stages of dementia, people are more likely to stay in one position for an extended time. This can lead to pressure sores.

• Encourage the person you care for to rock from side to side, or to change their position in the chair now and then while they're sitting.
• Help them stand up and walk around at least every couple of hours.

Friction

As people age, their skin becomes increasingly delicate, and even quite moderate friction on the skin can help produce pressure sores.

• Be careful not to drag the person you're caring for across the bed or chair unintentionally when you're helping them to move. 
• Make sure there are no rough seams in their clothes, or anything in their pockets that could rub. 
• Check their bedding is smooth. Even wrinkles in the sheets can contribute to pressure sores, and if the person is in the later stages of dementia, they may not be able to tell you if they're feeling uncomfortable. 
• Natural fibres, such as cotton or linen, are less likely to cause pressure sores than synthetic fibres.

Tips for preventing pressure sores

• Try to make sure that the person eats a good balanced diet, with plenty of fresh fruit and vegetables. Good nutrition makes the skin healthier and more resistant to sores. 
• Help the person exercise regularly. Exercise improves the circulation and helps relieve any pressure that has built up. 
• If the person is incontinent, make sure they don't stay in wet clothes or a wet bed. If skin is in contact with urine for any length of time, it becomes more susceptible to sores. 
• Excessive heat and moisture can contribute to pressure sores. Try not to let the person become hot and sweaty. 
• Avoid close-fitting clothing or tight bedding, especially over the feet. 
• Make sure the person is completely dry after a bath or a wash, particularly in the skin folds. Pat them dry - don't rub. 
• Never rub or massage any places where the skin has reddened, as this could cause further damage. 
• Encourage the person to move their position whenever they are lying or sitting for any length of time.

Carers' Advice Sheet 512

Last updated: June 2005
Last reviewed: June 2005