Prevention and management of pressure injuries

Pressure ulcers (pressure injuries, pressure sores, bedsores) occur when prolonged pressure damages the skin. Areas where pressure ulcers occur include the back/spine, bottom, heels and elbows. This is because bones are close to the skin in these areas.

Not eating and drinking well can make pressure ulcers more likely - this fact sheet shows how eating and drinking well can help avoid and treat pressure ulcers.

How can I avoid a pressure ulcer?

Skin needs both nutrients and fluids to stay healthy. Being a healthy weight and eating a good diet can reduce your risk of having pressure ulcers.

Pressure ulcers are more likely to occur if you are very thin, living with overweight or not able to move around.

If you are very thin, bones are closer to the skin. This can raise pressure in areas like your bottom and hips.

If you are living with overweight, weight on pressure areas can be high when you are sitting.

If you lose weight without trying, your nutrient stores can be lower and healing can take longer.

If you are not able to move around, this can raise pressure in areas like your bottom and hips.

How are pressure ulcers treated?

Eating and drinking well play a vital role in wound healing.

During wound healing your body will need a balance of nutrients. This includes more protein and energy (calories) together with vitamins, minerals and fluid.

Eating different kinds of foods from the following groups will help:

Protein sources (can also be a good source of vitamins and minerals):

• Meat, fish, eggs, cheese, beans and pulses, soya products like tofu, mycoprotein, seitan (wheat protein), nuts.

Try to have at least one of these foods at each meal.

Carbohydrate (starchy food) sources

• Rice, pasta, potatoes, bread, couscous, bulgar wheat, buckwheat, cornmeal, maize, cassava, yams or plantain and cereals, mainly wholegrain types.

Try to have at least one of these foods at each meal.

Dairy foods (or dairy alternatives)

• Milk, cheese, yoghurt or fortified dairy-free drinks

Have one pint (568ml) of milk per day or have two - three milk-based foods every day. If you use dairy-free alternatives choose a soya-based drink. The amount of protein in a soya-based drink is similar to cow’s milk. Other dairy-free alternatives contain less protein and other nutrients.

Fruit and vegetables

• Fresh, frozen and tinned - these are rich in important vitamins, minerals and fibre.

Aim for five portions of a variety of types and colours every day.

If you are very thin or have lost weight without trying, eating more nutrients will help. Nutrient-dense foods and drinks have lots of nutrients including energy, protein, vitamins and minerals and sometimes fibre. They will not make portions bigger.

Here are some ideas for increasing the number of nutrients you have:

• Make sure you have regular, balanced meals (as you’ve just read about).
• If you find it difficult to prepare and cook meals, ready meals may help. There are lots of chilled, frozen and room temperature ready meals available.
• Have three small meals and two to three nourishing snacks during the day. Nourishing snacks include foods such as yoghurt, cheese and biscuits and nuts.
• Include nourishing drinks each day such as milk or drinks made with milk.
• Food fortifiers can help improve the nutrient content of some foods. Add nutrient-dense fortifiers such as skimmed milk powder, cheese, egg or nut spread to foods.

See our Malnutrition in older adults Food Fact Sheet for more ideas about nutrient-dense foods.

If you are living with overweight and have a pressure ulcer, healing still needs nutrients and fluid. Avoid either gaining weight or trying to lose weight during this time. The following suggestions may help you:

• Make sure you have regular, balanced meals.
• Choose low-fat cooking methods such as grilling, baking, microwaving, steaming and air-frying.
• Choose low-fat versions of foods.
• Choose snacks that are lower in energy but high in protein. Ideas for higher protein snacks include higher protein yoghurt, soya-based yoghurt alternative, high protein puddings, low-fat rice pudding, low-fat custard, boiled eggs, crab sticks.
• Choose sugar-free hot and cold drinks.

How does fluid and hydration help with pressure ulcers?

Drinking enough fluid is important for good health. Good health is important for prevention and healing of a pressure ulcer.

Women should drink about 1600ml (3 pints) each day. Men should drink about 2000ml (3 1/2 pints) each day. See our Hydration in older adults Food Fact Sheet for more ideas.

Do I need vitamin and mineral supplements?

If you eat a varied diet, you probably don't need to take any extra vitamins and minerals.

If you can’t eat a varied diet, take an A to Z vitamin and mineral supplement. You can buy these in supermarkets, pharmacies and online.

Oral nutritional supplements (sip feeds)

If you cannot eat enough, a healthcare professional may advise oral nutritional supplements. Just like food, oral nutritional supplements contain energy, protein and other nutrients. These come as a powder to mix with milk or ready-made. They can be purchased or prescribed.

If you have three or more oral nutritional supplements each day, do not take a vitamin and mineral supplement as well.

What can I do if I have diabetes?

Poorly controlled diabetes can delay healing. Seek advice from your diabetes team about managing your diabetes.

Top tips

• Eating and drinking well and being a healthy body weight can help you avoid a pressure ulcer starting.
• If you have a pressure ulcer, eating nutrient-dense foods and drinking enough fluid will help it heal.
• Nutrient-dense foods and drinks contain energy, protein, vitamins and minerals and sometimes fibre. Nutrient-dense foods and drinks can improve intake without making portions too big.
• Take a vitamin and mineral supplement if you do not eat a varied diet.
• If you do not eat enough food to meet your body’s needs, a healthcare professional may advise you to take an oral nutritional supplement as well.