Pressure Injury Prevention for Seniors Who Sit or Lie Down

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Seniors Blue Book

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Posted on

Aug 06, 2026

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National

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Spending more time in a bed, recliner, or wheelchair may be necessary after an illness, injury, surgery, or change in mobility. It also means the skin needs closer attention.

A pressure injury can begin when one area of the body remains under pressure for too long. It may start as a small area of discoloration, warmth, firmness, or tenderness before the skin opens.

Early action matters. Pressure injuries can become painful, difficult to heal, and vulnerable to serious infection. Seniors and caregivers can reduce the risk by checking the skin, changing positions, managing moisture, and using equipment that fits correctly.

What Is a Pressure Injury?

A pressure injury is damage to the skin or tissue underneath it. It is also called a pressure sore, pressure ulcer, or bedsore.

Pressure injuries commonly form where a bone is close to the skin, including the:

  • Heels
  • Ankles
  • Hips
  • Tailbone
  • Buttocks
  • Elbows
  • Shoulder blades
  • Spine
  • Back of the head
  • Ears

Pressure reduces blood flow to the affected area. Friction, sliding, moisture, and poorly fitted equipment can add to the damage.

Who Is Most at Risk?

Pressure injuries can affect anyone who cannot change position easily, but certain factors increase the risk.

These include:

  • Staying in bed for extended periods
  • Using a wheelchair
  • Needing help with transfers
  • Reduced sensation
  • Paralysis or weakness
  • Fragile or dry skin
  • Urinary or bowel incontinence
  • Diabetes or vascular disease
  • Poor appetite or unintended weight loss
  • Memory or communication difficulties
  • Medical tubing, braces, masks, or other devices pressing on the skin

AHRQ pressure injury prevention resources identify mobility, moisture, nutrition, sensation, friction, shear, continence, and medical-device pressure as important areas to assess.

1. Check the Skin Every Day

A pressure injury may be easier to manage when it is recognized before the skin opens.

Inspect the skin at least daily. People at higher risk may need more frequent checks based on their care plan.

Use good lighting and check areas that may be difficult for the senior to see. A hand mirror can help, or a caregiver can inspect the skin with permission.

Look for these warning signs

  • Redness that does not fade after pressure is removed
  • A darker, purple, maroon, or bruised-looking area
  • Skin that feels warmer or cooler than nearby skin
  • A firm, hard, soft, or spongy area
  • Swelling
  • Tenderness, burning, itching, or pain
  • A blister
  • Cracked or broken skin
  • Drainage
  • A new open area

Pressure injuries can be more difficult to recognize in darker skin tones. Instead of relying only on redness, compare the area with nearby skin and look for changes in color, warmth, firmness, swelling, or sensation.

2. Change Positions Regularly

Regular movement reduces the amount of time one area remains under pressure.

The best schedule depends on the person’s mobility, skin condition, medical needs, support surface, comfort, and ability to reposition independently. A nurse, physical therapist, occupational therapist, or wound care professional can help create an individualized plan.

General patient guidance often recommends:

  • Changing position every 1 to 2 hours while in bed
  • Shifting weight every 15 to 20 minutes while sitting in a wheelchair

These are general starting points, not a substitute for an individualized care schedule.

3. Reposition Without Dragging the Skin

Sliding and dragging create friction and shear.

Friction occurs when skin rubs against clothing, bedding, or another surface. Shear occurs when the body moves but the skin remains in place, such as when a person slides down in bed.

MedlinePlus advises caregivers to lift or use a draw sheet rather than dragging a person across the bed.

Ask a physical therapist, occupational therapist, nurse, or home health professional to demonstrate safe repositioning. Improper lifting can injure both the senior and caregiver.

4. Protect the Skin While Sitting

A wheelchair or recliner should support the body without creating concentrated pressure.

MedlinePlus recommends having wheelchair fit checked regularly and whenever weight or pressure concerns change.

Use the correct cushion

A pressure-redistributing cushion may be made with:

  • Foam
  • Gel
  • Air cells
  • A combination of materials

The correct cushion depends on posture, pressure risk, moisture, transfers, stability, and the condition of the skin.

Do not use a donut-shaped or ring-shaped cushion for pressure injury prevention. These cushions may concentrate pressure and reduce blood flow around the opening.

A cushion does not replace regular weight shifting.

5. Make the Bed Safer for the Skin

A standard mattress may not provide enough pressure redistribution for someone at high risk.

A healthcare professional may recommend:

  • A pressure-redistributing mattress
  • A mattress overlay
  • A low-air-loss surface
  • Heel-offloading equipment
  • Positioning wedges
  • Pillows placed according to the care plan

AHRQ prevention resources include bed and chair support surfaces, pressure-relieving devices, repositioning, heel offloading, and individualized positioning as part of pressure injury prevention.

Protect the heels

Heels are especially vulnerable because there is little padding between the skin and bone.

A clinician may recommend positioning that lifts the heels completely away from the mattress. Follow professional instructions so pressure is not simply transferred to another area.

Do not place a pillow only under the knees. This may increase pressure on the heels.

Limit sliding in bed

When medically appropriate, keeping the head of the bed at a lower angle may reduce sliding and shear. MedlinePlus advises avoiding elevation above 30 degrees when possible, but positioning must also account for breathing, swallowing, reflux, feeding, and other medical needs.

Follow the care team’s instructions rather than changing the bed angle on your own.

6. Keep the Skin Clean and Dry

Moisture can soften the skin and make it more vulnerable to pressure and friction.

After an incontinence episode

  1. Remove the wet or soiled product promptly.
  2. Clean the skin gently.
  3. Avoid scrubbing.
  4. Pat the area dry.
  5. Apply a recommended moisture barrier.
  6. Replace wet clothing or bedding.
  7. Check the skin for discoloration or damage.

The National Institute on Aging recommends gentle cleansing, careful drying of skin folds, moisturizers for dry skin, and protective ointments for people experiencing incontinence.

AHRQ pressure injury prevention materials also include wet checks, hygiene support, skin barriers, and moisture management.

Avoid irritating products

Unless recommended by a healthcare professional, avoid:

  • Strong soaps
  • Aggressive scrubbing
  • Talc powder
  • Fragranced products that cause irritation
  • Excessive hot-water bathing

Use a gentle cleanser and moisturizer that match the senior’s skin-care plan.

7. Keep Clothing and Bedding Smooth

Wrinkles, seams, buttons, crumbs, tubing, and small objects can press into the skin.

MedlinePlus advises keeping clothing and sheets dry and wrinkle-free and removing objects that could create pressure.

8. Check Medical Devices for Pressure

Medical devices can press on the skin even when they are being used correctly.

Look for redness, indentation, moisture, swelling, or pain where the equipment touches the body.

Do not place extra padding under a device or loosen prescribed equipment unless a clinician or manufacturer confirms that the change is safe. Incorrect adjustments can interfere with treatment.

AHRQ identifies medical device-related pressure as a specific risk that should be included in prevention planning.

9. Support Nutrition and Hydration

Skin needs adequate nutrition and hydration to remain healthy and repair damage.

AHRQ pressure injury resources include monitoring food and fluid intake, addressing weight changes, and requesting a dietitian consultation when appropriate.

Do not begin protein drinks, vitamins, or other supplements without professional guidance. A healthcare provider or dietitian can evaluate the senior’s medical conditions, medications, kidney function, swallowing ability, and nutritional needs.

10. Encourage Safe Movement

Even small amounts of movement may reduce pressure and support circulation.

Depending on the senior’s abilities, a care plan may include:

  • Weight shifts
  • Repositioning in bed
  • Standing with assistance
  • Short walks
  • Range-of-motion exercises
  • Transfer practice
  • Physical or occupational therapy

The National Institute on Aging recommends asking for professional help when a person cannot move independently. Therapists, nurses, and home health aides can teach caregivers how to reposition the person safely.

Do not attempt exercises or transfers that have not been approved for the senior.


When to Contact a Healthcare Professional

Contact the healthcare provider when you notice:

  • Redness or discoloration that does not fade
  • A purple, maroon, or bruised-looking area
  • Warm, cool, firm, soft, or spongy skin
  • New tenderness or pain
  • A blister
  • Broken skin
  • An open sore
  • Drainage
  • A new area of numbness
  • Equipment pressing into the skin

Do not wait for a small area to become an open wound. Early evaluation may prevent more serious tissue damage.

Report possible infection immediately

Warning signs may include:

  • Pus
  • Foul odor
  • Increasing warmth or swelling
  • Worsening redness or discoloration
  • Increased pain
  • Fever
  • Loss of appetite
  • Rapid worsening of the wound

These symptoms require prompt medical guidance.

Do not apply an unapproved dressing, antiseptic, antibiotic cream, powder, or home remedy to a pressure injury. Treatment should be directed by a qualified healthcare professional.


Frequently Asked Questions

What is the first sign of a pressure injury?

The first sign may be persistent redness or discoloration. The skin may also feel warmer, cooler, firmer, softer, or more painful than surrounding skin.

Can a pressure injury develop without an open wound?

Yes. Pressure injuries can begin beneath intact skin. A purple, maroon, bruised-looking, firm, or painful area may signal deeper tissue damage.

How often should a person in bed be repositioned?

The schedule should be individualized. General guidance commonly suggests changing position every 1 to 2 hours, but the person’s skin, health, support surface, and comfort may require a different plan.

How often should a wheelchair user shift weight?

General patient guidance suggests shifting weight every 15 to 20 minutes. A therapist or clinician should recommend the safest technique and schedule for the individual.

Do cushions prevent all pressure injuries?

No. A correctly selected cushion can help redistribute pressure, but it does not replace regular movement, proper wheelchair fit, skin checks, or moisture management.

Should a red area be massaged?

No. Do not massage reddened, discolored, painful, or damaged skin because this can cause additional injury.

Are donut-shaped cushions safe?

They are not recommended for pressure injury prevention because they may reduce blood flow and concentrate pressure around the ring.

Who can help create a prevention plan?

A physician, nurse, wound care specialist, physical therapist, occupational therapist, dietitian, or home health professional may contribute to an individualized plan.


Healthcare providers and senior-serving organizations can also contact Seniors Blue Book to claim a free business listing. A listing helps local families find your services, while enhanced options provide additional visibility among seniors and caregivers searching for support.

Contact Seniors Blue Book:

Email: [email protected]
Phone: 800-201-9989

This article provides general educational information and does not replace medical evaluation, wound care, professional equipment fitting, or an individualized repositioning plan. Contact a healthcare professional promptly when new skin discoloration, pain, blisters, open areas, drainage, or signs of infection appear.

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