Pressure sores and falls: the two risks that unfold between visits

Why these two before anything else

A pressure sore and a fall share one property: they turn a stable situation into a hospital admission, sometimes ending home care for good.

They are almost entirely preventable through simple, repeated actions — which requires relatives to know which ones. That is the sole purpose of this page.

Pressure sores: the signs that should alert you

Redness that does not turn white under finger pressure — over the sacrum, heels, hips or elbows — is the first stage, and at that point everything is still reversible.

Regular repositioning, crease-free bedding, clean dry skin, and adequate food and fluids remain the most effective measures.

A heel is protected by letting it float, never by resting it on a cushion that presses on the same spot.

Falls: change the environment before changing the person

Loose rugs, cables crossing a room, poor lighting between bed and toilet at night, backless slippers: these are the most frequent and the easiest causes to remove.

Standing up abruptly after a meal or after a treatment change can cause dizziness. Getting up in two stages — sitting on the edge of the bed, waiting — prevents a share of these falls.

Every fall must be reported to us, even without immediate pain: for someone on anticoagulants, a knock to the head needs prompt medical advice.

What we put in place, week by week

The first week is for observing: when the person gets up, where they lean, how long they stay seated, what they actually eat. Prevention built on assumptions does not survive a fortnight.

Then come the concrete measures: pressure points relieved at set intervals, heels and sacrum protected, hydration monitored, protein intake discussed with the doctor, and closed shoes rather than slippers.

Every visit checks only two things, but always: the state of the skin at pressure points, and any new obstacle on the route between bed and bathroom. Those are the two places where it is won or lost.

When to call us

Persistent redness, a new wound, a change in the smell or appearance of an existing wound, unexplained fever, a fall with or without pain, lasting refusal to eat.

Outside our hours the rule is the same as for any emergency: 15 or 112. We would rather take an unnecessary call than receive a late one.

Pressure points, in the order they give way

Prevention becomes concrete the moment you name the places to look at. They are almost always the same, and they depend mainly on the position held for the longest time.

This table is an observation guide, not a care protocol: the measures themselves follow national health authority recommendations and the medical prescription.

The home, room by room

Most of the falls we see do not happen outdoors, but along three metres of hallway. One walk through the home settles part of the problem for months.

• Bedroom: clear route to the bed, switch or night light reachable from the bed.
• Hallway: no loose rug, no cable across the floor, enough light at night.
• Bathroom: non-slip mat, grab rail where prescribed, stable shower seat.
• Kitchen: everyday items at hand height, never on a stool.
• Stairs: solid handrail, clear steps, visible contrast on the first and last step.
• Footwear: closed shoes that hold the foot, instead of soft slippers.

After a fall: the twenty-four hours that count

A fall without immediate pain is not a fall without consequence. We ask to be told even when everything seems fine, because some complications appear late.

A fall with a head knock in someone taking anticoagulants warrants prompt medical advice, without waiting for a symptom. Where severity is uncertain, 15 decides better than reasoning at a distance.

We then record the exact circumstances: time, room, footwear, activity, lighting. A fall described precisely can be prevented; a fall summed up in one word repeats itself.

Pressure points to check every day

Between visits, relatives see it first. Looking does not mean treating: the task is to spot redness that does not fade under pressure, and to tell us.

• Heels, both lying down and seated.
• Sacrum and buttocks, the most exposed points when sitting for long periods.
• Hips and outer knees when lying on the side.
• Elbows and shoulder blades.
• Ears and back of the head in a bed-bound person.
• Areas in contact with a device: catheter, mask, splint, compression stockings.

What genuinely reduces fall risk

Three material changes matter more than any advice: night lighting along the bed-to-bathroom route, removing rugs, and a stable support where the person stands up.

Then comes wear: backless slippers, smooth soles, a badly adjusted walking stick, out-of-date glasses. These are fixed in a day and checked at every assessment.

Finally, a fall with no apparent consequence is still crucial information: it often announces the next one. We record it, even when the person prefers to play it down.

When to call

Redness that does not blanch under pressure, broken skin however small, new pain at a pressure point, a fall with or without pain, inability to get up alone, faintness on standing: call the same day.

A pressure sore caught at the redness stage is treated very differently from one found already open.

What we record, and what it triggers

An observed redness is dated, located and described; a fall is recorded even without consequence, with the time and circumstances. Both entries trigger a note to the GP the same day.

The point is not bookkeeping. Three falls in a month tell a different story from an isolated one: sometimes a treatment to review, sometimes failing eyesight, sometimes a home to adapt. Dated repetition is what makes the cause visible.

Frequently asked questions on this page

Terms explained

Pressure sore

Damage to skin and tissue caused by prolonged pressure on a support area (sacrum, heels, hips), common with immobility.

Anticoagulant

A medicine that slows blood clotting to prevent a clot. It requires watching for bleeding and, for some, regular blood tests.

Care protocol

A written, dated description of how a specific patient's care must be delivered: products, supplies, frequency, alert criteria.