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Much of the pressure care advice families receive focuses on beds and mattresses, and rightly so. But many people at risk of pressure ulcers spend eight, ten, even twelve hours a day in a chair. Whether that is an armchair in the front room, a dining chair at the table or a wheelchair, the same principle applies: pressure builds where the body meets a firm surface, and the two danger zones are the base of the spine (the sacrum) and the sitting bones (the ischial tuberosities).
When a chair is the wrong size, weight is squeezed into a small area rather than spread out, and the person cannot shift position easily. Getting the setup right lowers pressure, steadies the body and makes standing up less of a struggle. It is one of the most useful things a family carer can do, and it costs nothing but a little time and a tape measure.
Ask the person to sit well back in the chair with their shoes on. Their feet should rest flat on the floor (or on a properly adjusted footrest), and their knees should be level with the hips or just slightly lower — roughly a 90 to 100 degree angle at the hip.
A rough starting point: measure from the floor to the crease at the back of the knee while the person sits with their feet flat, then take off two to three centimetres for the cushion that will sit on top. Measure the sitting surface, not the chair frame, and re-check with any cushion in place.
With the person sitting back, there should be a gap of about two to three fingers — roughly five centimetres — between the back of the knee and the front edge of the seat.
A seat that is too deep presses on the back of the knees, restricts circulation and encourages a slumped, sliding posture. A seat that is too shallow leaves the thighs unsupported so the body weight is concentrated on a small patch of bottom. If the chair is too deep, a firm cushion placed behind the back can bring the person forward — but it must be firm and squared off, not soft enough to squash down and let them slide again.
Check the lower back too. The chair should support the natural inward curve of the lumbar spine. A small rolled towel or a proper lumbar roll tucked into the small of the back helps people sit upright without effort, which in turn keeps weight spread more evenly.
Armrests are often overlooked, yet they do a surprising amount of work. They give the arms somewhere to rest so the shoulders can relax, they help the person shift their weight from side to side, and they provide a push-off point when standing.
Flip-back or removable armrests make transfers much easier if the person uses a slide sheet, a transfer board or a hoist.
If the person has been assessed as at risk, use the pressure-redistributing cushion supplied by an occupational therapist or district nurse. Do not improvise with folded pillows, and avoid ring-shaped cushions, which can cause more harm than good. Never stack cushions — a wobbly base makes the person grip and tense, which is tiring and unsafe.
A good chair setup does not stay good forever. Re-measure after any weight change, a hospital stay, a new cushion, a new chair or a decline in mobility. If you need to raise a chair, use proper raiser blocks that fit securely under each leg — but never on a chair with castors, and never more than a few centimetres without advice, as the chair can become unstable.
If you are unsure, ask for help. A GP can refer you to an occupational therapist, and many local councils and NHS wheelchair services offer assessment at home. A twenty-minute visit can transform a person's comfort, protect their skin and make daily life noticeably easier for everyone involved.
Pressure Care Matters shares practical, down-to-earth guidance on pressure ulcer prevention and practical pressure care for uk families and carers for readers across the UK.
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