Dr Sarah Jarvis
My Weekly’s favourite GP from TV and radio writes for you
Over a million people in the UK suffer from pressure sores every year, and they’re a major cause of pain and disability. So how can you avoid them?
Pressure sores happen because of prolonged pressure on a vulnerable area of skin, depriving it of blood and vital oxygen. Small movements then cause friction, further damaging the skin and the tissue beneath it. Sooner or later, the protective layer of skin breaks down, exposing the flesh underneath. Skin over bony areas is at highest risk – over your sacrum or coccyx at the base of your spine, your heels and hips.
Pressure sores are particularly common if you’re older and frail, since you don’t tend to move around as much. If you’re sitting now, flop yourself back and relax all your muscles. Now think about where most of your weight is pressing – yes, it’s on those vulnerable pressure points on your heels and the base of your spine. Now imagine sitting or lying like that for hours at a time.
So one of the biggest risks for developing pressure sores is being immobile. Clearly, this is more likely if you’re laid up in hospital. But pressure sores can strike folk out in the community too, especially in nursing homes. Up to 1 in 10 people in nursing homes or hospital suffers a pressure sore.
Having incontinence increases risk of pressure sores, because it makes you prone to wet skin, which is more easily damaged. So do other long term medical conditions, like heart failure, Parkinson’s disease, arthritis and the lung condition COPD. Any condition which affects
SMOKING DAMAGES THE BLOOD VESSELS, REDUCING BLOOD SUPPLY – NOT SURPRISINGLY, STOPPING SMOKING CUTS THE RISK OF PRESSURE SORES
blood supply to your limbs – peripheral arterial disease, diabetes – also makes them more likely.
Being malnourished greatly increases your risk of developing pressure sores, and also slows down healing. Most folk assume you can only be malnourished if you’re underweight, but that isn’t true at all. Clearly if you’re skin and bone, you’re less likely to get all the vitamins and minerals your body needs to repair itself. But the same applies if you’ve recently lost a lot of weight. Many hospitals now regularly assess patients for malnutrition, and provide oral nutritional supplements, packed with calories and essential nutrients, if they are.
Your risk of malnutrition is high if you’re severely underweight, or you’ve lost more than 10% of your weight in the last 3-6 months, or you’ve been severely ill and unable to eat for some time. If you’re moderately underweight and lost 5-10% of your body weight, your risk is also high.
Once a pressure ulcer has formed, it can take months of careful nursing and regular changes of dressings to heal. Astonishingly, up to 60% of district nursing time is taken up with dressings, and pressure sores make up a large chunk of this workload. They can be very painful and prone to infection, so it’s not surprising that nursing staff work hard to prevent them in the first place. Keep moving – get up every couple of hours. Check your chair – slipping down in it can cause friction on your sacrum. For bedbound patients, specially designed cushions and mattresses help spread the load. Check skin on pressure areas regularly – red is a sign of skin damage. Some hospitals now have access to a SEM Scanner, which looks for early signs of damage before skin becomes red – real potential to prevent pressure sores happening. Next week: New developments for diabetics
IF YOU THINK YOUR LOVED ONE COULD BE AT RISK OF SUFFERING FROM MALNUTRITION, SPEAK TO YOUR HEALTH VISITOR OR GP