Last Updated: April 4, 2015
Our bodies undergo a series of natural changes as we
age-externally and internally. Our skin cells divide more slowly
and skin begins to thin. Skin retains less moisture, causing it to
become dry, scaly, and appear wrinkled. It loses its elasticity and
instead of springing back, starts to sag. The skin's ability to
repair itself diminishes, and wounds are slower to heal. Blood
vessels also become more fragile and it becomes more common for the
elderly to bruise. Certain conditions, diseases, or medications
also play a role in elderly bruising.
Bruises result when trauma or a blow to the body damages or
ruptures tiny blood vessels under the skin. In most cases, bruises
occur as a result of an injury or a fall,
or when people bump into things. Not only are the elderly more
prone to bruising, less force is required to cause a bruise. For
example, doctor visits involving intravenous (IV) procedures often
make their mark in the form of bruises in older patients, while
they may not in younger ones. With greater impact, deeper bruises
of the muscles or bone can happen, which take longer to heal.
The medical term for a bruise is contusion. Ecchymosis is the
visible skin discoloration caused by the ruptured blood vessels in
the tissue near the skin's surface. If a bruise increases in size
and becomes swollen and hard, it may be a hematoma, a localized
collection of blood which becomes clotted or partially clotted.
Tips on Prevention
It may be difficult to prevent elderly bruising, but Dr. Aarthi
Anand, a board certified geriatrician and family medicine
practitioner based in Los Angeles, suggests taking the following
- Remove furniture or other obstacles to create a clear path for
your loved one to move around in their personal space so they may
potentially avoid bumps or falls.
- Assist loved ones with sitting and standing if they are likely
- Discuss the use of a cane or walker with a doctor if your loved
one appears unstable while walking, or when trying to sit or stand
- Install handrails where possible for additional support.
- Be alert about potential signs of elder abuse.
Medical treatment is not usually necessary since the body
eventually reabsorbs the blood, and bruises tend to fade away
within two to three weeks. Elderly bruising, however, can take
several weeks, even months to go away. The pattern is somewhat
predictable, beginning with the appearance of a reddish mark as the
blood appears under the skin, which turns bluish-black or purple as
the red blood cells break down, then yellowish green to a lighter
brown before it gradually disappears.
To speed the healing process, Anand says that it is important to
apply a frozen compress (for twenty minutes at a time) and elevate
the bruised area to a level higher than the heart in the first
twenty-four hours to keep swelling and inflammation to a minimum.
This can help to reduce the size of a bruise by slowing the amount
of blood that leaks into the tissues. "Then apply a warm compress
to increase circulation, and rest to reduce the pressure on the
affected area," she says.
Understanding Related Conditions & Medications
"When bruising is related to a serious medical condition,
generally it is other presenting symptoms that an elderly patient
comes in for. But it is important to seek medical attention if
significant bruising occurs since in some cases it can reveal
health issues," Anand says. Leukemia and other diseases that affect
the blood and platelets can lead to more severe bruising.
Individuals with diseases of the liver may also experience easy
bruising since the liver is responsible for producing
blood-clotting factors. The risk of blood clots increases with age,
as does the likelihood of conditions such as atrial fibrillation
(irregular heart rhythms), which is associated with clotting and strokes.
Deep vein thrombosis, in which blood clots form in the veins of the
lower leg and thigh and travel through the bloodstream and lodge in
the brain, lungs, heart, or other areas, can be caused by prolonged
sitting or bed rest.
medications may contribute to elderly bruising. Anticoagulants
such as Coumadin® (warfarin) help prevent clotting by thinning the
blood, lowering the chances of heart
attack and artery blockages that may cause strokes, but also
increasing the possibility of bruising. Seniors taking Plavix®
(clopidogrel bisulfate) for heart disease and stroke may experience
the same effects. Common over-the-counter medications such as
ibuprofen, aspirin, antidepressants, asthma medications, and
cortisone medications may also increase the chances of
Recognizing Elder Abuse
According to the National Center on Elder Abuse (NCEA), the term
"elder abuse" refers to any knowing, intentional, or negligent act
by a caregiver or any other person that causes harm or a serious
risk of harm to a vulnerable older adult. Statistics compiled by
the NCEA indicate that elder abuse is on the rise. Frequent bruises
and bruises that appear from rough handling such as deep finger
print marks are some signs to watch for. In some cases, the elderly
may not remember, or even realize, that they are being abused due
to decreased pain perception and possible memory loss. Know the signs
of elder abuse.
"Talk to your loved one and be observant of bruises," suggests
Anand. If bruising occurs with unknown cause, particularly if it is
severe and extensive, or if a bruise hardens, increases in size,
becomes more painful, or does not appear to follow the predictable
healing pattern, contact a physician for an evaluation.