Part 7 · The caregiver
Care that prevents serious harm
Content under professional review before publication.
1The posture that slides: the danger of the sacral sore
The problem
A seated person who little by little slides forward and ends up sunken in the chair, with the back in a C shape, looks comfortable and calm. In reality it is one of the most dangerous postures, and many do not recognize it.
What is happening underneath
As they slide, the pelvis goes backward and all the weight falls on the tailbone (the sacrum and the coccyx). The skin stays trapped against the seat while the bone moves, and that pressure and rubbing over the bone can open a sore that is very hard to heal.
Step by step
- Learn to recognize it: the person slipped forward, sitting on the tailbone instead of on the buttocks, with the back rounded.
- Do not leave them like that even if it looks comfortable: the longer it lasts, the greater the risk of a sore and of sliding off the chair.
- Reposition them well back in the seat, with the tailbone against the backrest and the back supported and straight (see the wheelchair chapter).
- Check often how they are sitting, especially if they cannot reposition themselves.
- If there is already a red area on the tailbone that does not fade, take the pressure off it and tell the health team.
What you must never do
- Never confuse "still and sunken" with "comfortable and safe."
- Never leave them for hours in that posture without repositioning.
- Never ignore a red mark over the sacrum: it is the first sign of a sore.
When to ask for help
If they slide again and again, almost always the chair or the cushion is not the right one. An occupational therapist or physical therapist can adjust it. At redness that does not fade or a wound, consult the health team.
2Sitting well so as not to get hurt
The problem
Most people are not well seated in their chair, and that shows only when the pain or the sore appears. Good posture is not a luxury: it prevents serious wounds.
What is happening underneath
If the feet are not well supported, if the seat is too deep, or the knees end up higher than the hips, the body slips forward. Supporting the pelvis well is what prevents that sliding.
Step by step
- A firm base and a good cushion that distributes pressure are the key; a fabric seat that sags pulls the pelvis backward (see the wheelchair chapter).
- Hips and knees at a right angle, roughly 90 degrees, with the pelvis well back in the seat.
- Make sure the knees do not end up higher than the hips: when they are higher, the weight shifts to the sacrum and the person slides.
- The feet well supported, on the floor or on the footrests at the right height, with no gaps under the thighs.
- If they still slide, a wedge cushion or a pelvic belt, properly placed, help to hold them.
What you must never do
- Never use just "any chair" for someone who spends many hours seated.
- Never leave the feet dangling or the footrests at a height that raises the knees.
- Never choose a cushion or adjust the chair "by eye" for someone at risk: have a professional guide it.
When to ask for help
The chair and the cushion are chosen to fit each person, and the body changes over time. An occupational therapist or physical therapist experienced in seating is the one who best adjusts it.
3Reposition, check the skin, and the sling
The problem
Many hours without moving, skin that no one looks at, and a poorly placed sling are three silent causes of harm. The caregiver can prevent all three with simple gestures.
What is happening underneath
Sustained pressure over a bone cuts off the skin's circulation; within a few hours the damage begins. Shifting the weight and looking at the skin in time prevents it.
Step by step
- Help shift the weight often: lean forward, tilt to one side and the other, or stand up for a moment. Small changes every little while relieve a lot.
- Do not leave them sitting without moving for hours; if they cannot reposition themselves, do it yourself every so often (see the hydration and daily care chapter for repositioning in bed).
- Check the skin over the bones: tailbone (sacrum and coccyx), buttocks, hips, heels, elbows. A red area that does not fade when the pressure is removed is the warning.
- With the hoist, check that the sling sits well, with no folds or parts that pinch. The person with dementia may not complain even if it bothers them: check it yourself (see the hoist chapter).
- In transfers, lift without dragging: rubbing on the skin also opens sores (see the transfers chapter).
What you must never do
- Never leave the person for many hours in the same position.
- Never assume that "if they do not complain, they are fine": many cannot report the pain.
- Never leave someone sitting on the transfer sling if it is not made for that.
When to ask for help
At redness that does not fade, a blister, or a wound, tell the health team right away (nursing, doctor). A sore is easy to prevent and very hard to heal.
What about the home?
This library is free. iliapp.com is a professional service that assesses the home to make it safer.
Discover iliapp.com- This content is for educational and general guidance purposes. It does not constitute medical or nursing advice, and does not replace in-person evaluation by a qualified health professional.
- The choice and adjustment of the chair, the cushion, and the supports, as well as the care of skin and wounds, must be defined with professionals (occupational therapist, physical therapist, nursing, doctor).
- Inclusive Living International (ILI), together with its directors, employees, and representatives, shall not be liable for injuries, damages, or outcomes arising from the application of this information.
- Use of this guide is the responsibility of the person applying it. At redness that does not fade, a blister, or a wound, consult a health professional.
- The Spanish version is the governing legal document. Versions in other languages are a courtesy; in case of discrepancy, the Spanish version prevails.
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Content based on public-health and caregiver-support guidance and on internationally recognized clinical consensus. Not affiliated with or endorsed by any organization.