How often should you reposition someone in a chair? A caregiver's guide to prevention

According to the National Institutes of Health, millions of US patients suffer from pressure injuries each year. A cornerstone of prevention for those with limited mobility is knowing how often should you reposition someone in a chair to relieve pressure and maintain skin integrity. This authoritative guide provides crucial details for caregivers.

Quick Summary

The frequency depends on the individual's mobility level and risk factors. Those who can shift their weight independently should do so every 15 to 30 minutes, while individuals needing assistance should be repositioned at least every hour to avoid skin breakdown.

Key Points

• Frequency depends on mobility: Individuals who can move independently should shift their weight every 15-30 minutes, while those needing assistance require repositioning at least every hour.

• Monitor skin for changes: At each repositioning, perform a quick skin check on bony areas (tailbone, hips) for redness or irritation, which are early warning signs of pressure injuries.

• Use proper equipment: A drawsheet or transfer sling helps caregivers safely lift and reposition someone without causing skin shearing.

• Consider all risk factors: An individual's overall health, skin condition, circulation, and incontinence issues all influence how often they need to be moved.

• Utilize specialized seating: Pressure-redistributing cushions and tilt-in-space chairs can aid in relieving pressure but should be used in conjunction with a regular repositioning schedule.

• Never drag the person: Always lift and move, rather than drag, to prevent friction and shearing that can damage the skin.

Understanding the Need for Repositioning

For individuals with limited mobility, prolonged sitting can place continuous pressure on bony areas such as the tailbone, hips, and shoulder blades. This constant pressure restricts blood flow, which can lead to skin breakdown and the development of painful and serious pressure injuries, also known as pressure sores or bedsores. Regular repositioning is a simple yet critical preventive measure that redistributes pressure, promotes circulation, and enhances overall comfort.

Standard Guidelines for Repositioning

The frequency of repositioning is not a one-size-fits-all rule and is determined by the individual's specific needs. However, there are well-established guidelines that serve as a starting point for caregivers.

For those who can self-reposition

If the person can independently shift their weight, they should be encouraged to do so every 15 to 30 minutes. This might involve:

• Leaning side to side.
• Leaning forward.
• Using their arms to lift their body slightly off the seat.

For those needing assistance

For individuals who are unable to reposition themselves, a caregiver must provide assistance. The general recommendation is to reposition them at least every 60 minutes. This timing is a proactive measure to prevent pressure from building up and causing damage.

Factors that Influence Repositioning Frequency

Beyond general guidelines, several factors can necessitate more frequent repositioning. A personalized approach is always best and should be discussed with a healthcare professional.

Level of Activity and Mobility

• Fully immobile: An individual with no movement will require the most frequent and consistent repositioning. Their risk is high, especially if they spend most of their day seated.
• Some mobility: Even small, independent movements should be encouraged. The caregiver’s role is to ensure these movements are sufficient and supplement with assisted repositioning as needed.

Skin and Overall Health Condition

• Existing pressure sores: If the person already has a pressure injury, they must be repositioned more frequently to keep pressure off the affected area and promote healing. This requires diligent observation and careful technique.
• Poor circulation: Conditions that affect blood flow, like diabetes or peripheral artery disease, increase the risk of pressure injuries. Closer monitoring and more frequent repositioning are essential.
• Incontinence: Moisture on the skin increases the risk of skin breakdown. Ensuring the person is clean and dry is vital, and repositioning provides an opportunity for skin checks.

Seating Equipment

• Pressure-redistributing cushions: High-quality pressure cushions, made from materials like gel or specialized foam, can help distribute weight more evenly, potentially allowing for slightly longer intervals between full repositioning. However, they are not a substitute for regular movement.
• Tilt-in-space chairs: These chairs can be tilted backward, changing the angle of the hips and back and redistributing pressure. They are very effective for dependent individuals but still require a regular schedule for tilting and repositioning.

Proper Techniques for Assisted Repositioning

Using correct techniques is essential to prevent injury to both the caregiver and the person being moved.

Use a Drawsheet or Sling

To avoid shearing (dragging the skin), a drawsheet or sling is a necessary tool. For repositioning someone deeper into a chair:

1. Ensure the chair's brakes are locked.
2. With a helper, stand on either side of the chair.
3. On the count of three, lift the person up and back into the correct position, keeping their hips deep in the seat.

Assisted Weight Shift

For a simpler weight shift, a caregiver can assist without lifting the person completely.

1. Stand in front of the person with the chair's brakes locked.
2. Place one foot between their feet and a hand on their lower back for support.
3. Gently instruct them to lean forward as you provide stability and then guide them back into a new sitting position.

Comparing Repositioning Strategies

This table outlines different approaches based on an individual's capabilities and risk.

Scenario	Repositioning Method	Recommended Frequency	Key Considerations
Independent Mobility	Self-initiated weight shifts	Every 15–30 minutes	Ensure proper form, use a good cushion
Assisted Repositioning	Caregiver-assisted lifts or shifts	At least every 60 minutes	Use proper equipment (drawsheet), ensure good body mechanics
Tilt-in-Space Wheelchair	Tilting and reclining chair	At least every 60 minutes	Recline backrest after tilting the seat to prevent sliding
High-Risk Individuals	Combination of techniques	More frequently than hourly	Close skin monitoring, specialized equipment

The Importance of Skin Checks

Every time you reposition someone, take a moment to perform a quick skin check. Look for any signs of skin irritation or damage, especially on bony areas. Early signs of a pressure injury include redness that doesn't go away after the pressure is relieved (non-blanchable erythema). Catching these signs early is key to preventing a more serious injury.

Conclusion

Knowing how often should you reposition someone in a chair is not just about following a schedule; it’s about providing attentive, compassionate care that prioritizes well-being. By understanding the risk factors, using proper techniques, and staying vigilant with skin checks, caregivers can significantly reduce the risk of pressure injuries and improve the comfort and quality of life for those they care for. For more general resources on healthy aging, visit the National Institute on Aging.

Frequently Asked Questions

What is the primary reason to frequently reposition someone in a chair?

The main reason is to relieve constant pressure on the skin over bony areas, which prevents the development of pressure injuries, also known as bedsores or pressure ulcers. It also improves circulation and comfort.

How can I tell if a pressure sore is starting to form?

The first sign is often a red or discolored patch of skin that does not turn white when light pressure is applied (non-blanchable erythema). The area may also feel warm, hard, or spongy compared to the surrounding skin. Checking the skin during repositioning is key.

What if the person I am caring for refuses to be repositioned?

Resistance can occur due to discomfort or a desire to be left alone. Explain the importance of repositioning for preventing painful sores. You can also work with a physical therapist to find more comfortable positions and use specialized cushions to make the process more tolerable.

Can a person with a wheelchair reposition themselves effectively?

Many people in wheelchairs can perform independent weight shifts by leaning forward or side-to-side every 15-30 minutes. Caregivers should still monitor them, and assisted repositioning may be necessary, especially for full pressure relief.

What are the common trouble spots to check when repositioning?

Key areas to check for pressure injuries include the tailbone (coccyx), hip bones (ischial tuberosities), backs of the knees, shoulder blades, and elbows. Any area in constant contact with the chair's surface is at risk.

Is using a special cushion enough to prevent pressure sores?

While pressure-redistributing cushions are highly beneficial and recommended, they are not a substitute for regular repositioning. They reduce pressure but do not eliminate the need for movement. Repositioning and a good cushion work together for best results.

How should I properly use a tilt-in-space wheelchair for repositioning?

When using a tilt-in-space chair, tilt the seat back first, and then recline the backrest. This helps the person stay seated properly and shifts pressure off the buttocks. Reverse the process when returning to an upright position, reclining the backrest first.