Pressure sores

If someone with dementia has difficulty walking, or has any other movement difficulties, it is important to take particular care that they don't develop pressure sores - especially if they are older. Pressure sores can be easy to treat early on, but if they are left untreated they do get worse, and can be very painful.

People tend to develop pressure sores when they become seriously physically or mentally impaired. Someone with this level of impairment may not be able to say if an area of their skin is uncomfortable and so it is vitally important that those caring for them are aware of the possibility of pressure sores, and act quickly if they spot them.

Pressure sores can be a problem if not caught early enough, but there is plenty that can be done to prevent them developing in the first place.

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 anywhere on the skin that do not disappear after a few hours, these may well be pressure sores.

Things to watch out for

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

Treatment

• If you notice a 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 pressure-relieving 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.

Preventing pressure sores

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 the person lies 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 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. There are aids available that may help.

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 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.

Avoiding friction on the person's skin

As people age, their skin becomes increasingly delicate. Even quite moderate friction on the skin can, over time, cause pressure sores.

• If you help the person to move, be careful not to drag them across the bed or chair unintentionally. 
• 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 explain that they're feeling uncomfortable. 
• Use natural fibres, such as cotton or linen, as these are less likely to cause pressure sores than synthetic fibres.

General tips

• 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 has problems with continence, 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, so 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.

Your local Alzheimer's Society branch will always be willing to talk to you and offer advice and information to support your needs.

For more information, Dementia Catalogue, our specialist dementia information resource, is available on the website at alzheimers.org.uk/dementiacatalogue

Factsheet 512

Last updated: August 2008
Last reviewed: August 2008

Reviewed by Barry Aveyard, Senior Lecturer, Faculty of Health and Well Being, Sheffield Hallam University