The skin is the largest as well as the fastest growing organ in the body. It
would span about 20-22 square feet if you stretched it out. The skin’s job is to protect and to serve as a barrier. It protects from impact, pressure, micro-organisms and chemicals. The skin helps regulate body temperature and permits the sensations of touch, heat, and cold.
In this post, we discuss how to prevent pressure sores. But first, some information about what a pressure ulcer is. Pressure sores develop when there is continuous pressure on areas of the skin over boney areas such as the lower back, the coccyx, heels, buttocks, hips, elbows, knees, ankles, toes, and the back of the head. The pressure blocks the flow of blood to the area, which damages the skin and tissue causing redness, blisters or open sores.
The elderly are at increased risk for pressure sores because their skin is thin and their circulation is weak. The good news is that most skin sores are preventable. One basic practice to get in the habit of is looking at the skin at least daily. Look for redness, darkening, cracking, blisters, bruises, cracking, dry areas, scraped areas, redness, swelling, heat or warmth to an area.
One way to determine if a reddened area is becoming a pressure sore is to apply pressure to the site with your finger. The area should go white. When you remove pressure, the area should go back to red or pink. If the area stays white (blanching), blood flow has been impaired. Keep off the area and notify your nurse or doctor right away. Skin sores can worsen and go down to the bone. They can be a source of infection and can even be life-threatening if not treated.
NOTE: In darker skin, there may not be visible blanching even when it is healthy. Check for other signs of damage like changes in color or hardness compared to surrounding areas.
Now, how to prevent pressure sores. First, you need to keep the skin healthy. Keep it clean and dry (but not too dry). Be sure to clean skin folds and under breasts. Use a moisturizing lotion on areas of dryness. There are also skin protectants that you can apply to the skin. Your doctor can provide these.
Good nutrition and fluid intake are very important. Eating the proper diet and getting enough protein (especially plant-based protein) is essential. The elderly have decreased fat under the skin, and this can increase the risk of pressure areas. Dehydration is also a factor. Most sources say that we should drink eight glasses of water a day. The amount of fluid needed can vary with exercise or illness.
Since pressure sores are caused by pressure, we obviously need to minimize the amount of time spent on bony areas of the body. Frequently changing position is a good way to accomplish this. If your parent is confined to bed and cannot turn themselves, they should be turned every two hours. When sitting in a wheelchair, weight needs to be shifted every 15-30 minutes for at least 30-90 seconds.
There is a vast multitude of cushions, mattresses, pads and pillows available to decrease pressure on the body. No two skin areas should be against each other. Place pillows between knees when lying on the side. Don’t cross legs or ankles.
When changing a loved one’s position, lift, don’t slide. Sliding can cause shearing which injures the skin. Don’t raise the head of the bed too high as this can also cause shearing of skin.
Be sure their clothing fits properly. Wrinkles and buttons can cause pressure and skin irritation. Improperly fitting shoes can rub on toes and cause sores. Check for wrinkles or items that might have fallen in bed. All of these can cause pressure on the skin.
A light massage to an area increases blood flow. But, do not massage an area after it has become red because the friction can damage the skin further.
Finally, if able, have them wiggle toes, move legs, and flex arms. Movement keeps the blood flowing and helps prevent pressure sores as well as blood clots.