This article is designed to help users and carers in the public domain to learn more about preventing pressure ulcers when sitting in a chair or wheelchair. It is not intended for clinicians. The article was put together by BHTA industry expert members.
What is a pressure ulcer?
A pressure ulcer is any area of localised damage to the skin and underlying soft tissue. There are a number of risk factors, including age, diagnosis, medication, continence, nutrition, mobility, and weight. There are also other factors not specific to the person, such as the support surface, temperature, and moisture. (1)
Whilst sitting, the skin and soft tissues get squeezed and deformed between the bone and the support surface. Over time this can cause the cells to die and the area of resulting dead tissue is called a pressure ulcer.
TIP: Everyone is potentially at risk of developing a pressure ulcer (2)
Why is sitting important in pressure ulcer prevention?
When sitting in an upright stable position, we still have localised high-pressure areas:
Through buttocks and thighs: 75 percent Through the feet: 19 percent Through the arm supports: 2 percent Through the back support: 4 percent (3)
Therefore, posture and pressure are linked, with both affecting one another.
Why might someone be at risk of pressure ulcers?
Neurological impairment
Changes in body shape and size
Little or no active movement
Movements that are difficult to control
Lack of body awareness and/or sensory impairments
Difficulty communicating discomfort
What are the signs and symptoms to look out for?
Early symptoms of a pressure ulcer include:
Persistent discolouration of the skin
Discoloured patches not turning white when pressed
A patch of skin that feels warm, spongy, or hard
Pain or itchiness in the affected area
The skin may not be broken at first, but if the pressure ulcer gets worse, it can form an open wound or blister
A deep wound that reaches the deeper layers of the skin
A very deep wound that may reach the muscle and bone (4)
How does a pressure ulcer affect a person?
The impact of a pressure ulcer on a person is significant, with their being affected physically, psychologically, socially, emotionally, spiritually, and financially (5)
Pressure ulcers are often painful and debilitating (6)
Infected ulcers can cause an unpleasant odour and further health problems
Healthcare professionals may advise keeping weight off the pressure ulcer to allow healing, which can impact on independence and interaction
TIP: With care, pressure ulcers are mostly preventable (7)
Prevention can not only improve a person’s outcomes, but it can also reduce the costs to the NHS and benefit the wider community:
Where can you get further information or advice?
Consult a general practitioner or healthcare professional for information and advice on:
Ensuring a regular change of position: a person with a pressure ulcer, or at risk of developing a pressure ulcer, needs to change position frequently
Considering pressure relieving and postural management equipment
Applying special dressings that speed up the healing process
Eating a healthy, balanced diet
TIP: Chair functions, such as tilt-in-space, can be effective in redistributing pressure
Case study:
Mrs A, a 72-year-old lady diagnosed with dementia
Mrs A is frail, generally weak, and not always aware of her position
She struggles to sit upright and tends to slump with her head falling forward
Without a chair that is set up to her body shape and size, she is at risk of discomfort, sliding out of the chair, not being able to eat or drink safely, and developing pressure ulcers
With the appropriate chair, she is more comfortable, and her risk of pressure ulcers is reduced. She has a more stable upright position and her head is supported, making it easier for her to eat, drink and communicate
Needs regular change of position
Needs regular skin inspection to check if damage has started
2. National Institute for Health and Care Excellence (NICE) (2014) [CG179] Pressure ulcers: prevention and management. Available from: www.nice.org.uk/ guidance/cg179
Collins F (2001) Selecting cushions and armchairs: how to make an informed choice Journal of Wound Care / Therapy Weekly Supplement 13(5)
8. Jan YK, Crane BA, Liao F, Woods JA, Ennis WJ (2013) Comparison of muscle and skin perfusion over the ischial tuberosities in response to wheelchair tilt-in-space and recline angles in people with spinal cord injury Archives of Physical Medicine and Rehabilitation 94(10):1990-6
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