The Caregivers Guide to Bedsores or Pressure Ulcers

Bedsores, also known as pressure sores and pressure ulcers, occur when a part of the body has been under constant pressure for too long. The most common cause for bedsores is lack of movement and staying immobile in the same position for hours or even days at end. Naturally, elderly people unable to move by themselves fall victim to pressure ulcers the most.

Bedsores start off mild, but can quickly develop into painful and sometimes fatal injuries if left untreated. A bedsore in the later stages of its development is essentially a huge wound, and the affected person remains in severe pain and becomes prone to easily catching infections. Therefore, it is essential that these injuries be identified as early as possible for a timely treatment. This post includes how caregivers can deal with bedsores and prevent them from occurring in the first place.

Understanding Bedsores

Bedsores, as we briefly discussed above, occur when a part of your body receives restricted blood flow because it is under constant pressure. This leads to damage to both skin and tissue in that spot, which can continue to worsen if left untreated. Although laying in bed and sitting in chairs for extended periods of time are the primary causes of pressure sores, especially in elderly people unable to move on their own, these injuries can also occur in another way. As a caregiver, you need to be extra careful whenever moving your patient because even dragging them around frequently – thus causing friction to their body – can result in pressure ulcers forming.

The Main Stages of Bedsores

Bedsores develop as minor injuries that get worse as time goes on. Their development is generally divided into four main stages, each more difficult to treat than the last. Let’s look at what these four stages of pressure sores look like.

Stage One

In the first stage of development, bedsores appear as a slight red or purple patch on the skin. The area becomes irritated due to lack of blood flow and/or constant pressure. In this stage, the patient might feel pain on the irritated patch of skin, and complain when it is touched. When you press down on the bed sore and then let go, it remains red instead of lightening up like normal skin does. This stage is the easiest to treat, and you should always be monitoring the patient’s body for development of pressure sores.

Stage Two

During the second stage of development, the bedsore takes on a more serious look. The upper and lower layers of the patient’s skin have now been damaged, and the patch of skin might look like a red or pinkish blister. At this stage the upper layer of the skin is breaking apart, threatening to expose the growing wound beneath. Even this stage doesn’t take too long to recover if treated quickly enough.

Stage Three

The third stage is when the bedsore becomes a serious hazard to the patient and needs immediate medical attention. During this stage, the injury takes on the shape of a crater as the upper layer of the skin breaks apart and fat and tissue become exposed. The pressure sore is, at this point, an open wound requiring special care round the clock. Pus might leak from the wound and infection can take hold quickly if left unmonitored.

Stage Four

The last stage of a bed sore development is a deep, gaping wound that exposes muscles, tendons, and sometimes even bones. The damage is extensive, and the pain severe. There is a lot of dead tissue and treatment can take years. Sometimes, bedsores cannot be treated once they’ve reached this stage, even with surgical intervention.

An illustrated sheet explaining the different stages of bedsores and how to care for them.

Risk Factors for Developing Pressure Sores

As they say, prevention is better than cure. As anyone who’s ever had bedsores progress to the later stages will tell you, they would have much preferred to have never experienced this nightmare at all. A multitude of factors can contribute to the development of pressure ulcers, including:


Lack of movement and staying immobile in one position for extended periods of time is the leading cause of developing pressure sores. If a part of the body is under constant pressure and blood flow is getting cut off, you are at severe risk of developing bedsores.


Friction on the skin can lead to bedsores as well. When changing the position of a patient or transferring them from their bed to a chair or vice versa, it is important to remain gentle with them and not drag them on any surface lest they develop pressure sores from the friction of this motion.


Malnutrition and a poor diet can also contribute to the risk of getting a pressure ulcer. Without a proper diet, your body fails to perform at its peak capability and is more likely to get injured. This is why a robust diet plan is recommended when you do develop a bedsore; so your body can give its best trying to heal.


Much like malnutrition, you need to remain hydrated for proper body functionality. Though dehydration doesn’t directly contribute to the development of bedsores, it can influence it and slows down the healing process later on.


If your skin contains excessive moisture – be it from weather conditions, perspiration, or uncared for urinary incontinence – it will soften up more than usual and become prone to injury from pressure and friction. It is important you maintain a healthy level of moisture for your skin to prevent the risk of bedsores.

Dry Skin

Like excessive moisturization, having dry skin can also cause pressure sores to develop as the skin is more easily torn and roughed up in this state.

Body Weight

Being severely underweight or overweight can also lead to developing bed sores as your body is in an unnatural shape and more susceptible to a wide range of injuries.

Prevention Strategies

By now you’ve probably realized what a nightmare bedsores are, for both the affected and the caregiver. The smart move would be to make sure you and your patient never have to deal with bedsores at all, so it is advised you take all precautionary and preventive measures, so pressure sores never even get a chance to develop. Let’s discuss some proactive strategies and tips for caregivers to prevent bedsores from developing:

  • Reposition the patient every two hours. This ensures the best chances of proper blood flow throughout the body and significantly reduces the risk of bedsores developing.
  • Make use of cushions and pillows to prop up the patient when they are laying on their side.
  • When the patient is laying on one side, place a pillow between their legs so their spine alignment remains neutral and no pressure is applied on their hips.
  • Get the patient a donut pillow and alternate between sitting on that and sitting normally for whenever the patient needs to be placed on a chair. This reduces constant pressure on the butt and the underside of their thighs.
  • Make sure the patient gets plenty of water every day and remains hydrated.
  • Ensure that the patient’s diet is a healthy mix of food that fulfills their nutritional demands without being too heavy on the calories.
  • Give the patient proper skincare and keep it properly moisturized without going over the top and making it too soft.
  • Give the patient regular baths. Dirty skin is easier to injure and infect.
  • If possible, give the patient regular exercise. Yoga stretches to help blood flow and regular light walks can do wonders in preventing bedsores.
  • Do not elevate the patient’s bed unless they need to eat to reduce stress from shearing.
  • Inspect the patient’s body for signs of bedsores regularly.
  • Get the patient a pressure alternating air mattress that automatically inflates and deflates at different points periodically and keeps shifting the weight of the body to different places.
  • Use a draw sheet or lift up the patient whenever you need to reposition them so their skin isn’t dragged against the bed.
  • If the patient uses a wheelchair, make sure that it fits them right and isn’t too tight.
  • When the patient is sitting, it is recommended to position them every fifteen minutes. Cushions and pillows can come in handy here.

A woman helping an elderly person exercise

Treatment Options

If your patient has already contracted a bed sore, it is important you start caring for it right away. If it is in its initial stages, it can still be treated at home, though consulting with a medical professional is never a bad idea. If the bed sore is in the later stages however, it is imperative that doctors get involved as soon as possible. Let’s discuss treatment options and tips for each individual stage of a pressure ulcer development.

Stage One

If the patient’s bedsore is in the first stage of development – it merely resembles a red or purplish patch on the skin – you should take pressure off that area immediately and not position the patient in such a way. During this stage, you should clean the bedsore regularly and get it inspected by a doctor. The doctor can also tell you about any recommended skin moisturizers you should use. Give the patient a healthy, balanced diet and lots of water.

Stage Two

If the bedsore has entered its second stage of development, doctors have to get involved. Meanwhile, you can continue with the treatment mentioned for stage one as well as cleaning the sore regularly to wash off any dead tissue that might be accumulating there. At this stage, it is important that the affected area never be exposed to any pressure. Painkillers can be taken to alleviate the pain if the patient desires them.

Stage Three

This stage needs professional medical help. You can still help however, by cleaning leaking pus and looking for redness around the edges that might signal an infection. Let the doctors know if you see dead tissue or redness or if the patient has a fever. Antibiotics will most likely be administered to help fight any infections.

Stage Four

A stage four bed sore is entirely in the hands of qualified professionals, who may take surgical measures to try to treat the pressure sore. Remember to contact the doctors if a bed sore in its initial stages is refusing to heal. If a bed sore has gotten worse, doctors are your only option. Stage three and four bedsores cannot be treated at home and will worsen over time, leading to severe pain for the patient and can even prove to be fatal.

Emotional Support

Being a caregiver is one of the most difficult responsibilities a person can take upon themselves. Caring for a person day in and day out, sacrificing your sleep and attending to their every need can be exhausting. Which is why we keep stressing just how important it is that bedsores are caught early on. Caring for someone with bedsores can be a very stressful experience as you continuously shift them around, inspecting them for more sores and cleaning the sore repeatedly.

To give your best as a caregiver, you need to care for yourself too. Here are a few tips for self-care:

  • Set time out for yourself every day to relax or do something you enjoy.
  • Make sure you’re eating and drinking enough. It can be easy to get caught up in caring for others and forgetting about your own needs.
  • Try to get some light exercise in every now and then.
  • If you find yourself getting agitated easily or losing your appetite, you’re probably stressed and need a breather.
  • Take short breaks whenever you can. There’s no shame in asking for help from someone else if you have to.

A woman listening to music on a pair of headphones.


Nobody wants to deal with bedsores, neither the affected nor the caregivers. If you’re caring for someone who you suspect is at risk for developing pressure sores, you should start taking proactive action right now. And if your patient has already developed pressure ulcers, we encourage you to start caring for them and treating them right away while also contacting doctors for professional help. Lastly, you’re only human. Remember to look after yourself too. After all, you can only give your best when you’re feeling your best.