Proactive Prevention: The Caregiver's Role in Preventing Pressure Injuries

Pressure injuries, also known as bedsores, are a serious and common complication in the elderly, especially those with limited mobility or in palliative care. This condition not only causes pain and infection but also significantly affects the patient's quality of life and places a burden on caregivers [2]. Caregivers play an essential role in preventing this condition [1, 5]. Understanding risk factors, early signs, and applying appropriate care measures will help protect health and improve the quality of life for patients [1].

1. High-Risk Groups for Pressure Injuries

Pressure injuries can occur in anyone with limited mobility, but some individuals are at higher risk, requiring special attention from caregivers:

1.1. Elderly

Elderly individuals often have fragile skin, reduced elasticity, and slower healing capabilities [3]. They also frequently suffer from underlying conditions such as cardiovascular disease, diabetes, and neurological disorders, which weaken blood circulation and wound healing ability [3].

1.2. Palliative Care Patients

Patients in palliative care are often generally weakened, poorly nourished, and have limited mobility, making them particularly susceptible to pressure injuries [1, 2]. The goal of care for this group is to maintain comfort and quality of life, so pressure injury prevention is a top priority [2].

1.3. Factors Increasing Risk

• Immobility or reduced mobility: Patients who are bedridden or in wheelchairs for extended periods without regular repositioning are at the highest risk [1, 3, 7].
• Malnutrition and dehydration: A diet lacking protein, vitamins, and minerals reduces skin and tissue regeneration, increasing skin fragility [2, 3, 7]. Dehydration affects skin elasticity [1].
• Cognitive impairment or reduced sensation: Patients cannot recognize or express discomfort when experiencing pressure, or are unable to reposition themselves to relieve pressure [3, 7].
• Fragile, dry skin, or frequent exposure to moisture: Skin that is exposed to urine, feces, or sweat for prolonged periods can become macerated and damaged [2, 7].
• Underlying medical conditions: Diabetes, cardiovascular disease, neurological disorders, and anemia can affect blood circulation and weaken the skin's resilience [3, 7].

2. Early Signs of Pressure Injuries

Early recognition of pressure injury signs is crucial for timely intervention and preventing severe complications [2, 6]. Caregivers should pay special attention to checking the patient's skin at least twice daily, especially over bony prominences [1].

2.1. Skin Changes

• Redness that does not blanch with pressure: This is the earliest warning sign. When pressure is applied to a red area and then released, if the skin does not turn white, it indicates damage to the capillaries beneath the skin [2]. In individuals with darker skin tones, this sign may be harder to detect; the skin may appear purple or bluish [2].
• Skin discoloration: The affected skin area may have an unusual purple or bluish tint, especially in individuals with darker skin tones [2].
• Skin feeling warmer or cooler than surrounding areas: The affected area may feel warmer or cooler compared to the surrounding healthy skin [2].
• Swelling, firmness, or softness compared to surrounding skin: The texture upon touching the affected area may feel different from healthy skin [2].

2.2. Other Signs to Watch For

• The patient complains of pain or itching in the affected skin area [2].
• Small blisters or minor skin lesions appear on the skin surface.

3. Dire Consequences of Ineffective Prevention

If not prevented and treated promptly, pressure injuries can lead to numerous serious consequences, affecting the patient's physical, mental, and quality of life [2, 7].

3.1. Local Complications

• Deep ulcers, tissue necrosis: The ulcer can penetrate deep into the skin layers, muscle, and even bone, causing tissue necrosis [3].
• Skin and soft tissue infections: An open ulcer provides an entry point for bacteria, causing local infection, swelling, redness, pain, and pus discharge [3].

3.2. Systemic Complications

• Sepsis (blood infection): Bacteria from the ulcer can enter the bloodstream, causing systemic infection, which can be life-threatening [3].
• Osteomyelitis: If the ulcer penetrates to the bone, it can cause osteomyelitis, a very difficult complication to treat [3].
• Increased mortality risk: Severe pressure injuries, especially when complicated by infection, significantly increase the risk of mortality in the elderly and debilitated patients [1].

3.3. Impact on Quality of Life

• Persistent pain and discomfort: Significantly affects the patient's psychology, sleep, and social interaction [1].
• Prolonged treatment and hospitalization: Treating pressure injuries often requires significant time, effort, and cost, prolonging hospitalization or requiring specialized home care [3].
• Financial and psychological burden on families and caregivers: Medical costs, time, and caregiving efforts can place immense pressure on families and caregivers [1, 2, 7].

4. Recommended Actions: The Caregiver's Proactive Role

Caregivers play a central role in preventing pressure injuries [1, 5]. Implementing the following recommendations will significantly reduce the risk and improve the quality of care:

4.1. Risk Assessment and Regular Skin Monitoring

• Use risk assessment tools: If possible, caregivers should learn and use pressure injury risk assessment scales such as the Braden Scale to determine the patient's risk level [2, 3, 7].
• Inspect skin at least twice daily: Focus on bony prominences such as heels, ankles, hips, sacrum, elbows, shoulders, and back of the head [2]. Pay attention to non-blanchable redness, changes in skin temperature or texture [2].
• Document skin condition: Keep records of skin changes to track progression and report to healthcare professionals if necessary.

4.2. Frequent and Proper Repositioning

• Reposition bedridden patients: Caregivers should help change the patient's position every 2-4 hours [1, 2].
• Reposition wheelchair users: Patients in wheelchairs need assistance to lift themselves or change position every 15-30 minutes to relieve pressure [2, 7].
• Use lifting techniques: When moving patients, lift them instead of dragging to avoid friction and shear forces that can damage the skin [2].
• 30-degree tilted position: Positioning the patient at a 30-degree tilt or prone (if the condition allows) can help relieve pressure on the sacral area [1, 2].

4.3. Skin Care and Moisture Control

• Keep skin clean and dry: Cleanse skin daily with mild soap, avoiding vigorous rubbing [2, 9].
• Moisturize skin regularly: Use moisturizers to maintain skin elasticity, especially in dry areas [2, 6, 9].
• Manage incontinence: Use appropriate diapers or briefs and change them promptly to prevent prolonged skin contact with waste [2, 7]. Use skin barrier products (barrier creams) when necessary [2, 7].

4.4. Adequate Nutrition and Hydration

• Diet rich in protein, vitamins, and minerals: Ensure the patient receives sufficient nutrients to support wound healing and maintain skin health [2, 3, 6, 7].
• Drink enough water: Encourage the patient to drink enough water to maintain skin hydration and overall body function [2, 7].
• Consult a nutritionist: If the patient has nutritional issues, consult a nutritionist for an appropriate plan [2].

4.5. Use of Support Devices

• Pressure-relieving mattresses: Use air, water, or specialized foam mattresses to distribute pressure and reduce the risk of pressure injuries [2, 3, 7].
• Specialized pillows: Use small pillows or cushions to support bony prominences (heels, ankles, elbows) to relieve pressure [2, 7].
• Pressure-relieving cushions for wheelchairs: For wheelchair users, specialized cushions are needed to effectively distribute pressure [2, 7].

4.6. Education and Awareness for Caregivers

• Participate in training courses: Caregivers should attend courses or workshops on pressure injury prevention [1, 5, 6, 8, 10].
• Update knowledge and skills: Regularly seek new information and practice caregiving skills to ensure effectiveness [1].
• Communicate with healthcare professionals: Always maintain communication with doctors and nurses to receive specific and timely guidance [1, 2].

5. Frequently Asked Questions (FAQ)

1. What areas of the body are prone to pressure injuries? Pressure injuries commonly occur over bony prominences where skin and soft tissues are compressed between bone and a hard surface for extended periods. Common locations include the sacrum (tailbone area), heels, ankles, hips, elbows, shoulders, and back of the head [2, 7].

2. How can I tell if an elderly person is at high risk for pressure injuries? Elderly individuals are at high risk if they have limited mobility, are bedridden or in a wheelchair for extended periods, are malnourished, have underlying medical conditions (diabetes, cardiovascular disease), cognitive impairment, or fragile skin [3, 7]. Using risk assessment scales such as the Braden Scale can help identify risk more clearly [2, 7].

3. How often should a patient's position be changed? For bedridden patients, repositioning should occur every 2-4 hours [1, 2]. For wheelchair users, they should be assisted to lift or change position every 15-30 minutes [2, 7]. However, specific frequency can be adjusted based on skin condition, mobility level, and the type of support surface used [1, 7].

4. What role does nutrition play in preventing pressure injuries? Adequate nutrition, especially protein, vitamins, and minerals, is crucial for maintaining skin health, boosting the immune system, and supporting wound healing [2, 7]. Malnutrition significantly increases the risk of developing and delays the healing of pressure injuries [2, 7].

5. Is it necessary to use a pressure-relieving mattress in all cases? Pressure-relieving mattresses (air, water) are recommended for individuals at high risk or who already have pressure injuries to help distribute pressure [2, 7]. However, the selection of an appropriate mattress should be based on the patient's specific condition, risk level, and healthcare professional's advice [2, 7].

6. When should a patient be taken to a medical facility if a pressure injury is discovered? A patient should be taken to a medical facility immediately if the ulcer shows signs of infection (swelling, warmth, redness, pain, pus, fever), is deep, necrotic, or if home care measures are ineffective and the ulcer is worsening [3].

6. Expert Review & References

• Expert Consultant: Master of Nursing. Nguyen Thanh Ngoc - Department of Geriatrics - Palliative Care, University Medical Center HCMC
• Date Updated: 2025-11-15
• References:
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  • [2] Chen, Y., Cai, T., Le, P., Zhang, L., Chen, Y., Wu, L., Chen, K., Yuan, C., & Lu, Y. (2025). Family caregivers’ perceptions and challenges in the care of pressure injuries in daily life: a qualitative study. BMC Geriatrics, 25(1), 490. https://pmc.ncbi.nlm.nih.gov/articles/PMC12232193/. Accessed: 2025-11-15.
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  • [5] Mamom, J., & Daovisan, H. (2022). Telenursing: How do caregivers treat and prevent pressure injury in bedridden patients during the COVID-19 pandemic in Thailand? Using an embedded approach. Journal of Telemedicine and Telecare, 28(10), 755–763. https://pmc.ncbi.nlm.nih.gov/articles/PMC8927889/. Accessed: 2025-11-15.
  • [6] Alkhatieb, M. T., Shigdar, R. W., Alkhalifah, Z. A., Alkhalifah, H. A., Alsabri, H. F., Attar, L. W., Fatani, H. Z., & Alnahdi, H. M. (2025). Knowledge and confidence regarding pressure ulcer prevention among caregivers of high-risk individuals: A pre- and post-education assessment in a single-center. PEC Innovation, 6, 100393. https://pmc.ncbi.nlm.nih.gov/articles/PMC12416089/. Accessed: 2025-11-15.
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  • [9] Lyder, C. H., & Ayello, E. A. (2008). Pressure Ulcers: A Patient Safety Issue. In R. G. Hughes (Ed.), Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Agency for Healthcare Research and Quality (US). https://www.ncbi.nlm.nih.gov/books/NBK2650/. Accessed: 2025-11-15.
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The information above is for reference purposes only and does not constitute medical advice. Please consult a doctor for detailed advice.