Causes and treatment of the condition

Q What are pressure ulcers?

A Pressure ulcers are damaged skin, and possibly the tissues under the skin. They usually occur over bony areas.

In the early stage, they present as redness that does not disappear when pressed. In the late stage, there could be dead flesh all the way to the bone.

Q What causes them?

A Constant pressure at a particular spot. More common among the frail elderly, pressure ulcers can also affect the young who are immobilised, for example, after a fracture.

People with poor nutrition are at greater risk because their ability to heal is reduced.

Dampness to the skin, such as when a diaper is not changed often enough, raises the risk.

The skin can also be damaged by friction caused when a person is dragged, for example, when trying to get the person to sit up at the head of the bed.


Q Can they be prevented?

A Not always, though early treatment can prevent pressure ulcers from getting bad. But the majority can be prevented by:

•Making sure the person takes in enough nutrition, especially proteins, which are the building blocks.

•Getting those who use wheelchairs to get off their bums ever so often, to release the pressure. A cushion could help ease the pressure on bony joints.

•Regular toilet visits, for example, before every meal, helps keep the person continent and reduces the risk of moisture-associated skin damage.

•Turning and repositioning someone who is bed-bound every two to three hours. If possible, the person should be turned at least twice during the night. The person should also sleep on a pressure-relief mattress.

•Using alternating mattresses, which are electrically controlled with an undulating wavelike surface that eases the pressure on any one spot. These cost from $128 each, and there is a 90 per cent subsidy from the Agency for Integrated Care.

There is greater awareness of such mattresses, with sales at Changi General Hospital's pharmacy rising to 20 a month this year, from 15 a month last year.

When lifting such patients, the easiest way is to have a cotton sheet under them, then pull it to turn them and place a pillow to keep them in that position.

Q How to treat pressure ulcers:

A In the early stages, use barrier creams that prevent wetness, avoid putting pressure on the area and ensure there is no skin breakage.

Simply standing every hour can help. If the skin is broken or turns dark red or black, seek medical attention immediately.

The hospital also offers pictorial booklets on how to prevent and care for pressure ulcers in six languages, including Tagalog and the Myanmar language, to cater to caregivers in Singapore.

Caregivers, including maids looking after the elderly, should watch out for early signs of pressure ulcers so they can be quickly treated.

Salma Khalik

A version of this article appeared in the print edition of The Straits Times on December 22, 2016, with the headline 'Causes and treatment of the condition'. Print Edition | Subscribe