The dangers of pressure sores, pressure ulcers and bed sores

The dangers of pressure sores, pressure ulcers and bed sores

Pressure sores/ulcers and bed sores occur when pressure or friction is applied to an area of the skin over a period of time, and if left untreated, or not treated successfully – can develop into more serious problems which are difficult to cure, and in some cases infection can even prove fatal.

Elderly or frail individuals (often with thin skin) tend to be more susceptible to pressure sores (sometimes referred to as pressure ulcers or bed sores).

Pressure sores are predominantly caused by a significant lack of mobility, perhaps due to convalescing post-operative, being bed/wheelchair-bound, generally lying or sitting for too long in one position – or whether due to age or a particular medical condition that makes an individual less mobile. Common examples are clinical obesity, coronary heart disease, peripheral vascular disease, diabetes, MS, dementia or Parkinson’s.

Pressure sores can start off as being relatively innocuous, and look just like some swelling or redness, but if not diagnosed or treated, can rapidly deteriorate into a critical long term medical condition that can be difficult to heal.

Regardless of what a care home may say, most pressure sores are primarily caused by pure neglect and are avoidable. Whether the excuse is a case of too few staff looking after too many residents, or simply failing to risk assess or diagnose the problem at the outset – pressure sores are largely preventable. Spotting early warning signs, and immediate treatment are critical to their successful management.

How are pressure sores assessed?

Pressure sores are usually ssessed by reference to the ‘Waterlow Score’ – a prevention policy tool used by care homes, hospitals and health professionals alike to assess the potential risk of developing pressure sores.

The Waterlow score includes factors that might contribute to a pressure sore developing including: the person’s gender, age, build/weight for height, skin type, mobility, continence, recent weight loss, appetite, tissue malnutrition, neurological deficit (including diabetes, MS, CVA, stroke, motor/sensory, paraplegia), whether the individual has undergone surgery or trauma recently and medication (high dose steroids, cytotoxics, anti-inflammatories). The information then provides a final score.  The higher the Waterlow score, the greater the risk of pressure sores developing.

The Waterlow scores range from 0 and 49. The Waterlow score is interpreted in the following way:

  • 9 or less: Patient presents little to no risk;
  • 10 – 14: Patient is at risk;
  • 15 – 19: Patient is at high risk;
  • 20 and above: Patient is at very high risk.

How are pressure sores graded?

There are 4 grades of pressure sure, with Grade 1 being the least problematic and easiest to treat. The skin is not broken, can look discoloured or swollen, and can be treated successfully within a matter of days. As the skin breaks down and deteriorates, the grading increases, with Grade 4 being the most serious. Grade 4 is a condition where the skin is broken with extensive destruction (it looks black) and can take much longer to heal (if at all), often with complications (eg surgery) and can be fatal. The pain can be excruciating as the pressure sore can go down to muscle, tendons and bone.

So find out what the care home is doing to prevent your relative developing pressure sores?

We suggest that you check that the care home:

  • has a policy or guidelines in place to prevent and manage pressure sores;
  • will carry out a risk assessment as to skin integrity upon admission;
  • has enough capable staff to carry out ongoing risk assessments and that they will pro-actively monitor and inspect skin integrity;
  • will devise and implement a care plan, and diligently carry out and review that care plan frequently;
  • care plans identify the need for monitoring skin integrity and specify the frequency of inspections that should be carried out – those at greater risk will need more frequent monitoring; specify any devices/aids (eg special pressure relieving mattresses/cushions or lifting aids) that are required to avoid causing tears or damage to the skin; and when and how often the individual should be repositioned (eg 2 hourly etc).
  • will actually turn or reposition your relative regularly in accordance with their own risk assessment and care plan; and
  • has attentive staff who are committed to observing and constantly reviewing your relative’s skin integrity.


Most pressure sores are caused due to neglect. Failure to put basic preventative measures in place can lead to a very painful and debilitating condition if not picked up and treated successfully.

Pressure sores are often the source of litigation, as most are entirely avoidable. If your relative goes into a care home environment with no pressure sores and then develops symptoms, you have to question why – if staff were diligently caring for your relative? Consider legal advice.

For more help on pressure sores we suggest you read:

NICE Guidelines – Pressure ulcers: prevention and management

NHS Website – Treatment of Pressure ulcers (pressure sores)


  1. Maryanne Schreiber 1 year ago

    I would like a definition of grades of bedsores, i.e. what constitutes Grade 1, Grade 2 etc.
    This is in relation to my sister who has been bed-bound for 2 years following a stroke and we are appealing for NHS funding. So far her skin is intact due to competent carers, but ” a need well-managed is still a need”

  2. Pam Spruce 1 year ago

    The Waterlow Score is not the only risk assessment tool, as there are others which are used depending on local guidelines. It is in the interest of the Nursing Home to use the same one as is used locally – for purposes of communication and continuation of care.
    It’s very bold to suggest that a Grade 1 (or category 1) can be healed in a few days – it depends of the underlying condition of the individual, other factors such as nutrition. Taking medication such as steroids can significantly increase the risk of skin breakdown and also inhibit healing.
    It’s also important to state that while some pressure ulcers are due to poor care- for some individuals in the final stages of their life breakdown of skin is unavoidable.

    I’m a tissue viability specialist with 28years of experience. I also have a97 year old mother who has been recently admitted to a nursing home.

    • Mr Richard Andrews 2 days ago

      Hi Pam,

      I’m a stairlift engineer and have been thrown in the deepend regarding CHC and a DST that seems to either understate my mother’s needs or overstates her abilities! The skin domain….

      ‘Mrs A currently has no wounds or broken pressure sores (the word ‘currently’ makes me think she has had wounds within the past year) or broken pressure areas but is at high risk of breakdown due to her immobility, low weight and double incontinence.
      She has an air mattress on her bed and a pressure relieving cushion on her chair. Mrs A is able to minimally reposition herself (my mother is able to move her arms and legs a bit, but does not have the strength to reposition herself or if so, so insignificantly one wouldn’t notice) in the chair and the bed and staff report they check her pressure areas and apply barrier creams at all personal care interventions (if personal care interventions mean washing and dressing or changing 4 pads a day, then I assume my mother is checked 4 times a day – the number of pads it is decided she needs).
      Her skin is thin and fragile and tears easily. She has emollient applied twice a day to prevent dry skin.
      She has had a history of skin cancer but this has been resolved.

      A moderate level of need has been assigned…

      NO interrelationship has been provided with regard to the nutrition domain where a BMI of 17 indicates health is at risk. Nor any interrelationship with regard to the mobility domain where my mother requires 2 care workers and a hoist for transfers, unable to bear weight and, basically, left in bed or placed in a seat. No interrelationship with regard to the communication domain where my mother cannot say why she has raised her arm to attract the attention of care workers, nurses or other staff. Ni interrelationship with the psychological domain with regard to my mother’s advance dementia – such must be having an affect on her because she’s been prescribed anti-depressant medication as well as Butrans patches for pain. No interrelationship with regard to behaviour because my mother tries to push care workers away when they place her into an hoist which has previously resulted in a skin tear that required much dressing to stem the flow of blood (my mother is taking blood thinners due to Thrombosis clot in her leg) and required antibiotics due to infection. My mother has severe cognition needs and cannot determine hot and cold, hence may not be able to determine wet and dry.

      The minimalism in which skin and the interrelationship with immobility, low weight and double incontinence have been addressed is a cause of concern to myself. It sounds a bit like saying somebody with a brain haemorrhage has had a little bump on the head, but no need to worry.

      What would you write in response in an appeal? I’m sure the CHC Assessors count on the ignorance of the common man and take advantage of such.

      • Care to be Different 2 days ago

        Hi Richard – Many thanks for your post. It is a minefield I’m afraid. Please do call us if you’d lie to chat it through with one of our advisors. 0161 979 0430 Kind regards

  3. Glynis Evans 1 year ago

    My mum-in-law had a a history of pressure sores – with grade 2 & 3 when she was in hospital. We provided photographic evidence to both the local appeal panel & IRP of just the pressure sores (some of which had ulcerated craters) that were actually visible & they still said that her skin was “intact” & there was no evidence of pressure sores!! They are beyond belief. As she passed away last year, it is ironic that the money they spent on saying she was not eligible, has been far greater than they would have had to pay from the time of the DST to her passing (less than 4 months). They denied she was end of life, when the hospital had discharged her as end of life/palliative care. They are a law unto themselves.

  4. Kathy Sawdon 1 year ago

    At mum’s recent Review both assessors (mental health and general health) and the care home nurse ridiculed my mention that mum scored very highly in the Water low chart. They all chanted that is old hat and it has been superceded by another guideline. Is this the case.


Leave a reply

Your email address will not be published. Required fields are marked *


2100 characters max. All comments are moderated in line with our Acceptable Use Policy and our Terms of Website Use.