Being independent is one of the greatest blessings of life. However, many medical conditions can confine an individual to a bed/wheelchair temporarily or permanently. Caring for such a person is a challenging task, but a careful understanding of their problems is the key to preventing the occurrence of at least some of the problems.

One of the most common complications of immobility is bed sores or pressure ulcers. Usually seen in people suffering from paraplegia, elderly or the critically ill; they can occur due to constant pressure over almost anywhere in the body. Beginning as a patch of non-blanchable redness, they damage the skin and subsequently underlying fat, muscle, bone or joint if overlooked and untreated.

There are many factors which lead to bedsores such as continuous pressure, injury, moisture, malnutrition and anaemia. Moreover, diseases or drugs that affect blood flow such as smoking, diabetes, oedema and steroids can also cause bed sores.

The most affected parts are hip bone, lower back, heel, ankle, elbow and back of the head. As notorious and painful as they can be, the best way to deal with them is to prevent them. Pressure sores occur due to decreased blood flow to the skin over time. Changing posture, frequent movement along with stretching and exercising as much as possible will keep them at bay. Massaging the body with lotion or powder also helps by promoting blood flow.

The frequency of mobilisation varies from person to person, depending on his/her condition and general health. However, it is important to gradually improve the level of mobility in a patient, encouraging frequent, small pressure shifts to sitting on a chair or walking. Patients confined to bed should be gently turned from one side to the other every two hours, while people on wheelchair should be lifted every 10 minutes for 10 seconds or shift weight every 15 minutes. This can be done by chair push-ups, standing and reseating or elevating legs, etc. It is important to remember that bed creases or friction when dragging the individual can also lead to pressure ulcers.

In general, the body particularly the areas prone to pressure should be assessed carefully every day. Any change in skin colour, texture, temperature, feeling (boggyness or hardness), moisture, fluid collection, pain, itching or damage should be promptly addressed.

When lying on the bed, alternating directions such as right, left and back reduces pressure over bony prominences. The heels should be kept up by elevating calves on a soft cushion. When lying sideways, direct pressure on the hip bone should be avoided by placing a cushion between the heels to avoid contact between them. If any medical devices are being used, pressure from them should be minimised. Foam, pressure mattresses and chair cushions are some options that can assist in distributing pressure evenly over the body. The use of excess layers between body and pressure reducing material should be kept to a minimum.

Preventing moisture is another important aspect in ulcer prevention. Moisture softens the skin and reduces its resistance power. Daily sponging/bathing and frequent clothing change will help check excessive perspiration. If the patient is suffering from urinary/faecal incontinence, they should be cleaned and dried without rubbing. Incontinence should be checked every two hours.

The bed sheets, clothes and wound dressings should be changed frequently. However, the individual should be gently shifted by lifting rather than dragging during positioning, preferably with the help of more than one assistant or use of transfer aids such as slide sheets and slings. Nutrition and hydration needs vary depending on the individual, his condition and age and should be discussed with the physician. On an estimate, weight loss of more than five per cent or BMI (Body Mass Index) of 19 or less indicates lack of nutrition that needs to be addressed. Once pressure sores develop they should be treated by a doctor to prevent their progress to a critical stage.

Other problems of people confined to bed such as constipation, urinary tract infection and chest infection can be avoided by fibre-rich diet, sufficient water intake and chest physiotherapy tips like sharply tapping the back of the individual with palm for a couple of minutes to get rid of secretions at every posture change. Adequate attention, good skin care and maintenance of overall hygiene go a long way in making the individual feel good and stay motivated towards a healthy living.