Health Article | KIN Elderly Care

Pressure Injury Prevention
3 Essential Principles for Older Adults

A safer plan goes beyond a fixed turning timetable: assess risk, protect the skin, redistribute pressure and act early when changes appear.

Medically reviewed educational content | Updated: 26 June 2026 | Reading time: about 8 minutes

Pressure injuries can cause pain, infection and loss of function in people who spend long periods in bed or a chair. They develop from pressure, or pressure combined with shear, and may begin beneath skin that still looks intact.

Many injuries can be prevented or reduced, but prevention is not a simple three-item checklist. It requires an individual risk assessment, regular skin inspection, appropriate repositioning, pressure-redistribution equipment, moisture management, nutrition support and prompt clinical review.

1. Assess risk and inspect the skin every day

A pressure injury is localised damage to skin or deeper tissue caused by pressure, or pressure combined with shear. It may appear under intact skin or as an open wound and often occurs over the sacrum, hips, heels, ankles, elbows, shoulder blades or under a medical device.

Look for early changes

Persistent redness or discolouration, darker or lighter skin than the surrounding area, warmth, coolness, firmness, softness, swelling, pain, burning, itching, blistering or broken skin.

Check more than colour

Early damage can be harder to see on darker skin. Compare both sides and feel for temperature, firmness, swelling and tenderness.

Review changing risk

Illness, fever, reduced mobility, poor intake, weight loss, incontinence, oedema, sedation, surgery and new devices can change risk quickly.

2. Reposition on an individual schedule

A fixed “every two hours” rule is not suitable for everyone. The interval should be based on the person’s risk, skin response, comfort, mobility, medical condition and the pressure-redistribution surface being used. No mattress or cushion completely replaces repositioning.

In bed

Use positions that reduce pressure and shear. A gentle 30-degree side-lying position may be appropriate for some people. Avoid placing the person directly on an area of persistent redness, discolouration or existing injury.

In a chair or wheelchair

Encourage frequent independent weight shifts when safe. People who cannot reposition themselves need assisted changes and a seating assessment; a universal 15–30-minute schedule is not appropriate for every person.

Reduce shear

Do not drag the person across sheets or allow repeated sliding down in bed or a chair. Use suitable transfer equipment and trained handling techniques.

3. Protect the skin from moisture, dryness and friction

Clean gently

Clean promptly after urine or stool exposure using a gentle cleanser. Pat dry rather than rubbing, and avoid hot water or harsh products.

Use the right skin product

Moisturise dry, intact skin. Where incontinence or heavy moisture is present, use an appropriate moisture-barrier product according to professional advice.

Do not massage pressure points

Do not rub or massage reddened skin or skin over bony areas to prevent pressure injury; friction may worsen tissue damage.

Check pads and linen

Change wet or soiled pads and linen promptly. Keep bedding smooth, dry and free of crumbs, folds and hard objects.

4. Select pressure-redistribution surfaces individually

People at risk generally need a pressure-redistribution mattress rather than a standard mattress. The best surface depends on body size, mobility, skin condition, moisture, comfort, posture, care goals and response to the equipment.

Mattress

A high-specification pressure-redistribution foam mattress is often the first option. A dynamic or alternating-pressure surface may be considered when risk remains high or the current surface is not effective.

Wheelchair cushion

Use a pressure-redistribution seating cushion selected after assessing posture, pelvis position, transfers and mobility. A cushion still requires repositioning and skin checks.

Heels

Float the heels completely off the surface using a suitable heel-offloading device or pillows placed under the full length of the calves without pressure on the Achilles tendon or back of the knee.

Review effectiveness

Inspect the skin and comfort after introducing equipment. Reassess the surface, position and schedule if skin changes continue.

5. Support nutrition, hydration and movement

Malnutrition, unintended weight loss, dehydration and reduced muscle mass can increase vulnerability and slow healing. Screen nutrition risk and request assessment by a dietitian or another suitably trained professional when intake is poor, weight is falling or a pressure injury is present.

Provide a balanced diet that meets energy, protein and micronutrient needs. Supplements should address an identified deficiency or clinical need; they are not routinely required when intake and nutritional status are adequate. Encourage safe mobility and activity within the person’s medical and functional limits.

6. Act early when skin changes appear

Immediately remove pressure from a suspicious area and contact a nurse, doctor or wound-care professional. Do not wait for the skin to open, do not apply unprescribed dressings or antiseptics, and do not continue positioning on the affected area.

Seek urgent medical advice

Urgent review is needed for hot, swollen or spreading red/dark skin, pus, foul odour, fever, severe or worsening pain, rapidly increasing wound size, black tissue, confusion or other signs of infection or systemic illness.

7. What families should confirm with a care provider

Ask how pressure-injury risk is assessed, how repositioning schedules are individualised and documented, how skin and devices are checked, what mattresses and seating cushions are available, how continence and nutrition are managed, and when wound-care or medical review is arranged.

Related KIN information: elderly residential care, elderly homecare and home physical therapy. Current staffing, equipment and inclusions should be confirmed directly with the selected branch.

Effective prevention combines an individual repositioning plan, careful skin and moisture care, appropriate support surfaces, heel protection, nutrition and early reporting.

A mattress or cushion helps redistribute pressure, but it cannot replace trained care and regular reassessment.

KIN Rehabilitation & Homecare Clinical Content Team

Educational content prepared with nursing, rehabilitation and skin-care perspectives.

Important: This article provides general health information and does not replace an individual pressure-injury risk assessment or wound examination. Existing wounds or signs of infection require assessment by a qualified healthcare professional.

Choose a convenient branch

Please confirm current care scope, staffing and equipment with the selected branch.

Main branch

Sukhumvit 107

Chonburi

Nonthaburi

Frequently asked questions

About pressure injury prevention and early action

Are all pressure injuries preventable?

Many can be prevented or reduced with appropriate assessment and care, but not every pressure injury is avoidable. Risk may change rapidly because of critical illness, poor circulation, medical devices or other clinical factors.

Should every bedridden person be turned every two hours?

No single interval fits everyone. Repositioning should be individualised according to risk, skin response, comfort, mobility, medical condition and the support surface. The plan should be documented and reviewed.

How often should a wheelchair user shift weight?

Weight shifts should be frequent and matched to the person’s ability, posture, cushion and skin response. Independent users should be taught effective manoeuvres; dependent users need assisted repositioning and seating assessment.

Does an alternating-pressure air mattress replace turning?

No. A pressure-redistribution surface can reduce risk but does not completely replace repositioning, skin inspection, moisture management and heel offloading.

Can reddened skin be massaged?

No. Avoid rubbing or massaging reddened or discoloured skin and bony pressure points. Remove pressure and seek professional assessment.

What is the first sign of a pressure injury?

Early signs may include persistent colour change, warmth or coolness, firmness, softness, swelling, pain, burning, itching or a blister. Changes may be less visible on darker skin.

What should be done if the skin is already open?

Remove pressure and arrange prompt professional assessment. Do not self-stage the wound or use unprescribed dressings, antibiotics or antiseptics.

Which symptoms suggest infection or urgent review?

Hot or swollen skin, spreading redness or darkening, pus, bad odour, fever, severe or worsening pain, black tissue, rapid deterioration or confusion require urgent medical advice.

Pressure Injury Prevention3 Essential Principles for Older Adults