Pressure ulcers and bedsores

What is a pressure ulcer or bedsore?

A pressure ulcer, or bedsore, 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.

Why are people with dementia at a higher risk of pressure sores?

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.
• 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.

Spotting pressure ulcers

If a person has red patches anywhere on their skin (especially over raised bony areas), and these stay red when pressed lightly with a finger, this may well be an early sign of pressure ulcers. The area may also be painful, hard or hot to the touch.

Pressure ulcers may be more difficult to detect in people with darker skin. They may show up as patches, with a blue or purple tint, that do not go away.

If you help a person with dementia to wash or dress, always take a few moments to check their skin, especially around bony areas. Pressure ulcers are most likely to appear on the heels, ankles, knees, buttocks, hips, spine, elbows, shoulder blades and the back of the head.

If you think you have found a pressure ulcer, contact the GP as soon as possible and seek advice. It is important to act quickly, but not to feel that you are to blame.