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Here, we’ll discuss the different types of bruising that may occur in seniors, so you’ll know whether your loved one is experiencing normal skin changes or needs medical assistance.

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

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.

Now that we’ve looked into why aging skin is so susceptible to bruising, let’s dig deeper into the more common types of bruising that may occur.

Senile purpura: Common and harmless bruising

Senile purpura, also called actinic purpura, is a type of elderly skin 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, such as 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 in the Journal of Clinical and Aesthetic Dermatology. If your aging loved one 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

Sometimes, elderly skin 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 on 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.

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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.

Immobilization is another cause of elderly skin bruising. 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.

It’s difficult to prevent elderly skin bruising entirely. However, Dr. Aarthi Anand, a geriatrician and family medicine doctor in Los Angeles, suggests precautions that 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, such as canes and walkers, and home modifications, such as grab bars, can keep seniors safe.
• Discuss supplements with doctors. Talk to 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 while outside.

Don’t ignore unusual amounts of bruising, as this may be a warning sign of an underlying condition. Unusual bruising includes swelling, extremely large contusions, chronic bruising in the same areas of the body, and irregularly shaped bruises that typically mimic the shape of knuckles or fingers. These could be signs of internal bleeding or other serious conditions which should prompt an immediate visit to your loved one’s doctor.

“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.

Here are some examples of conditions and medications that can lead to bruising:

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• 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, such as 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 the torso.
• 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.

In some unfortunate circumstances, elderly skin bruising may be a sign of 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 versus intentional elderly skin bruising can help you determine whether elder abuse is a concern. Keep these things in mind regarding accidental versus intentional bruising:

• 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 bruisingin older adults.
• Inflicted bruises can be large and distinct in shape. Most adults who’ve 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 loved one’s doctor.

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