Preventing Pressure Sores
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Pressure sores can be extremely painful, and whilst there may be a visible redness, they can be painful without anything at all to see (and don't let anyone tell you otherwise). They arise when the blood circulation to the area is reduced, usually as a result of lack of movement so that the person's own weight presses on the same area for a prolonged period. We naturally adjust our position periodically to avoid it, but with age the need to move may not be felt as greatly or reduced mobility may prevent it.
Pressure sores can potentially develop into ulcers, with broken skin and damaged tissue underneath.
Precautions and equipment to reduce the risk of getting pressure sores are as follows.
Avoid wet skin (e.g. via incontinence), and dry by dabbing not rubbing
The situation is made much worse if the skin is wet, for example through incontinence, which also reduces the strength of the skin and makes it more likely to tear.
When drying skin use an absorbent towel (not a threadbare one) and dab rather than rub.
Avoid dehydration or poor nutrition
dehydration through not drinking enough, and poor nutrition, also make things worse.
Pressure cushions
There are many forms of pressure cushion available to sit on, with the aim of increasing comfort and reducing the risk of getting pressure sores. The one we prefer is an air cushion with a valve in that enables you to inflate it to the correct pressure, which it will keep for perhaps a month before needing a boost - this is the Repose brand cushion. It has a strap for fastening it round the back of a chair to keep it in place, but if the chair design doesn't allow this then keep this end of the cushion at the back anyway, so that the air pockets still run in the correct direction. The drawback of air cushions is that they're susceptible to damage, unlike gel cushions which are a good alternative. Foam cushions are also available, in differing stiffnesses, but whilst they're less susceptible to damage we don't think they offer the same level of comfort. Some gel or foam cushions are contoured, with the aim of distributing weight over a larger surface area, and whilst this may potentially work when sitting in a fixed position in a wheelchair, we don't recommend them for general use in other chairs, as the person's likely to slide down or move slightly and the contour will then be pressing harder in the wrong place.
Care chairs
For someone who's immobile and needs hoisting there are special chairs called 'care chairs'. These allow the whole of the chair to be tilted back by a carer, to put weight on a different part of the body periodically. There are usually several other adjustments, although these may be 'one-off' settings made without the person in the chair. They usually have a footrest to help spread the weight off the thighs, and to ensure feet can't drag on the floor or be bumped when the chair is wheeled about - although it's usually safest to remove the footrest whilst being hoisted. They're very much more padded and comfortable (and larger) than wheelchairs, which aren't designed for sitting in for long if pressure sores are a potential issue. New care chairs are very expensive, but you may be able to find a second-hand one or to hire one. Care chairs aren't suitable for someone to walk to and sit down on, because of their height and backwards tilt (and footrest when fitted).
Heel cushion in bed
When lying in bed on the back, there is concentrated pressure on the back of the heels and these can become sore. An air cushion can be placed under the fitted sheet, to go under the heels, as an alternative to a whole air mattress (see below).
There's a special Repose brand air boot ('foot protector'), but this is only designed for people who are completely immobile, as getting out of bed and trying to stand with the air cushion on the sole of your foot would lead to a fall.
Air mattresses and turning in bed
There is a Repose brand air mattress of the same design as their pressure cushion.
However, the greatest level of protection, for those who are largely immobile or are otherwise susceptible to pressure sores, is an alternating pressure air mattress. These use an electric pump to change periodically which parts of the mattress are most inflated, which helps give each part of the body a period of relief from high pressure. Hospitals and nursing homes use sophisticated ones with adjustments for the overall pressure level (to account for the person's weight) and for the period of the alternating cycle.
If necessary, hospitals and nursing homes may also physically turn patients between their back and each side every few hours.
For those who are immobile (i.e. are positioned in bed by carers), a 'half moon pillow' may be useful to support under the knees when they're lying on their back. If there's an elastic strap for attaching to a chair as lumbar support then consider cutting this off to avoid possible entanglement. A 'leg pillow' for between the knees and legs is useful when they're lying on their side.
Diabetes
Diabetic people have less feeling in their skin and may not be aware of a skin problem starting, particularly in their feet and extremities. Added to this, people with dementia may find it difficult to express where something feels wrong. It's important to check their skin periodically for signs of any problems, so these don't develop into skin ulcers and worse.