Bedsores, Pressure Sores and Decubitus Ulcers are easier to prevent than to treat, but that doesn’t mean the process is easy or uncomplicated. Although wounds can develop in spite of the most scrupulous care, it’s possible to prevent them in many cases.
The first step is to work with your nurses and doctor to develop a plan that you and any caregivers can follow. The cornerstones of such a plan include position changes along with supportive devices, daily skin inspections and a maximally nutritious diet.
Position changes can Help Prevent Pressure Sores:
Changing your position frequently and consistently is crucial to preventing bedsores. It takes just a few hours of immobility for a pressure sore to begin to form. For that reason, experts advise shifting position about every 15 minutes that you’re in a wheelchair and at least once every two hours, even during the night, if you spend most of your time in bed. If you can’t move on your own, a family member or caregiver must be available to help you.
A physical therapist can advise you on the best ways to position yourself in bed, but here are some general guidelines:
- Avoid lying directly on your hipbones. On your side, lie at a 30-degree angle.
- Support your legs correctly. When lying on your back, place a foam pad or pillow — not a doughnut-shaped cushion — under your legs from the middle of your calf to your ankle. Avoid placing a support directly behind your knee — it can severely restrict blood flow.
- Keep your knees and ankles from touching. Use small pillows or pads.
- Avoid raising the head of the bed more than 30 degrees. A higher incline makes it more likely that you’ll slide down, putting you at risk of friction and shearing injuries. If the bed needs to be higher when you eat, place pillows or foam wedges at your hips and shoulders to help maintain alignment.
- Use a pressure-reducing mattress or bed. You have many options, including foam, air, gel or water mattresses. Because these can vary widely in price and effectiveness, talk to your doctor about the best choice for you. For some people, a low-air-loss mattress may provide enough support. But more expensive and technologically sophisticated beds may be needed for people who have recurring pressure sores or who are at very high risk.
Pressure-release wheelchairs, which tilt to redistribute pressure, may make sitting for long periods easier and more comfortable. If you don’t have a pressure-release chair, you or your caregiver will need to manually change your position every 15 minutes or so. If you have movement and enough strength in your upper body, you can do wheelchair push-ups — raising your body off the seat by pushing on the arms of the chair.
All wheelchairs need cushions that reduce pressure and provide maximum support and comfort. Various cushions are available, including foam, gel, and water- or air-filled cushions. Although they may help relieve pressure, cushions and other devices don’t prevent pressure sores from forming or replace the need to change your position often.
Daily skin inspections for pressure sores are an integral part of prevention. Inspect your skin thoroughly at least once a day, using a mirror if necessary. A family member or caregiver can help if you’re not able to do it yourself.
If you’re confined to bed, pay special attention to your hips, spine and lower back, shoulder blades, elbows and heels. When you’re in a wheelchair, look especially for sores on your buttocks and tailbone, lower back, legs, heels and feet. If an area of your skin is red or discolored but not broken, keep pressure off the sore, wash it gently with mild soap and water, dry thoroughly, and apply a protective wound dressing.
If you see skin damage or any sign of infection such as drainage from a sore, a foul odor, and increased tenderness, redness and warmth in the surrounding skin, get medical help immediately.
A healthy diet is important in preventing skin breakdown and in aiding wound healing. Unfortunately, the people most likely to develop pressure sores are also often the most malnourished.
If you’re ill, recovering from surgery or living with paralysis, you may have little appetite and eating may be physically difficult. Yet it’s essential to get enough calories, protein, vitamins and minerals. A dietitian can help devise an eating plan that caters to your food preferences while supplying necessary nutrients. These measures also may help:
- Try smaller meals. If you feel full after eating only a small amount, try eating small meals more frequently when you do get the urge to eat. If you never seem to feel hungry, it’s often helpful to eat according to a schedule rather than to rely on appetite.
- Take advantage of the times when you feel your best. Eat a larger meal when you’re hungry. Many people have their best appetite in the morning, when they’re rested.
- Limit fluids during meals. Liquids can fill you up and prevent you from eating higher calorie foods. Don’t restrict your intake of water overall, however. It helps keep skin soft and supple.
- Consider pureed or liquid meals. If swallowing is difficult, emphasize soups, pureed foods or nutritional supplement drinks, which provide protein and calories but require little or no preparation. It may be easier for you to drink rather than to eat something.
- Consider protein alternatives. If meat isn’t appealing to you, consider other high-protein foods such as cottage cheese, peanut butter, yogurt and custards. Beans and nuts also are good protein sources but may be hard to digest.
- Find a comfortable position. Raise the head of your bed to a comfortable level while you eat.
- Don’t rush. Allow sufficient time for meals, and if you need assistance, don’t let your caregiver rush you.
Although you may need assistance with many aspects of your care, you can take control of some important preventive measures, including:
- Quitting smoking. Ask your doctor about the most effective way to stop smoking. Tobacco use damages your skin and slows wound healing.
- Exercise. Daily exercise improves circulation, builds up vital muscle tissue, stimulates your appetite and strengthens your body overall. A physical therapist can recommend an exercise program tailored to your needs.
- Support. Your physical and emotional well-being depend on having a strong support system. Don’t be afraid to ask for help with daily tasks or for emotional support.
About the Author
Attorney Steven Peck has been practicing law since 1981. A former successful business owner, Mr. Peck initially focused his legal career on business law. Within the first three years, after some colleagues and friend’s parents endured nursing home neglect and elder abuse, he continued his education to begin practicing elder law and nursing home abuse law.