Warm weather buts a smile on anyone's face, but for older adults or anyone who spends long periods seated or in bed, summer also increases a specific risk that is easy to overlook: pressure sores. Heat, sweating and long spells in the same position combine to make skin more vulnerable this time of year.
This guide explains why the risk rises in summer, what to watch for, and some practical steps that reduce it.
What is a pressure sore, and who is most at risk?
Pressure sores, also called pressure ulcers or bedsores, are injuries to the skin and the tissue underneath it, caused by prolonged pressure. They most often form over bony areas: the heels, elbows, hips and the base of the spine. They can develop slowly over days, but sustained pressure can begin to damage tissue within a few hours.
According to the HSE, those most at risk are those over 70, anyone confined to bed due to illness or surgery, anyone with limited mobility, anyone who is incontinent, has a poor diet, or has a condition that affects circulation or skin fragility. Immobility is the single most important contributing factor to developing pressure sores.
The earliest warning sign is a patch of skin that looks discoloured and does not turn white when pressed. On paler skin this appears red; on darker skin it may look purple or blue. The skin may also feel warm, spongy or hard, or be painful or itchy. This early stage is the point to act.
Why summer raises the risk
Three summer-specific factors matter.
Moisture. Sweat sits against the skin and softens it, a process that makes the surface more prone to breaking down. Clinical guidance lists moisture, alongside pressure, friction and shear, as one of the four external causes of pressure damage. Skin that stays damp in a skin fold or against a cushion is more vulnerable.
Dehydration. Hot weather makes it easier to become dehydrated, and good hydration helps maintain healthy, resilient skin. Tea and coffee are mild diuretics, so can dehydrate you and should not be fully counted towards daily fluids.
Warm weather leading to reduced movement. In very warm weather, older people can become lethargic and move less, and longer stretches in a chair or bed mean longer sustained pressure on the same points.
Gauging the risk: the Braden, Norton and Waterlow scales
Healthcare professionals use validated tools to judge how likely someone is to develop a pressure sore, and how well they would heal. The assessment weighs many factors together: age, underlying disease, ongoing treatment, nutrition, cognition, continence, skin integrity and mobility among them.
Three scales are widely used in Ireland and the UK, the Braden, Norton and Waterlow. Each scores the risk factors in its own way, but all do the same job, sorting a person into one of three levels:
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Low risk
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Moderate risk
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High risk
That level of risk of developing pressure sores is what guides the cushion choice.
Whatever the score, one principle guides the choice: the best pressure is no pressure. But the higher the risk, the more the cushion needs to actively offload the pressure:
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Low risk: usually a more basic foam cushion, for someone who still moves regularly.
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Moderate risk: often a high-specification foam or gel-infused foam cushion, for longer sitting or reduced mobility.
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High risk: typically an air, air-and-gel or high performance gel cushion that actively redistributes pressure, for people with very limited mobility.
Beyond this, posture, seating, body shape and weight all come into it, which is why an assessment by a trained professional matters. If you are at risk or have concerns, a formal assessment should be carried out by your own nurse, occupational therapist or GP.
Six steps to protect skin integrity this summer
1. Check the skin every day. Look at the heels, ankles, tailbone, hips, elbows and shoulders, and anywhere skin meets straps or equipment. Use a mirror or ask a carer for hard-to-reach areas. Redness that does not fade after pressure is removed should be taken seriously.
2. Reposition regularly. Changing position is the most effective single measure. As a general guide, reposition someone in bed at least every two hours and someone in a chair around every hour; on a pressure-relieving cushion or device this often extends to every two to four hours. Follow any schedule a clinician has set, and if the person can shift their own weight, encourage small, frequent movements.
3. Use a pressure-relieving cushion. For anyone sitting for long periods, a cushion that redistributes weight across a wider area reduces the load on vulnerable points. Avoid ring or "donut" cushions, which clinical guidance advises against because they concentrate pressure around the edges. Look for a breathable, multi-directional stretch cover, which helps limit heat and moisture build-up against the skin.
4. Keep skin clean, dry and moisturised. Wash with a mild, non-perfumed cleanser and warm, not hot, water, then pat the skin dry gently rather than rubbing, especially in skin folds. Moisturise afterwards to counter older, drier skin, and avoid scented products. Do not massage vigorously over bony areas. Where incontinence is a factor, a barrier cream (such as Cavilon) protects the skin from moisture and also helps guard against the shearing that can tear fragile skin when someone is moved.
5. Stay cool and hydrated. Choose light, breathable, moisture-wicking clothing and keep a cloth handy to wipe away sweat. Encourage regular fluids across the day. A balanced diet with enough protein, vitamins and minerals supports skin health and healing.
6. Mind the environment. Keep bedsheets smooth and unwrinkled, use cotton or similarly breathable fabrics, and avoid dragging heels or elbows across surfaces when moving someone, which causes friction damage.
When to seek medical advice
By the time a pressure sore is visible on the skin, it has usually been developing underneath for some time. So if someone complains of soreness or pain in a pressure area even when there is nothing to see, take it seriously.
Tell a GP, nurse or other healthcare professional promptly, and note any visible changes such as redness, broken or weeping skin, or discolouration. The area itself should be assessed by a trained professional. The HSE advises seeking medical advice immediately if there is red, swollen skin, pus from a wound, cold skin with a fast heartbeat, severe or worsening pain, or a high temperature, as these can signal serious infection.
Pressure sores are largely preventable, but once the skin breaks the situation becomes trickier to manage. Early action is always easier than treatment.
How Phelan's can help
As one of Ireland's leading healthcare and mobility aid stores, we stock a variety of pressure-relieving cushions and everyday skin-care essentials, and our expert team can talk you through the various options. We do not diagnose or treat pressure sores; for any wound or skin concern, please contact your GP or public health nurse.
Browse our pressure-relief cushions
Frequently asked questions
How quickly can a pressure sore form?
They often develop over days, but sustained pressure can start to damage tissue within the first hour to a few hours, which is why regular repositioning matters.
How often should someone be repositioned?
General guidance is at least every two hours in bed and around every hour in a chair, extending to every two to four hours when a pressure-relieving cushion or device is in use, unless a clinician advises a different schedule.
Are gel, foam or air cushions best?
Each suits different needs depending on weight, mobility and time spent sitting. Generally, foam is used for low risk, gel is used more for medium risk and air is often for high risk, but there is no single best type for everyone. This is why it helps to get advice before choosing.
Why avoid donut or ring cushions?
Clinical guidance advises against them for pressure related injuries because they concentrate pressure around the edge of the ring rather than redistributing it, which can make matters worse.
PLEASE REFER TO YOUR GP OR NURSE WITH SPECIFIC HEALTH CONCERNS
