Skin Bruising in the Elderly: Causes and Prevention

As they age, seniors experience physical changes inside and out. Aging skin bruises easily, which can be sensitive and painful. Bruises, also called contusions, occur when trauma damages or ruptures tiny blood vessels beneath the skin. In most cases, bruising in older adults is the result of an injury, a fall, or a collision.

Why aging skin bruises easily

Fragile skin is a common problem in older adults because skin cells divide more slowly, and skin begins to thin. Aging, sun exposure, and genetics all play a role in thinning of the skin.

In the elderly, skin retains less moisture and loses its elasticity. Its ability to repair itself diminishes, and wounds are slower to heal. Also, over time, people lose subcutaneous fat, which cushions and protects blood vessels.

Senile purpura: a common, harmless kind of bruising in the elderly

Senile purpura, also called actinic purpura, is a type of senior bruising that doesn’t result from serious trauma, even though it may look like an injury occurred. After years of sun exposure, blood vessels can burst with only minor impact, like a handshake or light bump, leaving noticeable marks on fragile, elderly skin.

The bruises are caused by bleeding under the skin on the arms and hands — though they can occasionally appear elsewhere — and generally take up to three weeks to fade.

Treatment for senile purpura is usually not necessary. However, it can cause psychological distress, according to a study of the unsightly skin condition in the Journal of Clinical and Aesthetic Dermatology. If your aging parent is upset about senile purpura, reassure them it’s normal or suggest discussing it at their next doctor’s visit.

Bruising on legs and arms in seniors

Sometimes, bruising on arms and legs is caused by medical procedures and everyday assistance. Older adults who require help with activities of daily living (ADLs) tend to have more bruises than those who don’t, according to a study about bruising by researchers at the University of California, Irvine. This is because caregivers must touch and lift seniors who need help bathing, dressing, or moving between seated positions, which can bruise elderly skin even when done carefully.

Older adults who need intravenous (IV) procedures and shots may have bruises from minor blood vessel damage when the needle is inserted. In this case, you can briefly ice and compress an injection or IV site to reduce bruising.

Another cause of bruising can be immobilization. Like bedsores, bruising often occurs when a bedridden senior’s body begins to break down skin tissue after prolonged pressure and inactivity. Gently repositioning immobile or wheelchair-bound seniors throughout the day helps to prevent this skin deterioration.

Steps to help prevent common causes of elderly skin bruising

It’s difficult to prevent elderly bruising entirely. However, these precautions from Dr. Aarthi Anand, a geriatrician and family medicine doctor in Los Angeles, can help lower the risk of common causes of bruising in older adults:

• Create clear paths throughout the senior’s home
  Removing furniture and obstacles lowers the chances of everyday bumps that may cause bruises.
• Take steps to prevent falls
  Mobility devices like canes and walkers, and home modifications like grab bars, can keep seniors safe.
• Discuss supplements with doctors
  Consult with a trusted expert to see if vitamin deficiencies could be a cause of bruising easily.
• Protect skin from the sun
  Seniors should wear protective clothing and sunscreen when outside during the day.

Unexplained bruising may be a sign of a medical condition or side effect

Bruising may be a warning sign of an underlying condition, so you shouldn’t ignore unusual amounts of bruising.

“When bruising is related to a serious medical condition, the elderly patient generally comes in for other symptoms,” Anand says. “But it’s important to seek medical attention if significant bruising occurs. In some cases, it can reveal health issues.”

Some prescriptions and over-the-counter medications can cause bruising. Ask your loved one’s doctor or pharmacist if a new prescription is likely to cause old-age bruising.

Conditions and medications often related to bruising include:

• Anemia is common in the elderly when their appetites change. Anemia leads to easy bruising, but diet and supplements may help
• Large bruises can be a sign of clotting disorders, like deep vein thrombosis, which can be caused by prolonged sitting or bed rest
• Anticoagulants and blood thinners lower the chances of heart attack and artery blockages that may cause strokes, but they also increase the risk of bruising. Seniors who take medicine for hypertension are more likely to develop bruises on their torsos
• Common over-the-counter medications such as ibuprofen, aspirin, asthma medications, and cortisone may also increase the chances of bruising
• Liver disease can lead to easy bruising because the liver is responsible for producing blood clotting platelets
• Diabetes can be linked to bruising on arms and legs, especially if the contusions take unusually long to heal

Old age bruising and elder abuse

Elder abuse is a knowing, intentional, or negligent act by a caregiver or other person that causes serious risk of harm to a vulnerable older adult, according to the National Center on Elder Abuse (NCEA).

Because aging skin bruises easily, increased bruising is generally not a sign of abuse. However, it’s important to be observant and communicate with your aging relative.

Understanding more about accidental vs. intentional bruising can help you determine whether elder abuse is a concern.

• Ninety percent of accidental bruising is on the extremities, not the neck, trunk, or head.
• If bruising is accidental, chances are seniors won’t remember the cause. But if they recall an incident, there might be reason for concern. Many seniors — even those with dementia or cognitive impairment — can recall abusive bruising, according to this NCEA infographic about bruising in older adults. 
• Inflicted bruises can be large and distinct in shape. Most adults who have been abused have bruises 2 inches or larger, which may show finger marks.
• Physicians see elderly bruising regularly and may be more likely to know if elder abuse is a concern. If you aren’t sure, schedule an appointment with your parent’s doctor.

Listen to your loved one. Ask about bruises calmly and in private. Remember that the source of elder abuse can be unexpected. Since older adults — especially those with dementia — can experience severe behavioral changes as they age, bruising could come from a partner who never had violent tendencies, or it could even be self-inflicted.