1 Pressure Injury Risk Factors

How risk factors combine

Pressure injury risk rises when a person cannot shift pressure, does not sense or respond to discomfort, or has medical conditions that reduce tissue tolerance or healing. Several factors may combine, so risk assessment should consider the person's overall condition rather than focusing on one factor alone.

Mobility and repositioning

Impaired mobility can leave pressure on vulnerable areas for longer, especially when a person cannot reposition independently. A bedbound person who needs help to change position has greater mobility-related risk than someone who walks and repositions independently. A person who is alert and can feel discomfort may still be at risk if weakness prevents them from turning without assistance.

Limited movement can also be associated with treatments or conditions. For example, sedation may limit movement or a person's response to discomfort.

Sensation and cognition

Sensory impairment can prevent someone from noticing pressure-related discomfort that might prompt a position change. For example, a person with a spinal cord injury who cannot feel discomfort below the waist may not recognize the need to shift pressure.

Cognitive impairment may make it harder to recognize or communicate discomfort, or to act on repositioning needs without prompting or help. These are distinct concerns from physical weakness: a person may be able to move but have difficulty recognizing or responding to the need to do so.

Circulation, nutrition, and history

Medical conditions and history can affect tissue tolerance or healing. Peripheral arterial disease and episodes of low blood pressure are concerning because they can impair tissue perfusion and reduce tissue tolerance to pressure. Diabetes with impaired circulation and poor nutritional intake are also risk factors.

A previous pressure injury is another factor that can increase risk. Consider these factors alongside the person's mobility, sensation, and ability to respond to discomfort.

Assessment and reassessment

A structured tool such as the Braden Scale can support assessment, but a single score does not determine an individual's care needs and does not replace clinical judgment. Use the tool as a guide while considering the person's overall condition and the combination of risk factors.

Reassessment is important when a person's condition changes. For example, a decline in mobility after surgery or the start of sedating medication calls for reassessment; do not rely unchanged on the admission assessment or wait for visible skin damage.