Elderly Bedsore Stages and Prevention

Claire Samuels
By Claire SamuelsAugust 20, 2020
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Bedsores — sometimes called pressure ulcers or decubitus ulcers — are the result of long-term pressure on one area of skin. Bedsores are painful, difficult to heal, and may lead to serious skin or bone infections. Up to one in 10 seniors with limited mobility develops bedsores, according to the Centers for Disease Control and Prevention (CDC).

Learn why bedsores in elderly adults are common, how to recognize symptoms, and ways to prevent bedsores at home.

How elderly bedsores form

The human body is normally in constant movement, even while we sleep. We constantly shift positions, unconsciously readjusting ourselves while watching TV, working at a desk, and even lying in bed.

When surgery, injury to the spinal cord, arthritis, or illness reduces mobility in seniors, those movements may stop. Without regular readjustment, the pressure of an immobilized body can reduce blood flow and damage skin.

Bedsores often form in areas with little padding from muscle and fat, near joints or prominent bones. The tailbone (coccyx), shoulder blades, hips, heels and elbows are common sites for bedsores.

Common bedsore causes

Bedsores generally form in seniors who need help moving or spend most of the day sitting or lying down. Three main factors contribute to elderly bedsores:

  • Pressure from limited mobility. Continued pressure on a body part can reduce blood flow to tissues there. The tissue and skin need blood flow to deliver oxygen and other nutrients — without these, they become damaged and may deteriorate. For seniors with limited mobility, this pressure often happens in areas without much muscle or fat, leading to bedsores.
  • Friction. When seniors reposition, this moving and rubbing can break down skin. Even gentle assistance can cause a friction wound, especially since skin gets thinner and more fragile with age. Avoid rough clothing and sheets, as these can be bedsore causes, and take care not to use rubbing motions when repositioning loved ones.
  • Shear. Shear occurs when the skin moves in one direction while the bone moves in another or stays still. For example, slowly sliding down a bed may cause tailbones or shoulder blades to move while skin remains in place. This can cause the skin to stretch and tear.

Bedsore stages and symptoms

Bedsores range from skin irritation to open wounds prone to infection. Early-stage pressure ulcers are more treatable; caregivers should check for bedsore symptoms often. The four stages of bedsores are:

  • Stage 1: The area of skin is discolored and warm to the touch. It may be red on seniors with lighter skin, or purplish-blue on seniors with darker skin. Older adults may also complain of itching or burning. Stage 1 bedsores will often disappear with regular repositioning and pressure relief.
  • Stage 2: Skin damage is more visible, and may include an open blister, sore, or scrape, in addition to discoloration. Someone with a stage 2 bedsore may feel serious pain or discomfort.
  • Stage 3: In addition to spreading discoloration and abrasions, the area takes on a crater-like appearance from damage beneath the skin’s surface.
  • Stage 4: A large wound is present and the skin is significantly, visibly deteriorated. Muscles, bones, and tendons may be damaged or even visible through the hole in the skin. Stage 4 bedsores often lead to serious infection and are hard to manage, even for professional caregivers.

Bedsore prevention

If caregivers don’t reposition an immobile or bedridden person correctly and frequently, the likelihood of decubitus ulcers increases. Similarly, poor hygiene, nutrition, and skin care can lead to bedsores.

These five steps can help prevent bedsores in elderly relatives at home:

  1. Regular movement. Reposition your loved one every one to two hours in bed and every 30 minutes in a wheelchair. This constant repositioning can cause new problems:
    • Bedsores in elderly adults with limited mobility can happen overnight, so repositioning needs to happen around the clock. To protect your own well-being, trade shifts with another family member or hire overnight home care if possible.
    • Tugging on elderly skin can cause friction, which can worsen bedsores. Rough movements can also lead to painful bruising. Lift and move loved ones gently, touching more muscular or padded areas of the body.
  1. Careful inspection. Bedsores are much easier to cure when they’re caught early. A stage 1 bedsore may be treatable at home, but later stages need a doctor or medical team. It may feel uncomfortable or invasive to inspect your loved one’s body so closely, but it’s necessary for bedsore prevention.
  2. Special mattresses and supports. Cushions, mattresses, and supports can all reduce the likelihood of bedsores in seniors. Ask your loved one’s doctor about options before making a purchase.
    • Mattresses made of foam, air, gel, or water can be readjusted on a regular schedule and change pressure on the body.
    • Foam pads or pillows support the legs and keep knees and ankles from touching. Never use rubber cushions or doughnut-shaped hemorrhoid pillows as treatment for bedsores on the buttocks.
    • Special heel and shoulder blade pads may reduce pressure on bony feet and backs.
  1. Incontinence care. Skin becomes more vulnerable when it’s exposed to urine or stool, even for short periods of time. If an elderly adult is experiencing urinary or fecal incontinence and is prone to bedsores, ask a doctor about special absorbent pads or underwear.
  2. Nutrition and physical activity. Without appropriate fluids, vitamins, minerals, and protein, bedsores won’t heal properly.
    • well-balanced diet that promotes skin and bone health can help prevent bedsores.
    • If your loved one is severely overweight, losing weight can reduce pressure on bones and joints. Conversely, if they’re underweight, lack of padding can lead to bedsores around sharp joints.
    • Even mild movement and stretching can increase blood flow. Ask your loved one’s doctor about low-impact stretches that can be safely performed in a bed or wheelchair.

How to treat bedsores

Bedsore treatment varies by stage and severity. Stage 1 bedsores can often be resolved at home, while later-stage pressure ulcers may need medical intervention. Regular doctor’s office or home care appointments will be needed to monitor the bedsore closely. Severe pressure ulcers may result in surgery or a hospital stay.

Stage 1: Bedsore treatment at home may work for stage 1 pressure ulcer symptoms. If you notice mild heat and discoloration, adjust positioning, clean skin with mild soap and water, pat dry thoroughly, and apply a moisture-barrier lotion. If bedsore stage 1 symptoms don’t improve within 48 hours, contact your loved one’s doctor.

Stage 2: Stage 2 pressure ulcers may be treatable by a doctor or prescribed at-home regimen of thorough cleaning, medicated gauze or bandages, and antibiotics.

Stage 3+:  Stage 3 or 4 bedsore symptoms may need specialized treatment or surgery from a wound care team. Once damage occurs beneath the skin’s surface, bedsore treatment may include:

  •  Negative pressure wound therapy from a doctor’s office or home health service
  • Removing damaged skin and tissue (debridement)
  • Transplanting healthy skin to the wound area (skin grafting)

Nursing home bedsores

Up to 28% of hospitalized seniors or long-term care residents in nursing homes experience bedsores, according to the CDC. Frail people may live in a nursing home because bedsores and other injuries are so hard to prevent at home. Or they may be transferred from the hospital to a long-term care facility or nursing home after an accident. Nursing home bedsores are made more likely by conditions like advanced dementia, severe diabetes, and paralysis.

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This Medicare tool tracks the percentage of residents with bedsores at nursing homes across the country and how each location compares to the national average.


Sources:

Johns Hopkins Medicine. “Bedsores.” 
https://www.hopkinsmedicine.org/health/conditions-and-diseases/bedsores

University of Pittsburgh Medical Center. “How to Treat Bedsores at Home.” 
https://share.upmc.com/treat-bedsores-at-home/

Centers for Disease Control and Prevention. “Pressure Ulcers Among Nursing Home Residents.” 
https://www.cdc.gov/nchs/products/databriefs/db14.htm

Harvard Health Publishing. “Bedsores.” 
https://www.health.harvard.edu/pain/bedsores-decubitus-ulcers-a-to-z

Claire Samuels
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Claire Samuels
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