A red mark over the tailbone, heel or hip can appear quickly, particularly after a long day in a chair or a period of illness in bed. It may seem minor, but skin that stays red, warm, painful or discoloured after pressure is relieved needs prompt attention. Knowing how to prevent pressure injuries helps protect comfort, mobility and independence before a small concern becomes a difficult wound.
Pressure injuries, also called pressure sores or bed sores, occur when sustained pressure, friction or shear damages the skin and underlying tissue. They are common where bone sits close to the surface, including the heels, sacrum, hips, ankles, elbows and shoulder blades. Prevention works best when it is part of everyday care, not something started only once skin breaks down.
Who is most at risk?
Anyone who cannot regularly change position without help may be at risk. This can include older people, people living with disability, people recovering from surgery or injury, and people who are unwell or spending extended periods in bed or a wheelchair.
Risk increases when mobility is limited, sensation is reduced, or a person cannot reliably feel discomfort and shift their weight. Moisture from perspiration or continence issues, poor nutrition, dehydration, fragile skin and some medical conditions can also make skin more vulnerable. Equipment that does not fit properly can add pressure in the wrong places.
A person may be at risk for only a short period, such as during recovery at home, or over the long term. The right approach depends on their mobility, skin condition, medical needs, daily routine and the surfaces they use. An Occupational Therapist, nurse, physiotherapist or GP can help develop an individual pressure-care plan where risk is high.
How to prevent pressure injuries with regular movement
Changing position is one of the most effective ways to reduce prolonged pressure. The goal is to redistribute weight before the skin and tissue are damaged. For someone who can move independently, this may mean standing, walking a short distance, or shifting their weight in the chair throughout the day.
For a person who needs assistance, repositioning needs to be planned into the care routine. In bed, this may involve alternating positions and using pillows or positioning aids to support the body without putting pressure directly on vulnerable areas. In a chair, it may mean assisted weight shifts, tilt functions on a powered wheelchair, or time out of the chair where practical.
There is no single repositioning schedule that suits everyone. A person with very fragile skin, reduced sensation or an existing injury may need more frequent changes than someone at lower risk. Follow the advice in their clinical care plan, and adjust it if skin changes, discomfort or illness develops.
Avoid dragging a person across sheets or sliding them down in a chair. This creates shear, where the skin stays in place while deeper tissue moves, and can cause damage that is not immediately visible. Slide sheets, transfer aids, correctly adjusted hoists and safe handling techniques can reduce this risk for both the person receiving care and the carer.
Check skin early and consistently
A brief skin check each day can identify concerns while they are still reversible. Focus on bony areas, skin beneath medical devices, and places exposed to moisture or rubbing. Check during dressing, showering, transfers or continence care so it becomes a normal part of the routine.
Look for redness that does not fade after pressure is removed, darker or purple discolouration on deeper skin tones, warmth, swelling, hardness, tenderness, blisters or broken skin. A person with reduced sensation may not report pain, so visual checks are especially valuable.
Keep skin clean and gently dry it after washing. Use products suited to continence care where needed, as prolonged moisture can weaken the skin and increase friction. Avoid vigorous rubbing, harsh soaps and heavily perfumed products that may irritate already fragile skin. Moisturising dry skin can be helpful, but apply products as directed and ensure they do not affect the safe use of dressings, adhesives or equipment.
If a new mark does not resolve after pressure is relieved, or if there is broken skin, seek clinical advice promptly. Do not massage a red or discoloured area, as this can cause further tissue damage.
Choose pressure-care equipment that matches the person
A pressure-care mattress, overlay or cushion can help spread weight more evenly, but it does not replace movement, skin checks or good clinical care. The best option depends on the person’s weight, posture, transfer ability, level of risk and whether they spend most of their time in bed, a lounge chair, a manual wheelchair or a powered mobility device.
For bed-based care, a pressure-relieving mattress or alternating air system may be appropriate for people who are unable to reposition independently or have high clinical risk. The bed base, mattress size and side-rail requirements all matter. An adjustable bed can also assist with positioning and transfers, though raising the backrest too high for extended periods can increase shear around the sacrum if the person slides down.
For seated care, a properly selected pressure-relieving cushion supports pelvic position as well as pressure distribution. A cushion that is too soft, too small or incorrectly placed can affect balance and transfers. Wheelchair seating should be assessed carefully, particularly after weight changes, a decline in mobility, new pain or a change in posture.
Heels deserve particular attention because they can be under pressure even when the rest of the body is well positioned. Heel offloading devices or pillows placed under the calves can lift the heels clear of the mattress when clinically appropriate. Do not use doughnut-shaped cushions, as they can concentrate pressure around the area they are intended to protect.
Equipment trials can be useful when needs are changing or when a person has complex seating and positioning requirements. A practical assessment helps make sure the equipment is comfortable, usable and suitable for the home or care environment.
Support skin from the inside
Skin needs adequate nutrition and fluid to remain resilient and repair itself. Illness, poor appetite, swallowing difficulties, weight loss and dehydration can all increase pressure-injury risk. Encourage regular meals, adequate protein and fluids in line with the person’s health needs and any prescribed dietary restrictions.
For someone eating poorly, losing weight without trying, or recovering from a wound, speak with their GP, dietitian or treating team. Nutrition supplements may be recommended, but they should support an individual care plan rather than replace ordinary meals where those are possible.
Continence management is also part of prevention. Prompt changes of pads or garments, suitable barrier products and well-fitted continence aids help keep moisture away from the skin. If leakage is frequent or new, reviewing the product choice and care routine can make a meaningful difference.
Make prevention workable for carers and care teams
The most effective plan is one that can be followed on a busy day. Record any areas of concern, note when positions have been changed where this is part of formal care, and ensure everyone involved knows the person’s preferred transfer methods and equipment setup. Consistency matters when family members, support workers and clinical teams share care.
Keep sheets smooth and free from crumbs, tubing or objects that can press into the skin. Check that footwear, braces, compression garments and medical devices are correctly fitted and not causing rubbing. Small adjustments, made early, often prevent bigger problems.
For home care, prepare the essentials close by: transfer aids, pillows or positioning supports, continence supplies, skin-care products and any prescribed dressings. This reduces rushed handling and makes safe routines easier to maintain. NevMed can assist with practical pressure-care, mobility and transfer equipment options for home, aged-care and clinical settings.
A pressure injury is not always avoidable, especially when a person is critically unwell or has complex health needs. But attentive daily care, suitable equipment and fast action when skin changes appear can greatly reduce the risk. If something does not look or feel right, treat it as a reason to review the plan, not a reason to wait.