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What Causes Bed Sores?

Reviewed by NYC Wound | September 24, 2025

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Bed sores, also known as pressure ulcers, are areas of damaged skin and underlying tissue that develop when prolonged pressure restricts blood flow. They most commonly occur over bony areas such as the heels, hips, tailbone, and elbows. Understanding what causes bed sores is crucial because early recognition and prevention can significantly reduce the risk of serious complications, including infections and prolonged healing times. NYC Wound provides expert in-home care, with licensed Wound Care Specialists who help patients and caregivers identify risks, manage existing sores, and implement preventative strategies to protect the skin and support overall health. By learning how pressure, nutrition, and health conditions contribute to their development, patients and caregivers can take proactive steps with professional guidance to maintain healthy skin.
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Bed Sores

Bed sores are areas of damaged skin and underlying tissue that develop due to prolonged pressure, often over bony parts of the body. They are commonly referred to as pressure sores or pressure ulcers. These wounds can range from mild reddening of the skin to deep tissue damage that exposes muscle or bone.
Certain groups of people are at higher risk of developing bed sores, including:
  • Individuals who are bedridden or use a wheelchair for extended periods
  • Older adults with thinner, more fragile skin
  • People with limited mobility due to injury, illness, or surgery
  • Patients with chronic health conditions such as diabetes or vascular disease
  • Those with poor nutrition or dehydration, which can weaken the skin and slow healing
Understanding who is most at risk helps caregivers and healthcare providers implement preventive measures to protect vulnerable individuals.
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Pressure Ulcers vs. Pressure Sores

The terms pressure ulcers and pressure sores are often used interchangeably, but there are subtle differences in how they are understood in medical contexts. A pressure ulcer generally refers to any localized injury to the skin or underlying tissue caused by prolonged pressure, often accompanied by friction or shear. Pressure sores are commonly used as a more general or layperson-friendly term for the same type of injury.
Both terms appear frequently in healthcare because:
  • Medical precision: Pressure ulcer is the preferred clinical term in medical guidelines and documentation.
  • Everyday language: Pressure sore is easier for patients and caregivers to understand and is widely used in patient education materials.
  • Interchangeable usage: Both describe the same condition and its stages, ranging from mild skin reddening to severe tissue damage.
Using either term correctly helps ensure clear communication between healthcare professionals, patients, and caregivers.
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Pressure Injuries

Pressure injuries occur when prolonged pressure on the skin reduces blood flow to the area, depriving tissues of oxygen and essential nutrients. This lack of circulation can cause the skin and underlying tissue to break down, leading to wounds that may become painful or infected if not treated promptly. Friction and shear forces, such as sliding in a bed or chair, can worsen the damage by stretching or tearing delicate skin layers.
Typical areas where pressure injuries develop include:
  • Heels
  • Tailbone
  • Hips
  • Elbows
  • Shoulders
  • Back of the head
These areas are more vulnerable because they have less cushioning from fat or muscle over bony prominences. Recognizing high-risk areas is essential for implementing preventive measures and protecting skin integrity.

Blood Flow and Tissue Damage

Adequate blood flow is essential for keeping skin and underlying tissues healthy. When circulation is reduced due to prolonged pressure, the affected areas receive less oxygen and nutrients, making the skin more vulnerable to breakdown. Without sufficient blood flow, even minor pressure can lead to tissue damage and the formation of bed sores over time.
Friction and shear can further worsen tissue damage by:
  • Rubbing the skin against surfaces, which can wear away the outer layer
  • Pulling and stretching underlying tissues, increasing the risk of deeper injuries
  • Making the skin more fragile and less able to recover from pressure
Understanding how blood flow, friction, and shear contribute to tissue damage helps caregivers take preventive steps, such as repositioning patients regularly and using supportive surfaces to reduce pressure on vulnerable areas.

Poor Nutrition

Proper nutrition plays a critical role in maintaining healthy skin and supporting the body’s ability to repair tissue. Key nutrients for skin health include:
  • Protein: Supports tissue repair and regeneration
  • Vitamins A, C, and E: Promote skin strength, healing, and elasticity
  • Zinc: Aids in wound healing and immune function
  • Hydration: Keeps skin supple and resilient
Deficiencies in these nutrients can increase the risk of developing bed sores by weakening the skin, slowing the healing process, and reducing the body’s ability to fight infection. Individuals with poor dietary intake, chronic illnesses, or difficulty eating may require additional nutritional support to protect against pressure injuries and promote recovery.
Bed sore from malnutrition
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Health Conditions That Increase Risk

Certain health conditions make individuals more susceptible to developing bed sores. Chronic illnesses such as diabetes and vascular disease can impair circulation and reduce the body’s ability to heal damaged skin. Conditions that limit mobility, including severe arthritis or recovery from surgery, increase the time a person spends in one position, putting constant pressure on vulnerable areas.
Neurological conditions can also raise the risk of pressure injuries by affecting sensation or movement. Examples include:
  • Spinal cord injuries, which may prevent a person from feeling discomfort that signals the need to shift position
  • Stroke, which can limit mobility on one side of the body
  • Multiple sclerosis or Parkinson’s disease, which can reduce muscle control and movement
Awareness of these conditions helps caregivers and healthcare professionals implement targeted prevention strategies and monitor high-risk individuals more closely.

Prevent Pressure Sores

Preventing pressure sores requires consistent care and attention to reduce prolonged pressure on vulnerable areas. Regular repositioning is one of the most effective strategies. Changing positions frequently helps maintain blood flow to the skin and prevents tissue damage from sustained pressure. For individuals who are bedridden or use a wheelchair, caregivers should establish a schedule for turning or shifting every two hours or as recommended by healthcare professionals.
Supportive surfaces can also play a key role in prevention. These include:
  • Special mattresses: Designed to redistribute pressure and reduce stress on bony areas
  • Cushions and pads: Provide extra support for chairs, wheelchairs, and beds
  • Heel protectors and foam wedges: Reduce pressure on the heels, hips, and elbows
Combining regular movement with appropriate supportive surfaces significantly lowers the risk of developing bed sores and promotes overall skin health.

Role of the Healthcare Team

The healthcare team plays a vital role in preventing and managing bed sores. Doctors, nurses, caregivers, and wound care specialists work together to monitor skin health, identify early signs of pressure injuries, and implement appropriate interventions. NYC Wound provides licensed Wound Care Specialists who deliver expert in-home care, ensuring patients receive timely monitoring and treatment without the stress of traveling. Regular skin assessments help detect redness, irritation, or breakdown before it progresses into a more serious wound.
Key responsibilities of the healthcare team include:
  • Monitoring skin condition: Checking high-risk areas such as heels, hips, elbows, and tailbone regularly
  • Providing education: Teaching patients and caregivers about pressure sore prevention and proper skin care
  • Early intervention: Treating minor skin damage promptly to prevent worsening injuries
  • Wound care management: Cleaning, dressing, and protecting affected areas to promote healing
A coordinated approach, supported by professionals from NYC Wound, ensures timely treatment, reduces the risk of complications, and improves outcomes for patients at risk of bed sores.

Nursing Homes and Long-Term Care Facilities

Nursing homes and long-term care facilities often care for residents with limited mobility or chronic health conditions, placing them at higher risk for developing bed sores. Prolonged periods in bed or in a wheelchair increase pressure on vulnerable areas, making consistent prevention strategies essential. NYC Wound provides licensed Wound Care Specialists who can support these facilities by offering expert in-home wound care, assisting with prevention, monitoring, and treatment of pressure sores.
Facilities use several approaches to reduce the risk of pressure injuries, including:
  • Regular repositioning schedules: Ensuring residents are turned or shifted at frequent intervals
  • Specialized mattresses and cushions: Distributing pressure and providing extra support
  • Skin assessments: Conducted by nursing staff to catch early signs of irritation or breakdown
  • Staff training: Educating caregivers on proper techniques for moving residents and preventing friction and shear
  • Nutrition and hydration programs: Supporting skin health and overall healing capacity
By implementing these strategies and leveraging support from NYC Wound, nursing homes can significantly lower the incidence of bed sores and improve the quality of care for residents.
Bed sores develop when prolonged pressure, poor blood flow, or underlying health conditions damage the skin and tissue, with those who have limited mobility or chronic illnesses at greatest risk. Prevention and early care are essential. NYC Wound provides licensed Wound Care Specialists who deliver expert in-home care, helping monitor skin, guide caregivers, and treat existing sores. By combining regular repositioning, supportive surfaces, proper nutrition, and professional guidance from NYC Wound, patients can reduce the risk of bed sores and support faster, safer healing.

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