1.3 Identify factors which might put an individual at risk of skin breakdown and pressure sores

This guide will help you answer 1.3 Identify factors which might put an individual at risk of skin breakdown and pressure sores.

Pressure sores, also called pressure ulcers or bedsores, occur when prolonged pressure restricts blood flow to the skin and underlying tissues. Without enough oxygen and nutrients, the skin becomes damaged and may eventually die, leading to wounds that can become serious if left untreated. Skin breakdown refers to the loss of skin integrity, making it more vulnerable to infection or open sores. Some people are at greater risk due to specific factors in their health or circumstances. In this guide, we cover some of the main factors contributing to this risk.

Reduced Mobility

A significant factor in pressure sore development is limited movement. When someone is unable to change their position frequently, pressure builds on certain parts of the body, particularly over bony areas like the sacrum (lower back), heels, hips, elbows, or shoulder blades. This often affects:

• People with spinal cord injuries
• Those recovering from surgery
• Individuals with long-term or chronic illnesses

Being confined to a wheelchair or bed for long periods creates constant pressure points. Even short-term immobility, such as during hospital stays, increases the risk.

Malnutrition and Dehydration

Good nutrition and hydration are crucial for healthy skin. Skin tissue needs protein, vitamin C, zinc, and other nutrients to repair itself and maintain elasticity. Dehydrated skin becomes dry and fragile, increasing the likelihood of cracking and injury. When someone is malnourished or not drinking enough fluids, their skin may struggle to heal even small wounds, which can worsen into pressure sores.

At-risk groups include older adults, people with eating disorders, and those with limited access to adequate food or water.

Ageing Skin

Older adults face a higher risk of pressure sores because their skin becomes thinner and less elastic over time. Fatty tissue under the skin, which provides cushioning and insulation, reduces as part of the ageing process. These changes make the skin more vulnerable to damage from pressure, friction, or shear forces (when the skin slides against surfaces).

Additionally, older people may experience slower cell regeneration, meaning any breaks in the skin take longer to heal.

Medical Conditions

Certain medical conditions also heighten the risk.

• Diabetes – People with diabetes may have poor circulation and nerve damage (neuropathy) that stops them from feeling discomfort in affected areas, delaying the detection of early signs of soreness.
• Cardiovascular conditions – Reduced blood flow to the extremities makes it harder for skin to receive the necessary nutrients and heal.
• Incontinence – Constant exposure to urine or faeces can weaken and irritate the skin. Moist conditions encourage bacterial growth and increase the risk of infection around delicate areas.
• Chronic illnesses – Conditions like Parkinson’s disease, dementia, or advanced cancer often reduce activity levels and independence, leaving individuals more susceptible.

Poor Circulation

Any condition that restricts blood flow, such as peripheral arterial disease or heart failure, can increase the likelihood of pressure sores. Poor circulation means there isn’t enough oxygen to sustain skin tissues when compressed, making them more likely to break down.

Friction and Shear

Skin damage often results from the combination of friction and shear forces. Friction occurs when skin rubs against a surface, such as bedding or clothes, leading to redness and irritation. Shear happens when skin stays in one position but the underlying bone moves, causing tissue layers to pull apart.

For example, a person sliding down in a hospital bed may experience shear around their lower back or buttocks. People with reduced sensitivity may not even notice these forces, putting their skin at risk.

Sensory Loss or Impairment

Individuals with sensory loss may not feel discomfort or pain, making it harder for them to detect early symptoms of skin breakdown.

Examples include:

• People with nerve damage following a stroke
• Those affected by multiple sclerosis
• Patients with paralysis

The inability to sense pressure or moisture means they are more likely to go too long without repositioning, contributing to pressure build-up.

Obesity

Excess weight can increase strain on certain areas of the body, such as the hips, thighs, or buttocks. This concentrated pressure can restrict blood flow and heighten the risk of tissue damage. Additionally, skin folds in obese individuals may trap moisture, creating an environment where bacteria and fungi thrive, leading to irritation or infection.

Low Body Weight

People with very low body weight or muscle mass have less natural padding to protect their skin from pressure. Conditions like anorexia, cancer, or advanced stages of frailty often contribute to this issue. Without enough cushioning, bones press directly against the skin, increasing the likelihood of sores.

Compromised Immune System

People with weakened immune systems are less able to repair damaged tissues or fight infections.

Common causes include:

• HIV/AIDS
• Chemotherapy or radiotherapy treatments
• Long-term use of steroids or immunosuppressant drugs

When the immune response is low, even minor skin injuries can quickly deteriorate into severe pressure sores.

Poor Skin Hygiene

Inadequate hygiene can lead to dirt, sweat, and bacteria building up on the skin. Poor cleanliness weakens the protective barrier of the skin, increasing the risk of infection when combined with pressure or friction.

Environmental Factors

The environment in which care is delivered plays a role in skin health. Factors include:

• Unsuitable bedding or seating – Hard mattresses, lack of pressure-relieving cushions, or improperly adjusted wheelchairs can cause pressure points.
• Excessive moisture – Hot, humid rooms can lead to sweating, which softens the skin and makes it prone to breakdown.
• Cold environments – Poor heating can result in reduced circulation, especially in older adults.

Cognitive Impairment

People with cognitive impairments (such as dementia) often lack the ability to express their discomfort or recognise a need to move. They may stay in one position for too long, increasing their risk of developing sores.

Psychosocial Factors

Stress or mental health conditions can lead individuals to neglect their basic needs, including nutrition, hydration, or movement. Social isolation may mean that an individual doesn’t receive the care they need to reduce risks.

Recognising the Warning Signs

It’s crucial to watch for the early warning signs of skin breakdown and pressure sores. These include:

• Redness or discolouration of the skin that doesn’t fade
• Swelling and tenderness over bony areas
• Changes in skin texture, such as becoming spongy or hard
• Warm or cool patches compared to surrounding skin
• Blisters, open wounds, or areas of moisture

Prompt action at the early stages can prevent the development of serious pressure sores.

Final Thoughts

A wide range of physical, medical, and environmental factors can put individuals at risk of skin breakdown and pressure sores. Care workers need to identify these risks and take preventative measures, such as encouraging movement, improving nutrition, and using specialist equipment. Communicating with the individual, their family, and health professionals helps create a personalised care plan to minimise skin breakdown and improve overall health outcomes.