More elderly people in Singapore suffering from pressure injuries
Published on
11 Mar 2025
Published by
The Straits Times
SINGAPORE – Mr Frederick Bakar had been living in a nursing home for years without major health issues. But in February, he developed a severe pressure injury on his left hip that required hospital admission.
The former army staff sergeant has been paralysed from the chest down since an accident 30 years ago. As a result, the 78-year-old developed a pressure injury that became worse over time. It emitted a foul odour and made him feel sick.
“It started as a small patch of damaged skin and progressed into a necrotic sore, leaking fluids,” says Mr Jason Er, a nurse clinician at Alexandra Hospital (AH), who treated Mr Bakar in a ward.
Pressure injuries – commonly referred to as pressure sores, pressure ulcers or bedsores – are skin and tissue injuries that happen when a person stays in one position for too long. It usually occurs over bony areas such as the tailbone, heels, hips and ankles.
A pressure injury usually starts off with some redness on the skin, and may present as red or maroon patches. If left untreated, it can progress rapidly, developing into a severe ulcer reaching the muscle, bone or joints within 24 to 48 hours, says Mr Er, who specialises in wound care.
Pressure injuries can be extremely painful, with the severity increasing as they advance through different stages.
Ms Fazila Aloweni, senior nurse manager at Singapore General Hospital’s (SGH) department of nursing division (research), says early-stage injuries may cause mild discomfort, while advanced stages can hurt significantly due to tissue damage, inflammation and potential infection.
Pressure injuries mostly affect people with limited mobility, such as those who are bedridden or use wheelchairs. Older adults are at risk due to factors such as reduced movement, fragile skin, poor nutrition, and chronic conditions like diabetes.
At SGH, Ms Aloweni says patients with pressure injuries often arrive at the emergency department due to other medical conditions requiring immediate attention.
“In some instances, they are admitted primarily due to the deterioration of their pressure injuries, especially when these are associated with wound infection and/or sepsis,” she adds.
In Mr Bakar’s case, his prolonged immobility and reluctance to change positions while lying on the bed in the nursing home contributed to the development and worsening of his wound, says Mr Er.
Spike in cases
AH has observed a sharp rise in patients with pressure injuries, notes Mr Er.
In 2022, there were 130 cases. This figure increased by more than 10 per cent to 145 cases in 2023. The number surged in 2024, jumping over 90 per cent to 279 cases.
About 90 per cent of patients with pressure injuries at AH are above age 65 with conditions such as dementia and stroke.
Dr Janet Hung, a consultant at AH’s plastic, reconstructive and aesthetic surgery department, says the increase is driven by several reasons.
As the population ages and life expectancy increases, a growing number of elderly people may experience reduced mobility, placing them at higher risk of developing pressure injuries.
Chronic conditions such as diabetes and vascular diseases also impair blood circulation and delay wound healing, increasing the risk of pressure injury development.
Elderly people with poor nutrition are at higher risk of skin breakdown as well, increasing their susceptibility to pressure injuries, notes Dr Hung.
Ms Doris Hung, a nurse clinician at National University Polyclinics’ (NUP) nursing administration department, says there has been an increase in patients visiting the wound clinic with pressure injuries across the seven polyclinics under NUP. These include Bukit Batok Polyclinic, Choa Chu Kang Polyclinic and Clementi Polyclinic.
There were 74 cases between February 2023 and January 2024. The number rose to 103 from February 2024 to January 2025.
The majority of patients are between the ages of 75 and 90.
Besides ageing skin, the lack of awareness and understanding in the prevention of pressure injuries among caregivers has contributed to the increase in numbers, says Ms Hung.
She oversees the wound care and dressing services of patients. Among her patients is Madam Diong Mee Hua, who developed pressure injuries around her buttocks after prolonged immobility.
The 78-year-old is in remission from lymphoma and has early-stage dementia, and spends most of her time in bed or on a wheelchair.
Her son Tan Tong Lee, 58, first discovered multiple wounds around his mother’s buttocks in December 2024. He and his wife were changing Madam Diong’s diapers as it was their helper’s day off.
“I had never seen them before. They were each about the size of a 20-cent coin,” he says.
“We took her to a general practitioner, but after weeks of applying medication, there was no improvement. The wounds started growing bigger. I became very worried,” says Mr Tan, who is a construction site supervisor.
The GP then referred Madam Diong to Bukit Batok Polyclinic, where she was treated by Ms Hung.
After three visits, the wounds have shrunk by 50 per cent and her skin condition has become better. As a result, her mood, alertness and appetite have improved.
Besides Madam Diong’s immobility, Ms Hung says contributing factors to the injuries could be incontinence and prolonged diaper use, which traps moisture. While diapers absorb urine, they must be changed at least four times a day to prevent skin irritation and breakdown, she advises.
Also, as people age, their skin becomes thinner and weaker due to reduced collagen production and immunity.
This makes it more prone to breakdown from pressure, friction and moisture. Hot and humid weather also aggravates the problem. So proper skincare becomes even more important, she adds.
Madam Diong’s wound dressings are changed daily after showers, with her helper managing the care, while her son provides support.
As her condition improves, Ms Hung will reduce check-ups to once a week.
Madam Diong’s wounds may take three to six months to fully heal, says Ms Hung.
To help with his mother’s recovery, Mr Tan bought a pressure-relieving mattress which evenly disperses body weight and prevents sore spots.
He also makes sure she is repositioned every two hours to prevent her wounds from worsening and reduce the risk of future pressure injuries.
Caregivers’ role in prevention
Mr Er and other researchers conducted a study on the causes of pressure injuries which was published in the Journal of the American Academy of Dermatology in 2024.
One key finding is that many caregivers lack proper education on how to prevent these injuries. They may also experience exhaustion and frustration, leading to inconsistent care.
“Some caregivers report sleep deprivation due to frequent repositioning of patients. The emotional stress leads to decisions like hospitalising the patient to treat the injury,” adds Mr Er.
At the hospital, wound care specialists like Mr Er manage Mr Bakar’s condition through debridement. This refers to the bedside treatment of removing dead, damaged or infected tissue to help a wound heal properly.
Unlike surgery, which aims for an immediate clean-up of the wound, bedside treatment is more gradual, but necessary for elderly patients who have underlying medical conditions, says Mr Er.
Mr Bakar, who is single, has hypertension, high cholesterol and diabetes.
After debridement, the wound heals in stages. Proper wound care – including dressings, infection prevention, pressure relief and good nutrition – supports healing, say experts.
Mr Bakar’s wound has mostly recovered. He was moved to community hospital St Luke’s to continue wound care, and will return to the nursing home when the wound is more manageable.
Full recovery difficult
Recovery time varies, with minor wounds healing in weeks and severe cases taking months, notes Mr Er.
He adds that less than 10 per cent of patients fully heal, with the others dying before their wounds close.
“Recovery is a long and difficult process, as the wound can heal only if the patient’s overall health improves. For the elderly, this is even more challenging, as they are more vulnerable to infections,” says Mr Er.
Plastic surgery, particularly reconstructive surgery, is also an option for some patients. It helps in wound closure by covering the area with healthy muscle or skin tissue, says Dr Hung.
It promotes healing, reduces the need for ongoing wound care and lowers the risk of infection. “In turn, this helps ease caregiver burden while lowering the cost and time commitment of regular wound care,” she adds.
The majority of patients, however, are not suitable for surgery due to existing medical conditions.
For those caring for elderly loved ones, Mr Tan has one key piece of advice: Be alert.
“If we hadn’t been observant, the wounds would have worsened. It’s important to check for any signs of injury, seek medical advice and follow through with proper care,” he says.
5 tips to avoid pressure injuries
Pressure injuries are preventable with proper care, but remain a persistent issue among seniors due to immobility, poor nutrition and inadequate prevention, says Ms Nanthakumahrie Gunasegaran, a nurse clinician at SGH’s department of nursing division (research).
“Unlike conditions such as diabetes and cancer, they often go unnoticed despite their serious impact. Greater awareness and education for healthcare providers, caregivers and the public are needed to reduce the incidence of pressure injuries,” she says.
Ms Nanthakumahrie and Ms Aloweni share five tips to reduce the risk of pressure injuries.
1. Frequent repositioning
Patients should be turned or shifted at least every two hours to relieve pressure on vulnerable areas. If they are seated, encourage small weight shifts every 15 to 30 minutes to reduce prolonged pressure on one spot.
2. Practise proper skincare
Skin should be kept clean and dry, but not overly dry, as both excessive moisture and dryness can contribute to skin breakdown.
Moisturising can help prevent cracking, while managing excess moisture from sweat, urine or wound fluid is crucial.
Change diapers regularly to prevent prolonged exposure to urine or faeces, which can cause irritation and breakdown. Applying a protective barrier cream can further safeguard the skin from moisture-related damage.
3. Use pressure-relieving aids
Specialised mattresses, cushions and heel protectors can minimise pressure on bony areas of the body.
When repositioning patients, caregivers should use sliding sheets to move them gently and prevent friction and shear that can damage the skin.
4. Pay attention to nutrition and hydration
A well-balanced diet with adequate protein intake is essential for tissue repair. Ensuring the patient stays hydrated is equally important, as dehydration can make skin more fragile. If caregivers are unsure about the patient’s nutritional needs, consult a dietitian.
5. Conduct regular checks
Caregivers should inspect the patient’s skin daily, especially over bony areas, for any signs of redness, swelling or sores.
Early detection allows for timely intervention which can prevent further complications. If the wound worsens and shows signs of infection – such as warmth, redness or pus – or does not improve despite proper care, seek medical attention.
- Amrita Kaur is a journalist at The Straits Times, where she covers the evolving healthcare landscape in Singapore, including mental health and wellness.
Source: The Straits Times © SPH Media Limited. Reproduced with permission.
Photo: The Straits Times
Written By: Amrita Kaur
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