Bed sores in elderly people can become a serious health problem, particularly when dementia, reduced mobility, incontinence or poor nutrition make it difficult to protect the skin.
Bed sores are also known as pressure sores, pressure ulcers or pressure injuries. They develop when prolonged pressure, friction or shear damages the skin and the tissue underneath it.
People living with dementia may be especially vulnerable because they may have difficulty moving independently, communicating discomfort or understanding why they need to change position.
The good news is that many pressure injuries can be prevented. Early detection is also important because a small area of skin damage can become much more difficult to treat if pressure continues.
According to MedlinePlus, people who spend much of the day in bed or a chair, cannot reposition themselves, have incontinence or have reduced sensation are at increased risk of pressure injuries.
What Are Bed Sores?
A pressure injury develops when sustained pressure reduces blood flow to an area of skin and underlying tissue.
Without adequate blood flow, the tissue receives less oxygen and nutrients and can eventually become damaged.
Bed sores most often form over bony parts of the body where there is relatively little padding between the skin and bone.
Common locations include:
- Heels
- Ankles
- Hips
- Tailbone and sacrum
- Elbows
- Shoulder blades
- Spine
- Back or sides of the head
- Ears
The Mayo Clinic explains that pressure injuries can develop over hours or days, particularly when someone cannot change position easily.
Why Are Bed Sores in Elderly People More Common?
Age alone does not cause a pressure injury, but older adults are more likely to have several risk factors at the same time.
These can include:
- Reduced mobility
- Fragile or thinner skin
- Reduced circulation
- Diabetes or vascular disease
- Reduced sensation
- Incontinence
- Dehydration
- Poor appetite or malnutrition
- Being underweight or significantly overweight
- Spending long periods in a bed, recliner or wheelchair
- Previous pressure injuries
This is why preventing bed sores in elderly people usually requires looking at the person’s overall health, mobility, nutrition, continence and skin condition rather than focusing on one factor alone.
Why Dementia Can Increase the Risk of Bed Sores
Dementia can make pressure injury prevention more complicated.
A person may not recognize discomfort or remember that changing position can relieve pressure. Others may have difficulty communicating pain, particularly in later stages of dementia.
Some people may also become frightened or distressed when a caregiver tries to move them because they do not understand what is happening.
Rather than viewing this as the person being “non-compliant,” it can help to consider what may be causing the resistance.
Helpful approaches can include:
- Explaining what you are going to do before touching or moving the person
- Using a calm, reassuring tone
- Moving slowly
- Offering simple choices where possible
- Watching facial expressions and body language for signs of pain
- Trying again later if the situation is not urgent and the person is becoming distressed
See our guide to caring for someone with dementia for more strategies.
What Causes Pressure Injuries?
Three mechanical forces play particularly important roles.
Pressure
Prolonged pressure between a bone and an external surface such as a mattress, chair or wheelchair can reduce blood flow to tissue.
The greater the pressure and the longer it continues, the greater the risk of tissue injury.
Friction
Friction occurs when skin rubs against bedding, clothing or another surface.
Fragile skin can be damaged more easily, especially when it is also damp.
Shear
Shear occurs when deeper tissues move while the skin remains relatively fixed.
A common example occurs when the head of a bed is raised and the person’s body gradually slides downward.
The skin may stay against the sheet while deeper tissue moves, placing stress on small blood vessels.
Moisture and Incontinence
Repeated exposure to urine, stool or perspiration can weaken the skin and increase the likelihood of damage.
This makes careful continence management particularly important for people living with dementia and incontinence.
Poor Nutrition and Hydration
Healthy skin and wound healing require adequate energy, protein, vitamins, minerals and fluid.
Unplanned weight loss, poor appetite and dehydration can therefore increase pressure-injury risk.
Warning Signs of a Pressure Injury
Early identification can prevent a minor problem from becoming a deeper wound.
Look for:
- A persistent change in skin color
- Redness that does not fade when pressure is removed
- Dark red, maroon or purple discoloration
- An area that feels warmer or cooler than nearby skin
- Skin that feels unusually firm, soft or spongy
- Swelling
- Tenderness or pain
- A blister
- Broken skin
- Drainage from a wound
Skin color changes may be harder to recognize in darker skin tones, so changes in temperature, firmness and texture are also important.
Any suspected pressure injury in a frail older adult should be assessed by a healthcare professional.
Stages of Pressure Injuries
Healthcare professionals classify pressure injuries according to the depth and type of tissue damage.
The National Pressure Injury Advisory Panel (NPIAP) uses Stage 1 through Stage 4, together with unstageable pressure injury and deep tissue pressure injury.
Stage 1 Pressure Injury
The skin remains intact, but there is an area of persistent non-blanching redness or discoloration.
In darker skin, the color change may not look bright red. Differences in temperature, firmness or sensation may provide additional clues.
Stage 2 Pressure Injury
There is partial loss of the outer layers of skin.
The wound may look shallow and pink or red, or it may appear as an intact or ruptured blister.
Stage 3 Pressure Injury
There is full-thickness loss of skin, and fatty tissue beneath the skin may be visible.
The wound may extend deeper than it first appears and requires professional wound assessment and treatment.
Stage 4 Pressure Injury
There is full-thickness skin and tissue loss with deeper structures such as muscle, tendon, cartilage or bone exposed or directly palpable.
Stage 4 injuries are serious wounds requiring specialist medical care.
Unstageable Pressure Injury
Sometimes the bottom of a deep wound is covered by dead tissue or eschar, making it impossible to determine its true depth until a clinician can assess it properly.
Deep Tissue Pressure Injury
A deep tissue pressure injury may appear as persistent dark red, maroon or purple discoloration, or sometimes a blood-filled blister.
Damage can exist beneath apparently intact skin and may progress rapidly.
Do not try to determine the stage of a serious wound yourself. Accurate staging should be performed by a healthcare professional with appropriate wound-care training.
How Are Bed Sores in Elderly People Treated?
Yes. Many pressure injuries can heal, particularly when they are identified early and the pressure that caused them is removed.
However, deeper pressure injuries may take weeks or months to heal and some may never heal completely.
The first priority is usually to relieve pressure from the affected area.
Professional treatment may also involve:
- Assessment and measurement of the wound
- Appropriate wound cleaning
- Specialized dressings
- Removal of dead tissue when medically appropriate
- Pain management
- Management of infection where present
- Pressure-redistributing mattresses or cushions
- Nutritional assessment
- Management of underlying medical problems
The Mayo Clinic notes that treatment depends on the depth and severity of the wound and may involve a multidisciplinary healthcare team.
How to Prevent Bed Sores in Elderly People With Dementia
Prevention should be individualized to the person’s mobility, health, skin condition and level of risk.
1. Reposition Regularly
People who cannot change position independently need assistance to relieve pressure.
There is no single repositioning schedule that is right for everyone.
The NPIAP recommends choosing repositioning frequency according to factors including the support surface, the person’s tolerance of pressure and individual preferences.
A 2024 NPIAP prevention protocol suggests repositioning people without independent bed mobility approximately every two to three hours where appropriate, but clinical circumstances can require a different schedule.
This is preferable to assuming that every person must automatically be turned exactly every two hours.
A nurse, doctor, wound-care specialist, occupational therapist or physical therapist can help develop an appropriate plan.
2. Use Pressure-Redistributing Surfaces
Specialized mattresses, overlays, wheelchair cushions and heel-offloading devices can reduce pressure on vulnerable areas.
The correct product depends on the person’s mobility, body size, skin condition, existing wounds and how much time they spend in bed or seated.
Avoid choosing equipment purely on the basis of advertising claims. Ask the healthcare team what type of support surface is appropriate.
3. Protect the Heels
Heels are particularly vulnerable because there is little soft tissue between the skin and bone.
For someone at high risk, a healthcare professional may recommend positioning or equipment that allows the heels to be completely offloaded from the mattress.
4. Keep Skin Clean and Dry
Clean the skin promptly after episodes of incontinence and dry it gently.
Barrier creams or other skin-protective products may be recommended when urine or stool repeatedly contacts the skin.
The NICE pressure-ulcer guideline recommends considering a barrier preparation for people at high risk of moisture-associated skin damage.
5. Reduce Friction and Shear
Avoid dragging a person across sheets when repositioning them.
Where possible, use appropriate lifting or transfer equipment and techniques.
Keeping bedding smooth and free from wrinkles and avoiding unnecessarily high elevation of the head of the bed can also reduce shear.
6. Check the Skin Every Day
For someone at high risk, check vulnerable areas regularly.
Pay particular attention to:
- Heels
- Ankles
- Hips
- Sacrum and tailbone
- Elbows
- Shoulder blades
- Back of the head
- Ears
Also check underneath or around medical devices such as oxygen tubing, braces and catheters where they contact the skin.
7. Support Nutrition and Hydration
A balanced diet and adequate fluid intake are important for maintaining healthy skin.
Someone with an existing pressure injury who is losing weight, eating poorly or showing signs of malnutrition may benefit from assessment by a dietitian.
NICE recommends nutritional assessment for adults who already have a pressure ulcer rather than automatically giving supplements to everyone.
Read more about nutrition and dementia.
8. Maintain Mobility Where Possible
Any safe movement can help reduce long periods of pressure in one location.
Depending on the person’s abilities, this might involve:
- Standing with assistance
- Short supervised walks
- Transferring between a bed and chair
- Changing sitting position
- Physical therapy exercises
A physical therapist can advise on safe exercise and mobility for someone with dementia.
Bed Sores and Incontinence
Incontinence deserves particular attention because moisture and contact with urine or stool can damage already fragile skin.
Helpful measures can include:
- Promptly changing wet or soiled continence products
- Gentle cleansing after episodes of incontinence
- Drying rather than rubbing the skin
- Using a suitable barrier product when advised
- Using absorbent products that wick moisture away from the skin
- A person-centered toileting routine where practical
See our guide to incontinence products for people with dementia.
Signs a Pressure Sore May Be Infected
Bed sores in elderly people can become infected, particularly when a wound is deep or difficult to keep clean.
Seek prompt medical advice if there is:
- Increasing redness, discoloration, warmth or swelling
- Pus or increased drainage
- A bad smell from the wound
- Increasing pain
- Fever
- Rapid deterioration of the wound
People with dementia may not be able to describe pain or feeling unwell clearly, so caregivers should also watch for sudden changes in behavior, alertness, appetite or mobility.
Sepsis Is a Medical Emergency
A serious wound infection can sometimes lead to sepsis.
Sepsis is the body’s extreme response to an infection and can become life-threatening very quickly.
The Centers for Disease Control and Prevention advises seeking immediate medical care when sepsis is suspected.
Warning signs can include:
- New confusion or disorientation
- Shortness of breath
- Fever, shivering or feeling unusually cold
- Clammy or sweaty skin
- Extreme pain or discomfort
- A fast heart rate or weak pulse
If someone with a pressure injury becomes suddenly very unwell, seek urgent medical care.
When Should You Contact a Healthcare Professional?
Contact a healthcare professional if you notice a new area of persistent redness, discoloration, broken skin or another suspected pressure injury.
Medical assessment is particularly important when:
- The skin has broken down
- The wound is deep
- There is dark purple or maroon discoloration
- There is drainage or a bad smell
- The person has diabetes or poor circulation
- The injury is worsening
- The person is in significant pain
- There are signs of infection
More advanced pressure injuries generally require professional wound care rather than home treatment alone.
Bed Sores in Elderly People: The Bottom Line
Bed sores in elderly people are common when mobility, skin health, nutrition or continence are compromised, and dementia can make prevention and treatment more challenging.
The most useful strategy is prevention: reduce prolonged pressure, help the person reposition, keep skin clean and dry, support nutrition and hydration, use appropriate pressure-relieving equipment and inspect vulnerable skin regularly.
If a pressure injury develops, getting professional advice early can make treatment easier and reduce the risk of the wound becoming deeper or infected.
For someone with dementia, care should also remain person-centered. Pain, fear and confusion may affect how the person responds to wound care and repositioning, so gentle communication and an individualized plan are important.
