Elderly Pressure Sores Prevention Living Alone: The 2-Hour Window
A pressure sore can begin to develop in under 2 hours of unrelieved pressure. For an elderly person living alone — especially one who's had a fall and lain on the floor, or spends long hours in a recliner watching TV, or has incontinence and sits in damp clothing — the risk is constant and quietly catastrophic.
Stage 4 pressure ulcers go down to bone, develop bone infection (osteomyelitis), and have a 30% one-year mortality rate. Yet they are almost entirely preventable. This guide covers the stages, the high-risk body areas, daily skin checks elderly Australians can do themselves or with caller prompting, when to escalate, and what district nursing services are free under My Aged Care.
Pressure Sores in Australia
For pressure damage to start
Of community care recipients develop one
Annual cost to Australian healthcare
One-year mortality with stage 4 ulcer
The Four Stages
Stage 1: Persistent redness
Skin is intact but red and won't blanch when pressed. Often warm to touch. Reversible if pressure is relieved within hours.
Stage 2: Skin broken (shallow)
Blister or shallow open wound. Looks like a graze or burst blister. Heals in 1–3 weeks if pressure relieved.
Stage 3: Full thickness loss into fat
Deep crater visible. Yellow slough or black eschar may be present. Heals in months with proper wound care, often requires district nursing.
Stage 4: Down to muscle, tendon, or bone
Most severe. May develop osteomyelitis (bone infection). Risk of sepsis, requires hospitalisation, sometimes surgical debridement. Significantly raises mortality.
High-Risk Body Areas (Where to Look)
When sitting (chair/recliner)
- • Tailbone (sacrum) — #1 risk site
- • Buttocks (ischial tuberosities)
- • Heels — especially in slippers
- • Behind knees
- • Shoulder blades
- • Back of head if reclined
When lying in bed
- • Sacrum (lying on back)
- • Greater trochanter (hip, lying on side)
- • Heels — pillow under calves prevents this
- • Elbows
- • Ears (lying on side)
- • Inner ankle bones
Highest-Risk Patients
- • Recently hospitalised — especially after surgery, hip fracture, stroke
- • Limited mobility — uses walker, can't shift weight, sits all day
- • Incontinent — urinary or faecal — moisture macerates skin
- • Underweight (BMI <20) — bony prominences with no padding
- • Diabetic — reduced sensation, slower healing
- • Vascular disease — reduced blood supply to extremities
- • Cognitively impaired — doesn't notice or report pain
- • On steroids — thin skin, slower healing
- • After a fall — lying on the floor for hours can cause damage even if rescued
Prevention: The SSKIN Bundle
Australian and international guidelines use the SSKIN bundle — five evidence-based steps that prevent over 90% of pressure sores.
| Letter | Action | How |
|---|---|---|
| S | Surface | Pressure-relieving mattress (RoHo, alternating air), gel cushion in chair |
| S | Skin inspection | Daily check of high-risk areas with mirror or carer help |
| K | Keep moving | Stand or shift every 30 min when seated, turn 2-hourly in bed |
| I | Incontinence care | Change pads promptly, barrier cream (Sudocrem, Cavilon) |
| N | Nutrition & hydration | Protein-rich diet, adequate fluids, supplement if BMI <20 |
Daily Calls Catch Pressure Sores Early
Daily call prompts
- • “Have you been able to move around today?”
- • “Is anywhere on your skin sore or red?”
- • “How long have you been sitting today?”
- • “Did the district nurse come?”
- • “Is your dressing still in place?”
Family alerts triggered by
- • New report of buttock or back pain
- • Increased time sitting reported across calls
- • Mention of broken skin, blister, redness
- • Reduced mobility — couldn't get up today
- • Fever or feeling generally unwell (sepsis risk)
Free Australian Services
| Service | How to Access |
|---|---|
| District nursing wound care | GP referral, often via My Aged Care or post-hospital discharge |
| My Aged Care | 1800 200 422 — pressure-relieving equipment via HCP |
| Continence Aids Payment Scheme (CAPS) | $721/year for incontinence products |
| Wounds Australia helpline | woundsaustralia.org |
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