Anyone can be at risk of developing pressure damage, but certain factors can make it more likely. 

Some people also have skin that’s more easily damaged. This can include skin that is thin or delicate, very dry or has been in contact with moisture (like sweat or urine) for extended periods.

You may be more at risk of getting pressure ulcers if:

• You find it hard to move or change position without help which causes pressure to build up on certain parts of your body. When that pressure isn’t relieved, it can slow down blood flow to the skin, which may lead to soreness and increase the risk of skin damage over time.
• You can’t feel pain in parts of your body which makes it harder to notice when you need to change position.
  
  
• Sitting or lying in a way that puts pressure on certain parts of your body, like slouching or not using cushions properly can lead to sore spots on your skin. Over time, these sore spots can cause the skin to break down.
  
  
• You spend long periods of time in bed or sitting in a chair without changing position which can put pressure on your skin. This can also cause rubbing (friction) or pulling (shear) which may lead to soreness or damage.
  
  
• You have trouble controlling your bladder or your bowels. If you have incontinence, moisture from urine and faeces can stay on the skin and make it more likely to get damaged. These fluids contain substances that can irritate the skin and make it weaker, increasing the risk of pressure damage.
  
  
• You are very unwell. Being unwell can increase your risk of pressure damage by affecting your mobility, skin health and ability heal.
  
  
• You are having or recovering from an operation. After surgery, you might find it harder to move around or change position, which can lead to pressure building up on certain parts of your body.
  
  
• You’ve had a pressure sore before and that area of skin has become weaker or more sensitive even after healing and may not be as strong as it was before.
  
  
• You don’t eat well or drink enough water. Not eating well or drinking enough can affect your overall health. Over time, a poor diet and not getting enough fluids can make your skin weaker and slow down it’s ability to heal.
  
  
• You have problems with memory or understanding which makes it harder to notice when you are uncomfortable or need to move. You may not remember to change position or ask for help.
  
  
• You have an injury that affects how you move such as a broken bone which makes it harder for you to move around or change position. Injured areas may also have poor blood flow or swelling which can make the skin weaker and slower to heal.
  
  
• You are elderly. As we get older, our skin becomes less stretchy, and we naturally lose some of the fat and muscle that help cushion and protect it. This can make the skin more fragile and more likely to get injured.
  
  
• You are frail which can make it harder for you to move around or change position. You are more likely to have less muscle and fat which normally help cushion your skin from pressure or your skin may be thinner and more delicate.

The more of these you have, the higher your risk.

How can I prevent a pressure ulcer?

One of the best ways to stop pressure ulcers from developing is to take pressure off areas of the body that are most at risk.

• You can do this by moving around or changing your position regularly.
  
  
• If you're at higher risk, you may need to move more often.
  
  
• Eating a balanced diet and staying hydrated

More information about the link between nutrition and pressure damage can be found here from the Association of Dietitians.

If you’re not able to move by yourself, a carer or healthcare professional can help you. Sometimes, special equipment like a hoist or slide sheets may be used to help move you safely and comfortably.

If you're at higher risk of getting pressure ulcers, you might be offered special equipment to help protect your skin. This could include:

• A pressure-relieving cushion to sit on
• A special mattress or mattress overlay to help spread pressure more evenly

If the skin around your bottom often gets wet because of bladder problems, you may also be given a barrier cream and skin cleansing products. These help to protect your skin from moisture and can lower the chance of pressure ulcers developing.

Keeping the skin clean, dry and supple can also help to reduce the risk of developing a pressure ulcer.

While some equipment can help prevent pressure ulcers, equipment can sometimes cause skin damage.

Medical items such as:

• Oxygen tubing
• Catheter tubing and catheter accessories for example leg straps
• Tight-fitting socks or compression stockings

These can press against the skin and reduce blood flow. This can lead to pressure damage, especially if the equipment stays in one place for too long or is too tight.

What you can do:

• Check the skin regularly where equipment touches
• Make sure socks and stockings fit well and aren’t too tight

Pressure ulcers can occur anywhere on the body, but are more commonly found over bony prominences such as the:

• Lower back and buttocks
• Heels
• Elbows
• Back of the head and ears
• Shoulders
• Inner knees
• Hips

Pressure ulcers can start with small changes in the skin which gradually appear but can also happen quite quickly, particularly for people who are seriously unwell. Catching these signs early can help prevent serious problems.

What to look for:

• Red skin that doesn’t turn white when you press it (on light skin tones)
• Blue, purple, or darker patches (on dark skin tones)
• Swelling or puffiness
• Pain or discomfort in the area
• Skin that feels different for example, it might be warm, firm, soft or spongey, or hard
• Blisters or shiny areas may also appear

Important note for darker skin tones:

It can be harder to spot pressure damage on darker skin. Instead of redness, look for:

• Darker areas than the surrounding skin
• Changes in skin texture
• Pain or warmth in the area

Resources:

Dark skin tones and pressure ulcers.pdf - Sources: University of Surrey.

Too much moisture on the skin, for example, from urine or faeces, can increase the risk of developing pressure ulcers. While moisture itself doesn’t directly cause pressure, it can weaken the skin and make it more vulnerable to damage.

To help protect the skin:

• Barrier creams can create a protective layer to reduce moisture damage.
• Skin cleansers with a neutral pH are gentler and help maintain healthy skin.
• Avoid perfumed soaps, as they can dry out the skin and remove its natural oils.

Keeping the skin clean, dry, and well cared for is an important part of preventing pressure ulcers, especially for people with bladder or bowel issues.

Continence Service referrals

Patients and carers can self-refer to the bladder and bowel team and continence nurse specialists. Please visit Continence Service referrals :: Lincolnshire Community Health Services NHS Trust.

The term “frailty” is often used to describe a person’s overall health and strength, especially in older adults. It refers to how well someone can cope with illness or recover from health problems. People living with frailty may experience things like tiredness, reduced muscle strength, and slower recovery after being unwell. Frailty can also increase the risk of developing pressure ulcers, especially in older people.

If you or someone you care for is living with frailty, there are local resources that can help support health and wellbeing:

• Age UK offers advice on staying active, eating well, and getting help when you're unwell.
  
  
• One You Lincolnshire provides free programmes to help with weight management, stopping smoking, drinking less, and moving more.
  
  
• Connect to Support Lincolnshire is a directory of local services and support, including help with physical and mental health, daily living, and community activities
  
  
• Lincolnshire Carers Service | Lincolnshire Carers Services offers services to support carers at every stage of their caring journey allowing them to find the balance they wish to achieve in their lives.

If you're at higher risk of pressure sores and are concerned about your skin, or if you're a carer worried about someone you support, it's important to speak to your GP. They can refer you to the right healthcare professional who can offer advice, support, and help with prevention and care.