Pressure ulcers

Pressure ulcers – also called pressure sores or bedsores – can develop if someone spends too long sitting or lying in one position. They are a particular risk for people with dementia.

It is important for anyone caring for a person with dementia to know about pressure ulcers. They can be easy to prevent early on but, if early signs of damage are not noticed, they can get worse and become very painful or infected. This section, for carers at home, explains what pressure ulcers are and how to prevent them.

What is a pressure ulcer?

A pressure ulcer is an area of skin – and sometimes also the tissue underneath – that has become damaged because of pressure. An ulcer may develop over bony areas that are close to the skin. The ulcer forms because the blood supply to the skin is reduced and the skin becomes starved of oxygen and nutrients.

Sitting or lying in the same position for too long is a common cause of pressure ulcers. If skin becomes thin, dry or weak due to ageing or disease, pressure ulcers also become more likely.

Older people in general are at higher risk of pressure ulcers, particularly if they have difficulty moving. Dementia makes this risk even higher, especially as it progresses. This is because of problems that a person with dementia may have with:

• movement and walking – people with dementia may have difficulty changing position without help. This can be when they are moving between their bed and a chair, or repositioning themselves while sitting or lying down. People who are caring for them may also sometimes discourage or limit movement because they are afraid the person with dementia will fall.
• frailty – this causes the loss of protective fat and muscle mass, and also means the skin can become thinner.
• poor diet and dehydration – not eating and drinking well can weaken the skin and make it less able to heal itself.
• incontinence – moisture from leaks can damage the skin.
• poor blood supply – conditions such as diabetes or vascular disease (eg in vascular dementia) increase the risk of ulcers.
• agitation or restlessness – rubbing of clothes, often over the heels or elbows, damages the skin and makes ulcers more likely.
• medication – some medicines can cause the person to be more sleepy or the skin to dry out.
• communication – the person may be less able to tell someone that they are in pain or want to move.