At a greater than 60-degree elevation, the patient is at risk for shearing damage to the skin and tissues overlying the bony prominences as the skeleton moves down the bed and the skin stays in the previous position. Tearing occurs when the fragile top layer of skin is removed with adhesives or scraping. Friction occurs when the patient is boosted in bed along the sheet. Maceration occurs when skin is moist/wet for an extended period of time.