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What Caregivers Need to Know About Bedsores

Your loved ones may be at risk for these pressure sores if they are bedridden or spend most of their time sitting


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If you care for an older person who is bedridden or spends most of the time sitting, you need to be vigilant about bedsores.

Also called pressure sores, pressure ulcers or decubitus ulcers, these wounds develop when something is constantly rubbing or pressing against the skin, causing the skin to break down.

“Pressure sores can get very deep and significantly decrease someone’s quality of life,” says Emily Zhou, M.D., a clinical assistant professor of medicine at New York University and geriatrician at NYU Langone Health.

Besides appearance, bedsores have other telltale signs. The skin might feel warm, look swollen and smell bad. In the advanced stage, they can cause fever, chills and confusion and lead to life-threatening problems.

What causes bedsores?

Pressure ulcers can happen to anyone who sits or lies in the same position for long periods of time with continuous pressure on the same area. Bedsores can escalate quickly and cause significant pain.

While young people can lie in the bed and watch Netflix all day, “older adults ... make less collagen, a protein that helps build the connective tissues in our body,” Zhou says. “Overall, the skin of an older adult is thinner, weaker and less elastic, which puts someone at higher risk for tears, pressure sores (and) bruising.”   

Older adults also have increased pressure on their skin.

“You lose that protective fat pad under the skin,” says Rebecca Conant, M.D., a geriatrician and founding director of the University of California San Francisco Care at Home Program. Urinary or fecal incontinence, which is more common in older adults, can raise the risk for pressure ulcers if the area is not cleaned and cared for properly. Other factors that can raise risk in older adults include poor circulation, certain health conditions, poor nutrition and dehydration.

What do bedsores look like?

Pressure sores crop up in spots where the bone is close to the skin, such as the tailbone, heels or any spot that absorbs constant pressure. What bedsores look like depends on the stage.

Stage 1. An early stage pressure sore may simply look like a bruise that doesn’t go away. On light skin, it could be red or pink. On darker skin, it might be blue, purple or brown. It keeps its color when you press on it. Your loved one may say that it burns or itches, and the area may be warm to the touch.

Stage 2. The skin is broken and the sore looks like a blister with discolored skin surrounding it.

Stage 3. The sore is deeper and will look like a crater. You may be able to see body fat in the ulcer. There may be dark patches of skin around the edges of the sore.

Stage 4. At this point, the sore is so deep that it’s caused damage to muscles, bones, tendons or joints. Life-threatening infections are possible.

When should I see a doctor about bedsores?

If you are new to caregiving or don’t have any experience with pressure sores, talk to your loved one’s doctor before attempting to treat one on your own. 

Your primary care provider may give you instructions to manage stage 1 sores at home. But once the skin breaks, you need specialized guidance from a health care professional.

“That is a stage 2 pressure ulcer, and it needs to be managed,” Conant says. “If it’s very shallow, sometimes we can get away with just adding barrier ointment and keeping it clean, and it will heal.

“But this is where we are starting to get into specialized dressings and wound care,” she says. “So we would often get home health involved.”

How should I treat early stage bedsores?

To familiarize yourself with the care of pressure ulcers, these are the steps your health care provider is likely to recommend for stage 1 bedsores.

Take the pressure off.  As soon as you see a red or purple mark in a high-pressure spot that does not turn white when you press it, “You’ve got to get the pressure off that area,” Conant says. Your health care provider can suggest ways to reposition the person so they are not sitting or lying on the sore spot. For example, if sores are on the heels, they may tell you to elevate the feet.

Add padding. “There are lots of great options out there to redistribute pressure,” Conant says. Your health care provider will take into account the location and cause of the sore and can give you a recommendation on the type of padding — air, gel, water or foam, as well as types of cushions or mattresses — to use.

But be mindful about the type of padding. Whatever you do, Conant says, “please, please do not sit on a donut cushion. It cuts off all blood supply to the tailbone and makes it worse instead of better.”

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If the tailbone is the problem area, use a c-shaped cushion or pad the area with a solid piece of cushioning.

Clean the sore. For a sore that hasn’t broken the skin, your health care provider will probably advise you to gently clean the area with mild soap and water.

If the sore is in an area that might get exposed to urine or feces, protect it with a barrier cream. Once the skin is broken, indicating a stage 2 sore, your doctor may recommend different ways to properly clean the wound, as well which barrier cream to use.

Cover the sore. Depending on the size and stage of the sore, your doctor or home health specialist may recommend dressings such as film, gauze, gel or foam to help prevent infection and encourage healing.

Video: Pressure Ulcers Prevention and Skin Care

What’s the best way to prevent bedsores?

The ideal treatment for pressure ulcers is to stop them from happening. To help keep your loved ones safe, have them:

Eat a well-balanced diet. Eating required daily nutrients — and enough calories — can help prevent ulcers from forming.

“Many older adults don’t get enough protein,” Conant says. “You want them to have at least a gram per kilogram of body weight every day.” That may mean eating high-protein foods at every meal and snack.

Stay hydrated. Hydration stimulates blood flow, which can help prevent pressure sores. Aim for at least six to eight cups of water a day.

Move daily. If it’s possible for your loved ones to move daily to improve circulation and prevent sores, they should. If they are bedridden, a caregiver can gently move their limbs daily.

A home health professional can offer advice.

Reposition often. To ensure any one area doesn't bear pressure for too long, talk to your physician or a home health care professional about proper body placement and the best schedule for position changes. Ideally, you want to move someone who is bedbound at least every two hours and someone in a chair or wheelchair about every 15 minutes.

You will likely need the help of another person or an assistive device, such as a sliding board or draw sheet. Home health professionals can teach you how to move your loved one safely.

Redistribute pressure. Healthcare providers can recommend devices that will redistribute weight and take pressure off any bony areas that might be pressing into a chair or mattress. Padded bandages are one option. “It softens the pressure between the bone and the surface, which is a part of both treatment and prevention,” Zhou says. 

Check high-pressure spots. It's critical to do a daily inspection of your loved one’s skin. “Whether you’re giving them a shower or helping them in the bathroom, look at the skin for redness that isn’t going away,” Conant says.

Be mindful that your loved one's age or medical condition may dull their senses. They may not feel bedsore symptoms such as pain or burning and be unaware that they are developing a sore.

As you check your loved one, pay close attention to these areas:

  • Ankles
  • Back
  • Back of head
  • Buttocks
  • Elbows
  • Heels
  • Hips
  • Shoulders

How to practice good skin care

Help keep your loved one’s skin strong and healthy with these tips:

  • Keep showers short and lukewarm to preserve protective oils on the skin.
  • Instead of soap, opt for gentle cleansers, which won’t strip the skin of essential oils.
  • Choose fragrance-free products, which are less likely to irritate skin.
  • Gently pat the skin dry after bathing.
  • Apply thick, creamy moisturizer while the skin is still damp.
  • If your loved one has fecal or urinary incontinence, apply diaper cream or another barrier cream your health care provider recommends​.

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