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3 tips to prevent bed sores

The Bottom Line

  • Research evidence shows that mattresses made with higher density (more supportive) foam can help prevent pressure sores - also known as bed sores - from developing or worsening. 
  • Sheepskin overlays also help lower the likelihood of pressure sores.
  • Remember to change position regularly. Setting an alarm or playing music on a regular schedule can help provide a cue that it’s time to move

Our beds can be places of comfort and healing, whether we are recovering from an injury or illness or laid up due to mobility issues or frailty. Unfortunately, even when confined to our beds we can face complications that can lead to more discomfort and hinder our healing, such as pressure sores.


Pressure sores - also called pressure ulcers and bed sores - are injuries to the skin and the tissue underneath caused by constant pressure or friction when sitting or lying down for a long time without changing position (1). Hospital patients and people who are immobile due to injury or medical conditions are especially vulnerable (2), as are frail older adults (3). Pressure sores are painful, often difficult to treat, can lead to even more serious complications and are a major burden for patients, their families and healthcare providers (4).


One important solution is to prevent pressure sores in the first place by reducing the pressure on the body, but how?


A recent systematic review included 59 studies that examined various products and strategies with the goal of finding out whether they help prevent pressure sores as well as which ones are most effective (5). The strategies were designed to relieve pressure by either cushioning the bonier parts of the body - heels, knees, hips, tailbone - or by redistributing body weight. “Low-tech” options included mattresses with enhanced features, such as higher density foam and special fillings (gel, air, water or beads). The researchers also measured the benefits of mattress covers, overlays (e.g. medical grade sheepskin) and specially designed cushions (e.g. limb protectors, and wheelchair cushions).


The studies also assessed some “high-tech” strategies such as alternating pressure mattresses featuring air pockets that mechanically fill and deflate to provide cushioning and relieve pressure.


What the research tells us

The good news is that low-tech, lower cost solutions do help. Research evidence shows that mattresses made with higher density foam can help prevent sores from developing or worsening. People who used these types of mattresses were less likely to develop pressure sores than people lying on standard foam mattresses of the type found in many homes and hospitals. Sheepskin overlays also helped lower the likelihood of pressure sores.


Further study is needed to determine the benefits and cost effectiveness of high tech solutions like alternating pressure mattresses and other types of pressure-relieving mattresses and overlays.


Another tip: remember to change position regularly. Although decisions about the best positions and how often to move are not universally agreed upon (6) and may depend on the type of support surface and condition of the patient (1), regular repositioning is still recognized and supported by research evidence as an effective and simple way to help prevent pressure sores (1,6,7). Setting an alarm or playing music on a regular schedule can help provide a cue that it’s time to move (7). Ontario nursing guidelines recommend changing sitting position at least once every hour (8).


For people confined to beds and chairs, whether temporarily or long term, pressure sores are an additional, serious concern. It is good to know that relatively simple and inexpensive options are available to offer relief.



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References

  1. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: quick reference guide. [Internet] 2014. [cited June 2016]. Available from: http://www.npuap.org/wp-content/uploads/2014/08/Updated-10-16-14-Quick-Reference-Guide-DIGITAL-NPUAP-EPUAP-PPPIA-16Oct2014.pdf
  2. Vanderwee K, Clark M, Dealey C et al. Pressure ulcer prevalence in Europe: a pilot study. J Eval Clin Pract. 2007; 13(2):227–235.
  3. Ronda L, Falce C. Skin care in older people. J Prim Health Care. 2002; 12(7):51–57.
  4. Franks PJ, Winterberg H, Moffatt CJ. Health-related quality of life and pressure ulceration assessment in patients treated in the community. Wound Repair Regen. 2002; 10(3):133–140.
  5. McInnes E, Jammali-Blasi A, Bell-Syer S et al. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev. 2015, Issue 9. Art. No.: CD001735. DOI: 10.1002/14651858.CD001735.pub4.
  6. Gillespie BM, Chaboyer WP, McInnes E et al. Repositioning for pressure ulcer prevention in adults. Cochrane Database Syst Rev. 2014, Issue 4. Art. No.: CD009958. DOI: 10.1002/14651858.CD009958.pub2.
  7. Yap TL, Kennerly SM, Simmons MR et al. Multidimensional team-based intervention using musical cues to reduce odds of facility-acquired pressure ulcers in long-term care: a paired randomized intervention study. J Am Geriatr Soc. 2013; 61(9):1552–1559.
  8. Registered Nurses’ Association of Ontario. Assessment and management of stage I to IV pressuer ulcers (Revised). [Internet] 2007. [cited July 2016]. Available from  http://rnao.ca/sites/rnao-ca/files/Assessment__Management_of_Stage_I_to_IV_Pressure_Ulcers.pdf

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