Taking Care When Sitting
Pressure ulcers are caused when the person is in one position for too long. It is important to have a chair that is the right size so that weight can be spread evenly in the chair. If the chair is the wrong size, extra pressure can build up on bony or vulnerable parts of the body that are supporting too much weight. The chair must also be the right size to give a good position for breathing, eating, drinking and communicating when sitting. It is also important to be able to move in the chair and get on and off the chair to reduce the risk of pressure damage and to keep active.
To check the chair is the right size:
Feet should be flat on floor
Bottom should reach the back of seat
Back should be supported by the backrest from seat level upwards.
Ankles, knees and hips should be at about 90°
Thighs should be parallel with the floor
Arms should be comfortably supported by each armrest
Shoulders should be level, not hunched or leaning
If the chair is too low: The person’s knees will be higher than the seat, which puts pressure on their lower back and buttocks, and makes it difficult to get out of the chair.
If a chair is too wide or the armrests too low: The person will lean to one side or the other for support when sitting. Leaning to one side puts more pressure that side, and this can cause pressure damage, back pain and problems with swallow and breathing.
If the chair is too high or seat too long from front to back: The person will slide forward to get their feet on the floor. The person leans back in the seat to get support from the backrest and slides forward in the seat to get feet onto the floor for stability. This slide and slumped position can cause pressure damage on the bony areas, the buttocks, thighs and back. This position can cause back pain and can make breathing, swallowing and talking difficult.
If a pressure cushion is added to a chair that is already the right size, it can raise the seat height by up to 5” so that the person’s feet cannot reach the floor for support. The armrests will be too low for support and the person will slide forwards or lean to the side for support and stability as in this picture. This position will increase the risk of pressure ulcers and can cause back pain and problems with swallow and breathing. If there is a risk of skin damage, refer to the community nursing team for advice and talk to our team about seating solutions to reduce the risk of skin damage.
Ideas to improve function and reduce pressure when sitting
Find a better chair at home that is a good fit for support, function and pressure relief, but if that is not possible then see if the support in the chair can be improved.
If the chair is too wide the person will lean to the side for support, a soft cushion either side of the person’s bottom or a pillow on their lap might help to support them upright and support their arms when seated.
If the chair seat is too high a bath step under their feet can help to give them support to sit upright in the chair. The step should be removed before they stand from the chair as it could be a trip hazard.
If the chair is too low chair raisers can be purchased for legs or castors, to increase the height, like these linked chair raisers from Langhams for chairs on legs. An extra cushion on the seat may seem like a good idea but it will make the chair seat unstable and reduce support from the armrests.
If the chair seat is too deep (front to back) a pillow placed from top to bottom of the backrest will reduce the seat depth. Small cushions are uneven and won’t stay in place.
When eating and drinking it is easier and safer to sit at a table, but if this is not possible, eat from a lap tray or an over-chair table to avoid leaning to reach the meal.
To reduce leg swelling, encourage the person to be as active as possible with periods of bed rest during the day. Raising legs on a footstool is not so effective and the position can cause back pain. A rise and recline chair may be a useful option to reduce leg swelling, but getting the right size chair is important. See our rise and recline chair ‘before you buy’ guidance.
Physiotherapists recommend getting up from your chair frequently during the day, and in between times. See the seated exercises recommended on our Taking Care when Seated notes.