Bedsores are a common problem for patients in nursing homes, along with anyone else who has a medical condition that confines them to one position throughout their days and nights. Also called “pressure ulcers” or decubitus ulcers, bedsores result from prolonged pressure on the skin.
An ulcer is a sore that is slow to heal or that keeps returning. There are different types of ulcers, some of which occur on the outside of your skin. Others might occur inside the body. For example, a peptic ulcer occurs on the inside lining of your stomach. Bedsores occur most often on the parts of the body where the skin is closest to the bone. Direct pressure from the body’s weight against a bed or wheelchair is one cause of bedsores.
Someone who is confined to a wheelchair might develop pressure ulcers on their tailbone or buttocks, shoulder blades, spine, or the backs of their arms or legs. These areas are almost always in contact with the wheelchair.
People who are confined to a bed and unable to adjust their position might develop bedsores on the back or sides of their head. Their shoulder blades, hips, lower back or tailbone are also common sites. They can also develop them on the heels, ankles, and behind the knees.
Types of Pressure That Can Cause Bedsores
Constant or nearly-constant pressure to an area of skin limits blood flow to that area. Without a constant blood supply, the area becomes deprived of essential nutrients the skin and other tissues need. Areas, where there is no fatty tissue or muscle between the skin and bone, are most vulnerable.
In addition to this type of constant pressure, other factors that might contribute to developing bedsores include:
– Friction – Friction occurs when one object rubs against another. Friction from bedding or clothing can irritate skin that is fragile, especially if it is moist.
– Shear – Shear occurs when two surfaces move against each other in opposite directions. When the forces apply to body tissues, it causes a shear wound. While both types of pressure cause ulcers, friction causes wounds to the skin and shearing causes damage to the deeper tissues. Shearing might occur if a person who is bedridden has their lower back stuck to the bed while gravity causes the tissues and bones inside the back to move downward.
Risk Factors for Developing Bedsores
Loss of mobility is the primary risk factor for developing bedsores. The human body is designed for constant movement, both during the day and while we sleep at night. Most people don’t even think about how much they move about while watching TV, at work, or while they sleep.
People who are confined to a bed or wheelchair don’t have the same luxury. Changing positions is something that must be planned for the purpose of preventing bedsores from developing. Since they can’t do it themselves, they often rely on caregivers to adjust their position when needed. Those people who don’t have someone available to provide the care they need can develop serious wounds without even realizing it.
Age – As we age, our skin degrades and becomes more fragile. There is less muscle and fat to cushion the skin from rubbing against the bones. There is a greater risk of developing many health conditions. Our need for nutrition changes and our ability to sense thirst is often diminished. The risk for fractures and a loss of mobility all increase with age. Age has a direct impact on every other risk factor listed below.
Lack of Sensory Perception – People with spinal injuries are the most vulnerable to bedsores. These and some neurological disorders lead to a lack of sensory perception. They can’t feel the pain or discomfort that the body normally uses to signal there’s a problem. They don’t know they need to change positions to restore blood flow.
Incontinence – Moisture from urine leaks makes the skin more susceptible to developing wounds.
Medical Conditions Affecting Circulation – Heart disease, diabetes, and vascular disease are just some of the conditions that affect circulation. People with problems affecting blood flow have a greater risk of getting tissue damage while those with diabetes often have problems healing. As people age, their risk of developing these health conditions increases, putting them at a greater risk of having a loss of mobility, developing bedsores, and experiencing complications from them when they do.
Poor Nutrition – A nutritious diet is important at any age. As you age, getting enough protein, vitamins, and minerals in your diet without eating too many calories is important. A healthy diet makes a big difference in the health and overall wellbeing of every person and boosts their immune system.
Dehydration – You need fluids to deliver nutrients to all parts of your body and to carry out bacteria. Older adults can lose their ability to sense thirst, making them more vulnerable to dehydration. This makes it even more difficult to keep the skin hydrated and healthy.
Alzheimer’s or Dementia – During the early stages of dementia, memory loss affects what the person can and can’t do for themselves. Some dementia patients have problems with movement and walking. They might need help repositioning themselves when sitting or lying down.
People with dementia become frailer. They don’t have as much fat and muscle mass between their skin and bone. The skin might become thinner and more fragile. They aren’t as active, sometimes because their loved ones or caregiver worries they will fall. This leads to them sitting or lying in one place for longer.
If they must take care of their own diet, they might eat poorly and not get enough to drink. They might become agitated or restless, rubbing their clothes or bedding over their skin more. Medications that make them sleepier or dry their skin out make them more susceptible to bedsores. Even if they experience painful symptoms, a loss of communication skills might prevent them from telling someone.
Symptoms and Stages of Bedsores
Everyone won’t experience the symptoms of bedsores. But caregivers should be vigilant at observing the person’s skin for any developing signs. These include:
- Unusual changes in the color or texture of the skin
- An area of skin that feels warmer or cooler to the touch than the rest of the skin
- Pus-like draining
- Areas that are tender
Bedsores can develop quickly and range from red, unbroken skin to deep injuries that involve the muscle and bone. Detecting the sore sooner rather than later makes treatment more effective and puts the person at a lesser risk for complications. The four stages of bedsores include:
Stage 1: The skin is red or discolored, but not broken. The skin stays red when you press on it and doesn’t change to white. After removing the pressure, the redness remains and doesn’t fade even after 30 minutes.
Stage 2: The outermost layer of skin is broken, giving the appearance of a shallow open sore. The second layer of skin underneath may, or may not, be broken. There might be drainage of pus.
Stage 3: During stage 3, the wound extends through the second layer of skin and into the fat below. You can see the bone, muscle, or tendon. Pus drainage and black tissue indicating necrosis, or tissue death, might be present.
Stage 4: The wound has reached the muscle and might go as deep as the bone. During stage 4, a lot of dead tissue and drainage are usually present. There is also a high risk of infection at this stage.
Bone & Joint Infections – Once the infection from the wound reaches the bones, it can cause damage to the bone tissue. Damage to the cartilage and tissue in a joint can lead to reduced function in the joints and limbs.
Cellulitis – Cellulitis is the infection of the skin and surrounding soft tissue. Symptoms include warmth, redness, and inflammation.
Sepsis – Although rare, it is possible for sepsis to occur in response to an infection from a bedsore. The condition occurs when the body’s immune response to the infection causes inflammation throughout the entire body. Severe cases lead to septic shock, a condition that requires emergency medical care.
Cancer – If bedsores go unnoticed or they don’t respond well to treatment, they can develop into a type of squamous cell carcinoma.
How to Prevent Bedsores
The best approach to treating bedsores is to prevent them from occurring in the first place. When caring for yourself, frequently reposition yourself and keep your skin clean and dry. Eat a nutritious diet and make sure you get enough water every day. Other tips include quitting smoking, managing stress, and getting exercise daily.
Many seniors don’t have the resources they need to stay healthy on their own. Those with any degree of memory loss might not have access to regular health care or the personal care they need on a daily basis. Assisted living offers the diversity of services needed to meet a broad range of situations. It provides the level of care that each person needs to achieve their optimal level of health.
How Caregivers Can Help Prevent Bedsores
The loss of flexibility and range-of-motion seniors experience often leads to problems grooming and bathing. Some aren’t able to do a good job of keeping their skin clean, while others avoid daily care altogether. Seniors with dementia often let all of their grooming and hygiene needs go. Personal care services ensure they get the care they need for their skin.
Personal care includes help with trivial tasks like grooming and bathing. Caregivers can also help with incontinence care. Incontinence is a major factor in keeping the skin dry and clean to prevent bedsores. Urine and feces that stay on the skin contain acids and enzymes that degrade the skin faster than usual. If the person can’t reposition themselves, they might develop a bedsore on the perineal area even faster than normal.
Keep the patient dry and clean by checking them as often as possible. Implement a barrier cream to help prevent early-stage bedsores from advancing. Repositioning the patient frequently will also help prevent the sore from getting worse.
Those who are at a higher risk of developing bedsores due to a loss of mobility might require more personal care. Monitoring their skin will help prevent pressure wounds from occurring.
Caregivers might check their skin frequently for the initial signs of pressure sores. A new sore can develop in only a few hours, so you don’t want to take any chances. Detecting a stage 1 pressure sore makes it possible to take steps that prevent it from progressing. Once it develops into a later stage bedsore, the outcome might be much different.
The use of special bedding designed to alleviate pressure can help too. There are also products that protect susceptible areas like the heels or elbows. These products prevent friction or pressure from causing wounds.
There are many issues that make seniors more susceptible to bedsores than younger adults. They are also at a higher risk of developing complications when they don’t eat a healthy diet. Assisted living gives them access to the healthy meal preparation they can no longer manage on their own. Caregivers can also help with medication reminders to ensure they keep their medical conditions under control.
Many seniors can’t drive themselves to doctor’s appointments. Those who are confined to a wheelchair or bed rest have fewer options for getting regular medical care. In assisted living, residents have access to safe transportation to the doctor whenever they need it.
For some people, confinement to a wheelchair or bed is temporary or intermittent. For others, it is a permanent situation that is a part of their lifestyle. Even those people who have limitations on mobility can enjoy a good quality of life and many of their favorite activities. Everyone can enjoy the companionship of other likeminded individuals that they will get to know in an assisted living facility.
Why Choose Villas at San Bernardino?
We all face obstacles as we grow older, but they don’t have to get in the way of enjoying our lives. At Villas of San Bernardino, we offer a choice of assisted living or memory care services to meet a range of individual needs. It’s a great place to live life on your terms while also getting the supportive services you need to stay your healthiest and happiest. You can even bring your dog along! Contact us today to schedule a tour and learn all the reasons to make us your new home.