If you’re caring for someone who spends most of the day in bed or in a wheelchair, bedsores are one of the most important things to watch for. These wounds, also called pressure ulcers or pressure injuries, can develop in a matter of hours, yet may take months to heal. They are painful, can become seriously infected, and often start in places that are easy to miss.

The good news is that most bedsores can be prevented. With a regular repositioning routine, daily skin checks, the right support surfaces and good nutrition, caregivers can dramatically lower the risk. This guide explains why bedsores form, where to look, how to recognize the earliest signs and the practical steps that protect your loved one’s skin every day.

Key Takeaways

• Bedsores form when constant pressure cuts off blood flow to the skin, often over bony areas.
• Regular repositioning is the most important prevention strategy.
• Check the skin every day, especially the tailbone, hips, heels, elbows and shoulder blades.
• Keep skin clean and dry, and use pressure-relieving mattresses and cushions.
• Redness that doesn’t fade when pressed can be the first sign. Report it right away.

In This Article

1. What Are Bedsores?
2. Where Bedsores Form
3. Who Is at Risk?
4. The Stages of Bedsores
5. 9 Ways to Prevent Bedsores
6. How to Do a Daily Skin Check
7. When to Call for Help
8. Support for Caregivers
9. Frequently Asked Questions

What Are Bedsores?

A bedsore is an area of damaged skin and underlying tissue caused by pressure, usually combined with friction or shear. When someone lies or sits in the same position for too long, their body weight presses the skin against the bone underneath. That pressure squeezes the tiny blood vessels that deliver oxygen and nutrients, and without blood flow the tissue begins to die.

Two other forces make things worse:

• Shear happens when the skin stays in place while the body slides, for example when someone slips down in bed with the head raised. The layers of tissue are pulled in opposite directions, damaging blood vessels.
• Friction occurs when skin rubs against sheets or clothing, such as being dragged rather than lifted during repositioning.

Where Bedsores Most Commonly Form

Bedsores develop over bony areas where there’s little fat or muscle to cushion the skin. The most common locations depend on position:

Who Is Most at Risk?

Anyone who can’t easily change position is at risk. The risk is highest for people who:

• Are bedbound, use a wheelchair or are recovering from surgery or a hospital stay
• Have reduced sensation, such as from diabetes, stroke or spinal cord injury, and can’t feel discomfort
• Are living with dementia or confusion and may not shift position on their own
• Have poor nutrition, recent weight loss or dehydration
• Experience incontinence, which keeps skin moist and fragile
• Have poor circulation, heart disease or diabetes
• Are very thin, or very heavy
• Are older, with thinner, more delicate skin

The Stages of Bedsores

Clinicians classify pressure injuries by how deep the damage goes. Knowing the stages helps you understand what you’re seeing and how urgent it is.

9 Practical Ways to Prevent Bedsores

1. Reposition regularlyChanging position is the single most important step. For people in bed, turning at least every two hours is commonly recommended; for people sitting in a chair, shifting weight far more frequently is advised. Your care team will set a schedule based on the person’s skin and support surface. A simple chart on the fridge or bedroom wall helps everyone keep track.
2. Use the 30-degree tiltWhen positioning on the side, tilt the body about 30 degrees and support the back with a pillow, rather than lying directly on the hip bone. Place a pillow between the knees and ankles so bony areas don’t press together.
3. Float the heelsHeels are one of the most common places for bedsores. Place a pillow lengthwise under the calves so the heels hang freely and don’t touch the mattress. Specialized heel boots can also help.
4. Keep the head of the bed lowUnless there’s a medical reason (such as eating or breathing difficulties), keep the head of the bed at or below 30 degrees. Higher angles cause the body to slide down, creating damaging shear on the tailbone.
5. Lift, don’t dragWhen moving someone up in bed, use a draw sheet or slide sheet with a second person to lift rather than pull. This prevents friction and shear.
6. Use pressure-relieving surfacesSpecialized foam, air or alternating-pressure mattresses and wheelchair cushions spread weight more evenly. Ask your care team what’s appropriate. Avoid donut-shaped cushions, which can actually reduce blood flow to the surrounding tissue.
7. Keep skin clean and dryClean skin promptly after any incontinence using a gentle, pH-balanced cleanser, pat it dry rather than rubbing, and apply a barrier cream to protect it from moisture. Change wet bedding and clothing quickly.
8. Support good nutrition and hydrationSkin needs protein, calories, vitamins and fluids to stay strong. Encourage regular meals and drinks. See our guide on foods that help wounds heal.
9. Encourage movementEven small movements help. If your loved one is able, encourage them to shift their weight, do simple range-of-motion exercises, or sit up and walk as much as their care team allows.

How to Do a Daily Skin Check

A quick, thorough skin check once or twice a day, often during bathing or repositioning, is one of the best ways to catch problems early.

• Use good lighting and look at every pressure point: back of the head, ears, shoulders, shoulder blades, elbows, spine, tailbone, buttocks, hips, knees, ankles and heels.
• Look for color changes: redness on lighter skin, or purple, blue or darker patches on darker skin.
• Feel the skin gently for areas that are warmer, cooler, firmer or softer (boggy) than the surrounding skin.
• Ask about pain or tenderness, and watch facial expressions in people who can’t easily communicate.
• Check under devices such as oxygen tubing, braces and compression stockings.
• Note anything new, and take a photo if you can so you can compare over time.

When to Call for Professional Help

Contact your wound care provider or doctor promptly if you notice:

• Red or discolored skin that doesn’t fade within about 30 minutes of relieving pressure
• Any blister, open area or broken skin over a pressure point
• Skin that feels unusually warm, hard, spongy or painful
• A dark purple or maroon area, even if the skin is unbroken
• Signs of infection: increasing redness, swelling, drainage, bad smell or fever

Seek emergency care if your loved one develops a high fever, confusion, a rapid heartbeat or rapid breathing, which may be signs of a serious infection. Our article on signs of wound infection explains what to look for.

Pressure injuries heal best when treatment starts early. Our clinicians provide specialized pressure ulcer care at home, in nursing homes and in assisted living facilities across Troy and Metro Detroit. That includes assessing wounds, recommending support surfaces, performing treatments and working closely with facility staff and families.

Support for Caregivers

Preventing bedsores is demanding, round-the-clock work, and caregivers need support too. Share the repositioning schedule with other family members, ask your care team to demonstrate safe turning techniques, and don’t hesitate to ask about equipment like hospital beds, lift devices or specialty mattresses, which may be covered by insurance when medically necessary.

You don’t have to do this alone. A good care team will teach you, support you and share the load.

Frequently Asked Questions

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Medical disclaimer: This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Always follow the instructions of your own healthcare provider. If you think you are experiencing a medical emergency, call 911 immediately.