Pressure ulcers (also referred to as "bedsores") cause the breakdown of skin and underlying tissues and are an unfortunate consequence of immobility. These ulcers are caused by constant pressure against the skin and are the result of shearing forces, which is basically friction of skin against a surface. Bony parts of the body like a heel or tailbone are the most common places for ulcers to happen.
Risk factors for pressure ulcers include:
· trouble with blood flow
· edema or swelling
· poor nutrition
· advanced age
· cognitive impairment
The management of pressure ulcers includes treatment after an ulcer has occurred as well as prevention, and like most medical conditions, prevention is preferable to treatment, which can be costly and painful!
In addition to managing the risk factors listed above, ulcer prevention involves modification of the surface that the body part will rest on. Surfaces that relieve or modulate pressure range from “constant low pressure (CLP)” devices to “alternating low pressure (ALP)” ones. The ALP devices are usually sophisticated mattresses or cushions that alternately inflate and deflate to prevent pressure spots from developing, and are probably used most commonly in hospitals, or for people with long term immobility. There are even beds that will turn a person or tilt them into different positions.
Low tech CLP devices are probably more accessible for most, and include sheepskin covers or booties, foam mattress toppers, or mattress toppers made of other pressure relieving materials.
A recent meta-analysis (1), which is a large study comparing the results of other similar research studies, of pressure ulcer preventing surfaces looked at the effectiveness of several CLP's . The patients in the studies were in hospitals and aged care rehabilitation facilities, and when all the data was analyzed together, there was about a 50% lower risk of any ulcer (including grade 1, or very mild ulcer) in patients who had a sheepskin mattress overlay. Alternative foam mattresses (for example cubed foam, bead-filled foam, viscoelastic foam) were better than standard hospital foam mattresses at preventing ulcers, with a 60% lower risk of ulcer development. The authors also concluded that there isn’t enough research data to show that seat cushions can prevent ulcers.
The bottom line is that if you have a family member who is staying in bed most of the time, on a chronic basis or even just because of an acute stay in hospital, it is worth asking about an alternative to the standard hospital mattress. Better yet, find out from staff when you can safely get your family member up and walking and encourage movement as much as possible.
1. Cochrane Database Syst Rev. 2015 Sep 3;(9):CD001735. doi: 10.1002/14651858.CD001735.pub5.
Support surfaces for pressure ulcer prevention.
McInnes E1, Jammali-Blasi A, Bell-Syer SE, Dumville JC, Middleton V, Cullum N.
Facts about Pressure Ulcers
1. Ulcers can develop in 4 to 6 hours, so awareness of the risk for pressure ulcers is so important
2. By the time of pressure ulcer is obvious there is probably already being quite a bit of extensive tissue damage.
3. Treatment of pressure ulcers can include some unusual things, like maggot debridement therapy, but typically involves cleansing with water or saline, removal of dead tissue (debridement) and a dressing that provides a moist but not wet environment for healing. Sometimes a specialized wound care nurse or team is required.
4. Many in the medical field advise protein supplementation to speed ulcer healing. Although evidence is mixed, adequate nutrition can certainly help with overall fitness and recovery.