If you or someone you care for is bedridden, has limited mobility, or spends extended periods of time sitting or lying in the same position, preventing bed sores is vital. Bed sores, also known as pressure sores or decubitus ulcers, are injuries to the skin and underlying tissue caused by prolonged pressure on the skin. They often develop on bony areas of the body where the skin is thin and close to the bone, such as the heels, ankles, hips, and tailbone. Bed sores are a common source of infection resulting in additional medical care, bills, and stress.

Common Causes of Bed Sores

Bed sores develop when prolonged pressure restricts blood flow to the skin and tissue in a particular area, which eventually causes skin breakdown. The three primary contributing factors are pressures, shear and friction. 

• Pressure: Constant pressure in one position reduces blood flow to the skin, depriving it of oxygen and nutrients.
• Shear: This occurs when skin moves one way and the underlying bone or tissue moves in the opposite direction, such as sliding down in bed, causing the skin to stretch and tear.
• Friction: Repeated rubbing of the skin against surfaces like sheets or clothing weakens the skin and makes it more vulnerable to breakdown.

People with limited mobility are prone to pressure ulcers in areas not often padded by fat or muscle. In these zones, skin is usually stretched over a bone and little else, leaving it vulnerable to damage. Bed sores most frequently appear on areas with little cushioning from fat or muscle, such as:

• Tailbone and lower back
• Heels and ankles
• Hips
• Shoulders and shoulder blades
• Back of the head

As a bed sore worsens it can penetrate deeper into the skin and cause significant damage. Bed sores progress in stages and knowing the stages can help you get necessary medical attention before things become serious.

Stage 1: Redness on the skin that does not turn white when pressed. Skin remains unbroken, and there may be some pain or a warm feeling.

Stage 2: The skin may start to blister or form an open sore. There is some loss of skin thickness, and the area might look like a scrape or blister.

Stage 3: Full-thickness skin loss with a deep, open wound that might expose fat tissue. The ulcer appears crater-like and may have signs of infection.

Stage 4: Deep wound exposing muscle, bone, or tendons. The ulcer is large, may be infected, and often causes extensive damage to surrounding tissue.

Strategies for Preventing Bed Sores

Preventing bed sores is essential for people at risk, as they can develop quickly and become serious. For anyone who is bedridden or has limited mobility, enlisting the help of a caregiver or healthcare provider can make it easier to follow these preventive measures. Catching early signs and maintaining skin health is key to avoiding the development of bed sores. Here are some effective strategies to prevent bed sores:

Frequent Position Changes

• For someone lying in bed, changing positions every 1-2 hours can relieve pressure on vulnerable areas like the tailbone, hips, heels, and elbows. If sitting, try to shift weight every 15-30 minutes. Be sure to set alarms/reminders and ask a caregiver to help with repositioning when available.

Use Supportive Surfaces

• Special mattresses, like foam or air mattresses, help distribute weight more evenly. Try gel cushions or memory foam pillows to relieve pressure in specific areas. Placing pillows under vulnerable areas, like the elbows or between the knees, can help relieve pressure.

Skin Care and Hygiene

• Moisture from sweat or incontinence can increase skin breakdown. Regularly clean and gently dry the skin, especially in vulnerable areas. Dry skin is more likely to crack which leads to sores. Use a gentle moisturizer on the skin but avoid over-moisturizing, as excess moisture can also weaken skin integrity.

Inspect Skin Daily

• Redness, warmth, or hardness in specific areas are early signs of pressure sores. If you notice any of these signs, adjust positioning and monitor the area closely. For bedridden individuals, caregivers can help inspect areas like the lower back, heels, and sides of the hips.

Good Nutrition and Hydration

• Drinking enough water keeps skin hydrated and less prone to breakdown. Having a balanced diet with protein helps repair tissues, while vitamins and minerals like vitamin C, zinc, and iron support skin health and wound healing.

Use Special Aids if Necessary

• Heel protectors and elbow pads protect the heels and elbows from friction and pressure.

Exercise and Blood Flow Promotion

• Limited movement, like leg lifts or arm stretches, can improve circulation and relieve pressure in certain areas. Sitting up, even if only for a short time, can relieve prolonged pressure on certain body parts.