Risk Factors for Pressure Ulcers

There are several risk factors for pressure ulcers, which are now referred to as pressure injuries. They are skin sores that typically develop over bony areas, such as the lower spine, hips, and elbows. Also known as bedsores, pressure injuries are a common problem for people who have low mobility and spend most of their time in bed.

Pressure injuries are painful and can be difficult to treat. Preventing pressure injuries is critical to maintaining comfort, and treating them promptly is essential. But how do you know if your loved one is at risk of developing one? Should you be concerned?

Mature man asleep on bed, close up
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People at the greatest risk of developing pressure injuries are those who are immobile. Once a person loses the ability to move and becomes inactive, the risk of developing bedsores increases.​

Sensory Loss

A loss of sensation as the result of spinal cord injury or neurological disease increases the risk of developing pressure injuries. A person with normal physical sensation can feel pain and will generally feel uncomfortable after spending a lot of time in one position. With sensory loss, a person may not feel uncomfortable or recognize the need to reposition.

Changes in Mental Status

Likewise, a person with an altered level of consciousness may not feel discomfort or may not be awake enough to physically reposition themselves if they do.


Shear is the rubbing of skin and fatty tissues across bones, and it is caused by the combination of gravity and friction. Shear most commonly occurs when a patient is lying with the head of the bed raised.

The spine may slide down in the bed while the skin and fatty tissues stay in place. This type of force causes damage to the underlying blood vessels, resulting in a large area of internal tissue damage and less noticeable damage at the surface of the skin.


Friction occurs when two surfaces move across one another. Friction decreases the skin's tolerance to pressure by causing abrasions and compounds the effect of shear. This can happen when a person slides down in bed or is repositioned in bed the wrong way.


Moisture is a common problem in people who have become incontinent and have to wear diapers. Moisture from sweat can also be a problem. Moisture removes oils from the skin that normally act to protect it and soften the skin’s connective tissues, making the effects of shear and friction more damaging.


Incontinence of bowel movements and urine creates moisture on the skin and increases the risk of tissue breakdown. Fecal incontinence has the added risk of damage to the skin from bacteria and enzymes in the stool and also increases the risk of infection.

Poor Nutrition

Poor nutrition can lead to weight loss, which can then increase the pressure on bony areas of the body. Proper nutrition is also important to the healing of pressure ulcers.


As a person ages, the skin becomes thinner and more fragile, increasing the risk of skin breakdown.

If your loved one has any of these risk factors, it's important for you to take steps to prevent a pressure ulcer from developing.

Medical Risk Factors

Cardiovascular disease, peripheral vascular disease, and diabetes, all cause impaired circulation, increasing the risk of pressure injuries.

And long stays In intensive care or long surgical procedures can lead to prolonged skin tissue pressure.

2 Sources
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  1. Sprigle S, McNair D, Sonenblum S. Pressure ulcer risk factors in persons with mobility-related disabilities. Adv Skin Wound Care. 2020 Mar;33(3):146-154. doi: 10.1097/01.ASW.0000653152.36482.7d

  2. Gillespie BM, Walker RM, Latimer SL, Thalib L, Whitty JA, McInnes E, Chaboyer WP. Repositioning for pressure injury prevention in adults. Cochrane Database Syst Rev. 2020 Jun 2;6(6):CD009958. doi:10.1002/14651858.CD009958.pub3

By Angela Morrow, RN
Angela Morrow, RN, BSN, CHPN, is a certified hospice and palliative care nurse.