Pressure sores in older people: prevention and care at home

By CareFinder Team · Published 2026-09-17 · Last reviewed 2026-09-17

Pressure sores (pressure ulcers) form when skin and tissue are squashed between bone and a surface, cutting off blood supply. They can start within hours in someone who is frail, immobile or unwell. Prevention rests on relieving pressure, checking skin daily, managing moisture and eating and drinking well. Any broken skin or redness that does not fade needs a district nurse or GP assessment the same day — the article below explains why waiting is risky.

Pressure sores — also called pressure ulcers or bedsores — are areas of damaged skin and underlying tissue caused by sustained pressure, usually over a bony part of the body. They can develop in a matter of hours in someone who is frail, immobile or acutely unwell, and they can take months to heal. The good news is that most are preventable, and the things that prevent them are practical, unglamorous and largely within a family's control.

This page is general information, not personal clinical advice. If you are worried about someone's skin now, contact their GP surgery or district nursing team rather than waiting.

What is a pressure sore and where do they form?

When body weight presses skin against a hard surface for too long, the tiny blood vessels in the skin are squashed shut. Without blood, tissue starts to die — sometimes from the inside out, so the surface can look deceptively mild while deeper damage is already done.

The usual sites are wherever bone sits close to the skin:

• Base of the spine (sacrum) and tailbone — by far the most common in people who sit or lie for long periods
• Heels and ankles
• Hips and the sides of the buttocks
• Shoulder blades, elbows and the back of the head
• Ears, from oxygen tubing or glasses
• Under a poorly fitted sling, catheter tube, cast or even a wrinkled sheet

Clinicians grade pressure damage in categories from 1 to 4. Category 1 is intact skin with redness that does not fade when pressed. Category 2 is a shallow open sore or blister. Categories 3 and 4 involve full-thickness loss, exposing fat, muscle or bone. Some wounds are recorded as "unstageable" or as a deep tissue injury where the depth cannot yet be seen. The NHS overview of pressure ulcers covers the symptoms, causes and treatment in more detail; ask the nurse or GP how a particular wound has been categorised.

Who is most at risk?

Risk rises sharply when several of these overlap:

• Reduced mobility — being unable to shift position in bed or a chair without help, or sleeping very deeply
• Recent illness, surgery or hospital admission, especially after a hip fracture
• Poor appetite, weight loss or dehydration — thin tissue cushions less and heals slowly
• Incontinence or heavy sweating — moisture softens skin and makes it easier to damage
• Reduced sensation, for example from diabetes, stroke or spinal problems, so the person does not feel discomfort
• Advanced dementia, where someone may not report pain or move spontaneously
• Very thin or very heavy body weight
• End of life, when the body's circulation and skin integrity change

Staff in hospitals and care homes use a formal risk assessment tool such as Waterlow or Braden, usually on admission and whenever the person's condition changes. At home, a district nurse or community matron can do the same. You are entitled to ask what the score was and what plan follows from it.

How do you prevent pressure sores?

NHS services across the UK teach prevention using the SSKIN bundle. It is a good checklist for families too.

Surface

The right mattress or cushion spreads weight rather than concentrating it. Options range from high-specification foam through to alternating-pressure (air) mattresses for people at high risk. A pressure-relieving cushion matters just as much for anyone who spends the day in a chair — sitting concentrates enormous pressure on a small area. Never use old-style ring or "donut" cushions; they cut off circulation to the tissue in the middle.

Skin inspection

Check the skin at least once a day, ideally when washing or changing. Look at the sacrum, heels, hips and any area under equipment. Press gently on any red patch: if it stays red rather than turning white briefly (non-blanching), treat it as early pressure damage. On brown and black skin, redness is harder to see — look instead for patches that are purplish, bluish or darker than the surrounding skin, and for areas that feel warmer, cooler, firmer, boggy or swollen. Pain or itching in one spot is an early warning too.

Keep moving

Regular repositioning is the single most effective measure. NICE guideline CG179 advises that adults at risk are repositioned at least every six hours, and those at high risk at least every four hours, including overnight. Small, frequent shifts help: a 30-degree tilt using pillows, offloading heels completely by placing a pillow lengthways under the calves, and standing or walking a few steps where possible. Encourage anyone sitting in a chair to change position roughly every 15 to 30 minutes if they can.

Incontinence and moisture

Urine, faeces and sweat break down the skin barrier. Change pads promptly, wash with a pH-balanced skin cleanser rather than soap, pat dry rather than rub, and use a barrier cream or film if the district nurse recommends one. Avoid talc and thick greasy layers that trap moisture. A continence assessment through the GP or district nursing team is free and often overlooked.

Nutrition and hydration

Skin needs protein, calories and fluid to stay intact and to repair. If someone is eating little, ask the GP about a referral to a dietitian and about food-first strategies (fortified milk, snacks between meals) before reaching for supplements. Dehydration is common in older people and easy to miss.

One more thing: do not massage or rub reddened skin over a bony point. It was standard advice decades ago and is now known to cause further damage.

What should you do if you spot one?

Act the same day for anything beyond a red mark that fades within a few minutes.

1. Take the pressure off that area completely — reposition and keep the person off it.
2. Photograph it with the date, if the person consents, so change can be tracked.
3. Contact the district nursing team through the GP surgery, or in a care home tell the nurse in charge and ask for the tissue viability referral. District nurses lead pressure ulcer care in the community across all four UK nations.
4. Ask for a formal assessment: wound category, a documented care plan, equipment review and a review date.
5. Call 111, or 999 if the person is very unwell. Signs of infection — spreading redness, heat, swelling, pus, a foul smell, fever, confusion or sudden deterioration — need urgent attention. Infected pressure ulcers can cause sepsis.

Avoid home remedies. Do not apply antiseptics, hydrogen peroxide or household creams to an open wound, and do not remove dressings put on by a nurse unless you have been shown how.

How are pressure sores treated?

Treatment depends on the category, but the principles are consistent: relieve the pressure, keep the wound clean and appropriately moist, manage pain, treat infection and support nutrition.

• Category 1 usually resolves within days once pressure is removed, with skin protection and closer monitoring.
• Category 2 needs a dressing chosen by a nurse — often a foam or hydrocolloid — changed at set intervals.
• Categories 3 and 4 may need debridement (removing dead tissue), specialist dressings, negative-pressure wound therapy, antibiotics or, rarely, surgery. Referral to a tissue viability nurse is standard.

Healing is slow. Deep ulcers commonly take months, and some in very frail people or at end of life will not heal at all. In that situation the goal shifts honestly to comfort, odour control and pain relief rather than closure — Marie Curie has helpful material on skin care at the end of life.

Who pays for equipment and specialist mattresses?

Pressure-relieving equipment is normally provided free through the NHS or a joint community equipment service when a clinician assesses it as needed. In practice:

• England and Wales: an occupational therapist or district nurse assesses and orders the mattress, cushion or hospital bed. There is no charge for NHS-provided equipment.
• Scotland: equipment usually comes through the local health and social care partnership; see mygov.scot for local contacts.
• Northern Ireland: health and social care trusts provide equipment following assessment — nidirect explains the route.

In a care home, the home is responsible for providing suitable beds and basic pressure-relieving surfaces as part of the fee. Specialist air mattresses are often supplied by the NHS on loan. If someone has a complex, unstable wound, it can also be worth asking about an NHS continuing healthcare assessment, since significant tissue viability needs count in that decision.

If you need help with the funding side generally, MoneyHelper and Age UK both offer free, impartial guidance.

What if a pressure sore develops in hospital or a care home?

Not every pressure ulcer means poor care — some are genuinely unavoidable in people at the very end of life or with failing circulation. But a deep ulcer that appears without anyone noticing, or one that worsens without a change of plan, should be investigated.

What to do:

1. Ask for the care plan and repositioning records and for a meeting with the manager or ward sister.
2. Ask whether a safeguarding referral has been made. In England, where a council has reasonable cause to suspect an adult with care needs is experiencing abuse or neglect it must make safeguarding enquiries under section 42 of the Care Act 2014, so serious pressure damage is often raised with the local authority safeguarding adults team; Wales, Scotland and Northern Ireland have their own safeguarding arrangements, and Northern Ireland's framework is currently policy-based rather than set out in a single adult protection statute. You can raise a concern yourself through the council.
3. Use the formal complaints procedure — the provider's own first, then the relevant ombudsman. In England that is the Local Government and Social Care Ombudsman for councils and adult social care providers, and the Parliamentary and Health Service Ombudsman for NHS care; elsewhere it is the Public Services Ombudsman for Wales, the Scottish Public Services Ombudsman, or the NI Public Services Ombudsman.
4. Tell the regulator: CQC in England, Care Inspectorate in Scotland, Care Inspectorate Wales or RQIA in Northern Ireland. CQC in England does not investigate individual complaints, but uses what it is told in its inspections; the Care Inspectorate in Scotland does have a statutory duty to deal with complaints about registered care services, and anyone can complain to it directly.

Citizens Advice can help you frame a complaint, and if you are considering legal action, take advice from a solicitor experienced in clinical negligence.

Frequently asked questions

How quickly can a pressure sore develop?

Pressure ulcers usually develop gradually, but in a vulnerable person they can sometimes appear over a few hours, and deeper tissue damage can begin before much is visible on the surface. This is why repositioning matters overnight as well as during the day, and why long waits on a trolley, in a chair or in a wheelchair carry real risk.

Is redness always the first sign?

No. On darker skin tones, early damage often shows as a patch that is purplish, bluish or simply darker than the skin around it, sometimes with a change in texture or temperature. Pain, itching or a firm, boggy feel over a bony point can all come before any visible colour change, so use your hands as well as your eyes.

Should I buy an air mattress myself?

Ask for an assessment first. The wrong surface can be less effective than good foam, and an air mattress set at the wrong pressure for someone's weight gives little benefit. If a clinician recommends one, it should normally be supplied by the NHS or community equipment service at no cost rather than bought privately.

Do pressure sores mean someone is neglected?

Not necessarily. Some are unavoidable despite excellent care, particularly at the end of life. What should always be present is evidence of assessment, a prevention plan, the right equipment and prompt action once damage appears. If any of that is missing, it is reasonable to raise a safeguarding concern.

Can a pressure sore be looked after at home?

Yes, very often. District nurses visit to dress wounds, review equipment and train family carers, and GPs manage pain and infection. What matters is that someone with clinical training assesses the wound regularly and that the underlying pressure problem is fixed, not just dressed.

Does a pressure sore affect care home or NHS funding?

It can. A complex wound needing skilled nursing input may support a claim for NHS-funded nursing care in a nursing home, or feed into an NHS continuing healthcare assessment. Ask the district nurse or care home manager to record the wound accurately in any assessment paperwork.

Key takeaways

• Pressure sores come from unrelieved pressure over bony points and can start within hours in a frail or immobile person.
• Prevention follows the SSKIN approach: the right surface, daily skin checks, regular repositioning, moisture management and good nutrition and hydration.
• NICE advises repositioning at least every six hours for adults at risk, and at least every four hours for those at high risk, including overnight.
• Non-blanching redness — or a darker, warmer, firmer patch on brown or black skin — is an early warning; contact the district nursing team the same day.
• Never massage reddened skin and never use ring cushions.
• Pressure-relieving equipment assessed as clinically necessary is provided free by the NHS or community equipment services across the UK.
• If a serious sore develops in hospital or a care home, ask for the records, consider a safeguarding referral, and complain formally if care fell short.
• This is general information; get advice from the GP, district nurse or a specialist adviser for your relative's situation.