Pressure ulcers, commonly referred to as bed sores, are one of the most feared complications that can happen to bedridden patients. Because of certain risk factors associated with old age, bed sores in elderly people are particularly prevalent. If we take a look at the data collected by the Agency for Healthcare Research and Quality (AHRQ), we can see that they all but confirm this connection and reveal other unsettling statistics.
Bed sore facts:
- Bed sores in the elderly (65+) account for 50% of all bed sores.
- 2.5 million patients per year develop bed sores.
- The cost to treat them is $9.1 billion to $11.6 billion per year in the US.
- Individual patient care ranges from $20,900 to $151,700 per bed sore.
- Each bed sore adds $43,180 in costs to a hospital stay.
- 60,000 patients die as a direct result of a bed sore each year.
Even though we cannot prevent all bed sores, it’s still much easier to prevent them than it is to treat them. Therefore, preventing bed sores in elderly people must be a priority for caregivers. This post will explain everything from what bed sores are, what causes them, the risk factors, common sites, and the stages of bed sores to the treatment and, of course, prevention of bed sores.
What Are Bed Sores?
Bed sores (also known as pressure ulcers or decubitus ulcers) are injuries to the skin and underlying tissues that are results of prolonged pressure on the skin, which leads to inadequate blood flow to the area. Without the blood that carries oxygen and nutrients, the cells in the affected tissues can’t function normally, so they become damaged and eventually die.
Bed sores in elderly patients can develop quickly, typically in places where the skin covers the bony prominences of the body. They can lead to serious complications and even death, so it’s very important to recognize and treat them as soon as the first signs become noticeable.
Common Sites of Pressure Sores
Areas of the body where the skin presses directly against bone are at risk for developing bed sores because this is where it’s easiest to compromise blood flow. Virtually all bed sores in seniors form in the following places after prolonged periods of immobility.
For bedridden people, common sites include:
- Hips, lower back, and tailbone
- Shoulder blades
- Back or sides of the head
- Heels, ankles, and behind the knees
For people who use a wheelchair, common sites include:
- Tailbone and buttocks
- Shoulder blades and spine
- Backs of arms and legs
What Are the Signs and Symptoms of Bed Sores?
When it comes to the signs and symptoms of bed sores, stages differ, playing a big role in how they appear. Bed sores are classified into several stages according to their depth, their severity, and other factors. We will describe the signs and symptoms of each stage individually.
What Are the Stages of Pressure Ulcers?
The National Pressure Ulcer Advisory Panel (NPUAP) updated their terminology and classification in 2016. The preferred term is now “pressure injury” because it is more accurate, though “pressure ulcer” remains more widespread. There are four stages now, and two additional categories.
The updated staging system includes the following:
Stage 1 pressure injury: nonblanchable erythema of intact skin
What is the first sign of a pressure sore? It’s redness of the skin that’s still intact but doesn’t turn white when pressed. Changes in sensation, temperature, or firmness can also be present. Purple or maroon discoloration does not belong in this stage because it may indicate deep tissue injury.
Stage 2 pressure injury: partial-thickness skin loss with exposed dermis
The second stage is characterized by the painful partial loss of skin where the underlying tissue (but not fat tissue) becomes visible. Intact or ruptured serum-filled blisters also belong in this stage. The wound is still viable, meaning it can heal, but any second degree bed sores medication treatment in elderly people and other adults has to include antibiotics to prevent infections.
Stage 3 pressure injury: full-thickness skin loss
In the third stage, all layers of the skin are lost, exposing fat tissue. Undermining and tunneling may occur, but deeper tissues are not visible. Slough and/or eschar (dead tissue) may be present, but not to the point of obscuring the extent of the tissue loss.
Stage 4 pressure injury: full-thickness skin and tissue loss
The fourth stage includes all the above signs, but the loss of tissue extends all the way to the fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer. Often there is no pain in this stage of pressure ulcers in elderly people, because the sensory nerves are completely lost as well.
Unstageable pressure injury: obscured full-thickness skin and tissue loss
Ulcers belonging in this stage have full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it’s obscured by slough or eschar. If the slough or eschar is removed, a stage 3 or stage 4 pressure injury will be revealed. Stable eschar in pressure ulcers in older adults should not be softened or removed.
Deep tissue pressure injury: persistent, nonblanchable maroon or purple discoloration
Intact or broken skin with a localized area of nonblanchable deep red, maroon, or purple discoloration indicates a deep tissue injury. Discoloration may appear differently in darkly pigmented skin. Pain and temperature change often precede skin color changes. The wound may evolve quickly to reveal the actual extent of tissue injury, or it may resolve without tissue loss.
What Causes Bed Sores in the Elderly?
Three main factors contribute to the formation of bed sores:
- Pressure: Persistent pressure that compromises the blood flow to a localized area of the body is the main cause of bed sores. As noted, without oxygen and nutrients, our cells will die. Damage starts from the skin and moves deeper toward the bones.
- Friction: Can lying on a towel cause bed sores in elderly patients? Yes, friction against rough towels, clothing, and bedding can make fragile skin more vulnerable to injury. Moisture makes things even worse.
- Shear: This occurs when two surfaces move in the opposite direction. For instance, when you elevate the bed, you may slide down, but your skin may stay in place. Shearing in places where very little tissue separates skin and bones can damage it.
What Are the Risk Factors for Bed Sores?
Bed sores in older adults form more often than in other age groups because, in addition to frailty and thin skin, they tend to have more risk factors, which include the following:
- Immobility: Poor health, spinal cord injury, and other causes can lead to immobility. This, in turn, prevents people from easily changing position in order to alleviate pressure to the affected parts of the body.
- Changes in sensory perception: Diabetes and other conditions that cause nerve damage can result in loss of sensation in parts of the body. Without the ability to sense discomfort and change position, bed sores in elderly people are more likely to occur.
- Reduced blood flow: Certain medical conditions, such as atherosclerosis and other vascular diseases, affect blood flow. This is a predisposing factor that increases the risk of tissue damage.
- Malnutrition and dehydration: Not eating enough nutritious foods and not drinking enough fluids can lead to frailty and dry skin, which makes the breakdown of tissues easier.
Complications of Bed Sores in the Elderly
Without proper treatment, complications of pressure ulcers can be life-threatening. These include:
- Cellulitis: This is an infection of the skin and underlying soft tissues. Its symptoms include warmth, redness, and swelling.
- Bone and joint infections: The infection can also reach bones and joints, leading to bone infections (osteomyelitis) and joint infections (septic arthritis).
- Sepsis: Rarely, the infection from a bed sore can enter the blood, which means it can cause sepsis. Can bed sores lead to death? Yes, if sepsis progresses into septic shock.
- Cancer: Pressure ulcers can even cause cancer. Long-term irritation is a risk factor for cancer, and nonhealing wounds (Marjolin’s ulcers) can turn into a type of skin cancer.
How Are Bed Sores Diagnosed?
Pressure ulcers are diagnosed by performing a physical exam. Your doctor will asses the damage and assign a stage, which will also determine the treatment. Additionally, they may perform blood tests and take swabs of the wound. They can also perform more tests to discover possible complications.
How to Treat Bed Sores in Elderly Patients
The treatment of bed sores includes relieving pressure on the affected area, controlling pain, caring for the wounds, and fighting infections. A broad team of medical experts may be involved in the treatment. It can include a family doctor, a doctor or nurse specializing in wound care, and a physical therapist for help in improving mobility. Depending on the stage of bed sores, treatment can also call for a dermatologist, neurologist, orthopedic surgeon, or a plastic surgeon.
So how do you treat bed sores?
- Reduce pressure: It’s important to find a way to avoid putting pressure on the wound and frequently change positions in the bed, at least every two hours. Specially designed cushions may also be used for pressure relief.
- Clean and dress wounds: Wound care depends on the stage, but it has to be cleaned every time before changing bandages. A bandage helps healing by keeping the wound moist, creates a barrier against infections, and keeps the surrounding skin dry.
- Remove dead tissue: Infected, damaged, or dead tissue must be removed for the wounds to heal properly. This is done by performing debridement (tissue removal), usually by a surgeon capable of using a number of methods.
- Control pain: Treating bed sores in the elderly often includes long-term oral and topical pain medication, because pressure ulcers can be very painful.
- Fight infection: Infected pressure ulcers also have to be treated with local and systemic antibiotics, in addition to regular wound care.
- Negative pressure therapy: Also known as vacuum-assisted closure, this method uses a device to drain the wound and clean it with suction.
- Surgery: Sometimes large pressure ulcers won’t heal on their own, and reconstructive surgery may be necessary to repair the skin and other tissues.
How to Treat Bed Sores in the Elderly at Home
Stage 1 and uncomplicated stage 2 bed sores can be treated at home. Properly caring for the wound and reducing pressure by repositioning the body are key. It’s necessary to frequently change position and avoid putting pressure on the wound as much as possible. Purchasing a good mattress can help reduce pressure as well.
Treatment for bedsores in elderly people must also include dealing with underlying causes, such as diabetes, and improving nutrition and hydration. Also, medical alert systems can help people with mobility issues who live alone. They’re very useful in emergencies when you need to reach your caregiver as soon as possible.
Prognosis of Pressure Ulcers in the Elderly
About 70%–90% of pressure ulcers are stage 1 or stage 2. They can heal within one to six weeks. Stage 3 and 4 pressure ulcers can take months to heal, which is another reason for aggressive prevention and treatment that will halt progression into later stages.
How to Prevent Bed Sores in the Elderly
Preventing bed sores is easier than treating them, but this can be challenging as well. Encouraging mobility is the best way to prevent bed sores. But often this isn’t possible. In those cases, seniors have to rely on the dedication of their caregivers.
Bed sores prevention tips include:
- Moving the senior every two hours in the bed
- Shifting their weight every 15 minutes in the wheelchair
- Regular skin inspections
- Keeping the skin healthy and dry
- Maintaining good nutrition and hydration
- Quitting smoking
- Treating chronic conditions
Bed sores in elderly people are more common than in other age groups. That’s why we need to take special care of our seniors. Improving mobility should be a priority, but when that isn’t possible, caregivers have to take all the necessary measures to prevent bed sores from developing.