Older people in hospital - Skin care and preventing pressure sores

Skin and ageing#

Skin thins with age and can become very weak. Older skin may injure easily and take longer to heal. Not eating and drinking enough, and not moving enough, can lead to skin damage or sores.

Pressure sores (sometimes called bed sores or pressure ulcers) can be caused by lying or sitting in one position for too long. They are most likely to occur over the bony parts of the body, such as the elbows, hips, ankles and tailbone (the sacrum, at the base of the spine).

Pressure sores and skin tears are very painful and can take a long time to heal. They can cause other, sometimes severe, problems such as infections or permanent muscle or bone loss. Having a wound can make your hospital stay longer, and can reduce your independence and your ability to look after yourself once you leave.

During a hospital stay, your skin may be affected by the hospital environment, by staying in bed or sitting in one position for too long, by whether you are eating and drinking enough, and by your physical condition. Ask hospital staff to check your skin regularly, particularly if you feel any pain.

Skin care in hospital#

There are several things you can do to look after your skin:

• Keep your skin clean and dry.
• Avoid products that dry out your skin, including many soaps, body washes and talcum powder. Ask nursing staff or your pharmacist for non-drying skin cleanser options.
• Use a water-based moisturiser daily.
• Be careful with bony areas, and don’t rub or massage them.
• Ask staff for help if you need it.

Check your skin every day, or ask for help if you are concerned. Let a doctor or nurse know about any changes, especially redness, swelling or soreness. If you are at risk of pressure sores, a nurse will change your position often, including during the night.

Always use any devices given to you to protect your skin from tearing and pressure sores. These may include protective mattresses, seat cushions, heel wedges and limb protectors.

Eat regular main meals and snacks, and sit out of bed to eat if you can. Drink plenty of water, unless your doctor has told you not to.

If you have a wound, a plan will be developed with you and your family or carers before you leave hospital, explaining how to dress and care for the wound.

What pressure sores are#

A pressure sore (also called a bed sore or pressure ulcer) is a painful wound that affects the skin and the flesh underneath it. If you sit in a chair or lie in a bed for long periods, the weight on the bony parts of your body stops blood from flowing over time.

Pressure sores can particularly occur over bony areas such as the:

• heels
• hips
• knees
• tailbone (sacrum)

Pressure sores can begin to form in as little as two hours and can be serious, potentially leading to an infection that spreads to the bloodstream if untreated.

Pressure sores are more likely to develop in people who are undernourished, or who leak urine or feces involuntarily (are incontinent). Being undernourished makes the skin thin, dry, rigid and more likely to tear or break. Incontinence exposes the skin to moisture from urine and feces, which can cause irritation and pressure sores.

Reducing your risk of pressure sores#

Keeping mobile is important for your skin. Movement increases the blood supply to tissue and means you are not staying in one position for too long. To reduce your risk, try to move regularly and check your skin.

• Do what you can for yourself, as long as you can do it safely, such as showering, dressing and walking to the toilet.
• Walk around the ward every few hours if you can.
• If you have been advised not to walk by yourself, change your position every one to two hours, particularly moving your legs and ankles.
• Whenever possible, sit out of bed rather than sitting up in bed, as sitting up puts pressure on your tailbone.
• Move as frequently as possible. Even small changes in how you sit or lie make a difference.
• Ask staff if you need an air mattress, cushions, pillows or booties to ease sore spots. Staff will help if you can’t do these things yourself.

Check your skin regularly for warning signs:

• Is your skin red, blistered or broken?
• Do you have any pain near a bony area?
• Are your bed or clothes damp?

Let staff know if you see any changes that could lead to pressure sores.

Eating healthy food and drinking enough water are also important in maintaining healthy skin and play a key role in wound healing. Make sure you eat regular main meals and snacks, and drink plenty of water (unless your doctor has told you not to). Try to maintain your regular toilet routine.

Key points#

• Pressure sores can cause other, sometimes severe, problems such as infections or permanent muscle or bone loss.
• If you are at risk of pressure sores, a nurse will change your position often, including during the night.
• Eat regular main meals and snacks.
• Keeping mobile and moving is important for your skin.
• Eating healthy food and drinking enough water help maintain healthy skin and play a key role in wound healing.

Where to get help#