Pressure Injury Prevention in Older Adults: A Caregiver Checklist

A pressure injury can begin as a small area of discoloration, but continued pressure and shear can damage tissue beneath the skin. Older adults who spend long periods in bed or a chair should have their risk assessed, their skin checked and their position supported according to an individual care plan before an open wound develops.

A pressure injury, also called a pressure ulcer or bedsore, develops when pressureor pressure combined with shearreduces blood flow to the skin and underlying tissue. It often appears over a bony area such as the heel, ankle, tailbone, hip, elbow, shoulder blade, back of the head or ear. Prevention requires attention to movement, skin, moisture, support surfaces, nutrition and medical conditions together; an air mattress alone is not a complete plan.

This article gives general information for families and caregivers. It does not replace assessment, diagnosis or treatment by a healthcare professional. An older adult with an existing wound, vascular disease, diabetes, swelling, poor nutrition or medical restrictions on repositioning needs an individual plan.

Which older adults are at risk of a pressure injury?

• People with limited mobility who spend long periods in bed, a wheelchair or a chair
• People who cannot reposition themselves or have difficulty communicating pain and discomfort
• People with reduced sensation because of a neurological condition, diabetes or injury
• Anyone with a previous pressure injury or skin that is fragile, swollen, dry, cracked or often damp
• People with bladder or bowel incontinence, which exposes skin to moisture and waste
• People eating poorly, losing weight, living with malnutrition or at risk of dehydration
• People who have recently had surgery, severe illness or a decline in mobility
• People using feeding tubes, oxygen tubing, casts, braces or other devices that press on the skin

Risk can change quickly. Reassessment is important after hospital discharge, surgery, new weakness or a change in mobility, eating or general health.

Areas to check every day and early warning signs

Check the skin from head to toe. Pay particular attention to the back of the head, ears, shoulder blades, spine, elbows, hips, tailbone, knees, ankles and heels, as well as skin beneath tubing, braces and other devices.

• Redness or discoloration that does not fade after pressure is removed
• An area that feels warmer, cooler, firmer, softer or more swollen than nearby skin
• Pain, burning, itching, tenderness or unusual sensitivity
• A blister, abrasion, crack or open area
• Fluid, odor or unusual residue from the skin

On darker skin tones, early damage may not appear bright red. Compare color, temperature, firmness, moisture and tenderness with the surrounding skin. A dated photograph taken according to privacy policies may help the care team monitor change, but it does not replace an assessment.

A seven-part pressure injury prevention checklist

1. Assess risk and review it when health changes

Consider mobility, sensation, nutrition, moisture, medical conditions, medicines, devices and any previous wound. A validated risk tool may support judgement, but it should not replace an assessment by a trained professional.

2. Check the skin systematically and document findings

Set a clear routine and responsibility. Record the location, color, temperature, firmness, moisture, pain and date. If discoloration does not fade, a blister appears or the skin opens, relieve pressure and contact the care team promptly.

3. Reposition according to an individual care plan

No single timetable suits everyone. Frequency depends on risk, skin condition, the mattress or cushion, the persons ability to move, comfort and medical restrictions. NICE recommends frequent repositioning and documentation of the required frequency. A person who cannot move independently should receive help with suitable equipment. Avoid dragging across the bed because this increases shear and friction.

An older adult who is dizzy, weak or recently discharged from hospital also needs a mobility plan that accounts for fall risk. Read more: Fall Prevention Checklist After Hospital Discharge.

4. Choose the mattress, cushion and heel support carefully

A pressure-redistributing surface should match the persons size, position and level of risk. Keep sheets smooth and remove hard objects from beneath the person. Supporting the calves so the heels are free of pressure may help, but the knees, ankles and body must remain safely aligned. A special mattress or cushion does not replace repositioning and skin checks.

5. Keep skin clean, appropriately dry and protected from moisture

Clean the skin promptly after urine or stool, pat gently rather than rubbing, and change damp pads or clothing. Use cleansers, moisturizers or barrier products as advised. Do not massage an area that is discolored, painful, warm or suspected of tissue damage.

6. Match food and fluid support to the health plan

Energy, protein, vitamins, minerals and fluid all matter to skin health, but the right amounts are individual. Kidney disease, heart disease, diabetes, swelling, swallowing difficulty and prescribed fluid or dietary restrictions must be considered. Unplanned weight loss, low intake or an existing wound should prompt assessment by a doctor, dietitian or appropriate care professional. Do not add concentrated protein or supplements without advice.

7. Check clothing, devices and transfer technique

Keep sheets dry and free of wrinkles. Look for pressure from seams, buttons, zips, oxygen tubing, feeding tubes, casts and braces. A wheelchair and cushion should fit the person. Transfers should use appropriate techniques and equipment that reduce dragging, while preserving privacy and dignity.

What should caregivers avoid?

• Do not massage, rub or press again on an area that is discolored, painful or unusually warm.
• Do not use a ring or donut cushion unless an appropriate professional recommends it; pressure can concentrate around the edge.
• Do not apply unapproved creams, herbs, alcohol or makeshift dressings.
• Do not puncture a blister, remove dead tissue or attempt deep wound care at home without training.
• Do not wait for the skin to open before reporting a concerning change.

Warning signs that need medical assessment

Contact a doctor, nurse or wound-care service promptly for discoloration that does not fade, a blister, broken skin, increasing pain, swelling, heat, pus, odor or a wound that is getting worse. Fever, new drowsiness or confusion, a major drop in food or fluid intake, or rapid deterioration needs urgent assessment.

Call Thailands emergency medical service at 1669 for unconsciousness, breathing difficulty, a severe rapid decline or another emergency. Do not transport the person yourself if moving them would be unsafe.

Questions to ask when choosing a nursing home

• How are pressure injury risk and skin assessed on admission and after a health change?
• How are repositioning and pressure-relief plans documented and handed over between shifts?
• Are staff trained in safe transfers, slide sheets and pressure-redistributing equipment?
• How are incontinence, moisture, nutrition and fluid needs considered together?
• Who reviews mattresses, cushions, wheelchairs, tubing and devices that contact the skin?
• How quickly are a nurse, doctor and family informed when a concerning change is found?

Discuss an individual care plan with Khunkha Nursing Home

Khunkha Nursing Home plans care with each family by considering mobility, skin condition, medical conditions, medicines, nutrition, continence, equipment and fall risk. Call 095-047-9091 or contact LINE: @Khunkhahome to ask questions or request an initial, no-obligation assessment.

Frequently asked questions

How often should an older adult be repositioned?

There is no interval that suits everyone. The schedule should reflect risk, skin condition, support surface, ability to move, comfort and medical restrictions. It should be documented and reviewed whenever health changes.

What should a caregiver do first after noticing redness?

Relieve pressure from the area, do not massage or rub it, and record when and what was seen. Contact a healthcare professional promptly if the color does not fade or the area is warm, painful, swollen, blistered or open.

Does an air mattress remove the need to reposition?

No. A pressure-redistributing mattress or cushion may reduce pressure, but it does not replace an individual repositioning plan, skin checks, moisture management, nutrition and monitoring.

Do pressure injuries occur only in people confined to bed?

No. A person who sits in a wheelchair or chair for long periods, cannot shift weight or has a device pressing on the skin can also develop a pressure injury.

Can a family treat a pressure injury at home?

A healthcare professional should first assess the wounds depth, infection risk, circulation, nutrition and cause. An unsuitable dressing or product can hide deterioration or cause harm.

Sources

• Siriraj Hospital: Practice guidance for preventing pressure injuries
• Thailand Department of Health: Common skin conditions in older adults
• NICE: Pressure ulcersprevention and management
• MedlinePlus: Preventing pressure injuries
• NHS: Pressure ulcers
• AHRQ: Skin Under PressurePreventing Pressure Injury