The Importance of Pressure Sores in Total Health Care

Abstract

At the end of a century which has seen unparalleled advances in science and engineering there remains a number of major health care problems. Two of them are inextricably linked, although at first sight they might seem to be unrelated. They are the problems of pain (Bonica, 1984) and of pressure sores. Pain is a common cause of disablement; pressure sores occur only on disabled persons. Pain and pressure sores are linked by the common factor of movement. Movement, either voluntary or involuntary, inevitably produces postural change. As Sherrington said, ‘posture follows movement like a shadow’. The parts of the body in contact with supporting

surfaces are called pressure points. Pressure borne at these points may be sufficient to produce local ischaemia. In a normal individual this is tolerated only briefly. Discomfort signals the need to alter posture, a new set of pressure points is brought into play and ischaemia is relieved at former load-bearing sites before tissue viability is compromised. This system breaks down if the signal to move is not appreciated, or if, though appreciated, it cannot be acted upon. The former occurs if the pressure point is numb or, of course, in an unconscious patient. The latter occurs when severe pain inhibits movement or the affected part is paralysed or immobilised. Too little pain is as dangerous as too much in predisposing to sores (Figures 1.1 to 1.3).