Esther C. Kane, C.D.S.Bed sores (aka pressure ulcers or decubitus ulcers) on the skin are generally caused by prolonged pressure on soft tissue against bony areas of the body and can cause serious infections for those who are bedridden or wheelchair bound.
If left untreated, they can lead to septic shock which can lead to organ failure and death.
Bedsores have a significant impact on the mortality rates in patients admitted to hospital and nursing care facilities. Studies have shown that of 3,000 people who were admitted to hospital with a pressure sore, 16.7% developed at least one new sore. It was found that patients with a bedsore were 2.8 times more likely to die in hospital. The studies also showed that the mortality rate of patients with a bedsore was vastly increased compared with a patient without a bedsore at a rate of 9.1% to 1.8%.
Edwards & Ragatz, PA
The most common parts of the body where bed sores occur are:
- Buttocks
- Heels of feet
- Backs and sides of knees
- Shoulder blades
- Back of the head
- Hips
- Elbows
What Is A Bed Sore?
Bed sores are a very serious and potentially deadly condition that can be caused by sitting or lying in one position for too long.
What happens is that the blood supply to that part of your skin is cut off and the skin then begins to essentially die.
They typically occur when the skin is continuously rubbed against a rough surface, such as a mattress or sheets.
It will eventually lead to an open wound with exposed tissue, which could then get infected if not treated properly.
Bed sores can begin in as little as 2 to 3 hours – depending on the integrity of the person’s skin and other medical issues.
When I worked as an Occupational Therapist, I often helped nurses as they treated a nursing home resident with bed sores and I have seen some that were so deep that I could see the bone!
Any family member or health care providers who are caring for an elderly loved one should be informed on the dangers of bed sores.
If left untreated, these wounds can lead to gangrene and even death in extreme cases.
The most important thing to know about pressure ulcers is prevention, in this article we will go over what you need to do if you discover a bed sore and also how to help prevent them in the first place.
Why Do Seniors Get Bed Sores?
Lack of mobility and movement is the number one cause for bed sores, but underlying illnesses and injury to tissue linings can put someone at higher risk as well.
Although it can be a sign of neglect, it does not necessarily have to be.
What Are Some Risk Factors That Contribute To Bed Sores?
The Mayo Clinic mentions the following risk factors:
- Immobility – we’ll be mentioning this several times in this article but it is noted as a main cause of pressure ulcers. Lack of movement can be due to many factors – spinal cord injury, neurological problems from a stroke, poor health, etc.
- Incontinence – many seniors have problems with incontinence and when the skin is exposed to urine and feces for periods of time it can cause it to become more vulnerable. This is a big problem with nursing home patients.
- Lack of sensory perception – the inability to feel a certain part of your body due to paralysis or neurological damage or even diabetes can certainly contribute. After all, if you don’t feel discomfort or pain, why would you shift your body?
- Poor nutrition – we all know that not getting enough vitamins, nutrients and hydration can only make someone more ill than they already are.
- Medical conditions – there are certain medical problems that can certainly make someone more prone to bed sores such as diabetes and vascular disease.
If you are caring for someone with any of these risk factors – then they are in a high risk category.
Make sure to follow the recommendations that I am about to give you and please speak with your doctor!
Several Complications From Bed Sores
These pressure injuries can lead to the development of antibiotic-resistant bacteria within the wound, which means that they’re not always so easy to treat.
Bed sore sufferers may also develop deep tissue damage beneath their skin that may end up being very difficult to treat.
Following are some complications that can result from bed sores.
Amputations
In order to avoid a possible death due to sepsis that has resulted from a pressure ulcer – amputation may be the only solution.
Cellulitis
Cellulitis is a really painful skin condition characterized by redness, swelling and tenderness. It typically affects the lower limbs but can happen anywhere on your body.
If you have an open wound on your body and the surrounding tissue starts to become red, swollen or warm to the touch then you might be suffering from cellulitis.
When left untreated for too long a person can develop other medical complications such as meningitis or sepsis which are both very serious conditions that need immediate attention.
Necrotizing Fasciitis
Bedsores also increase the risk that necrotizing fasciitis will occur.
This condition slowly eats away at tissue surrounding an affected area and can destroy muscle tissue within hours with no treatment!
If this type of infection goes unnoticed or untreated, death from complications could happen within 24 hours.
Myonecrosis (aka Gas Gangrene)
Some of the most dangerous types of infections that can be contracted with progressive bed sores are gas gangrene and myonecrosis.
Gas gangrene is when infectious bacteria destroys muscle tissue in your body, ultimately leading to death if untreated or caught too late.
Bone Infections
A bed sore infection can get into your blood to spread all throughout the body, and it may even affect cartilage in nearby joints.
A bone infection that is not treated could eat away at a certain area until there’s nothing more left than mangled bones over time.
Osteomyelitis
Osteomyelitis can come about as a complication of late-stage bed sores.
This can occur if a bacterial infection gets into the bone tissues.
An estimated 80% comes from open wounds, such as those sustained by people with serious conditions like osteoporosis or obesity.
Symptoms Of Bed Sores
The most common symptom of bed sores is pain while lying down and getting up from bed and during movement over bony prominences on the body, such as elbows, heels, shoulder blades and hips.
A person may not notice them at first because they start out as a small red area on the skin.
But if left untreated they will grow larger until they eventually break through the skin’s outer layer causing bleeding under it.
I can’t stress enough how important it is to begin treatment and prevention methods before any of these stages begin but at the very least, in the early stages .
The 4 Stages Of Pressure Sores
Recognizing these 4 stages can help you to identify a possible pressure ulcer developing so that you can begin treating it right away.
Stage 1 – A reddish colored area on the skin that is warm when you touch it. If the person has darker colored skin, it may appear blue or purple. There may also be complaints of burning, itching and pain.
Stage 2 – An open break of the skin is now showing with discoloration around that open area. More complaints of pain, itching and burning.
Stage 3 – Now the break in the skin is wider and deeper. More complaints of pain and discomfort.
Stage 4 – In this advanced stage, you will see a large wound. You may even be able to see muscles, bones, tendons, etc.
Treatment at this stage may include surgery, certainly debridement of dead tissue and medical interventions.
The chances of infection increase with each stage.
How Do You Avoid Bed Sores?
There are certain things that you can do to help prevent your senior loved one from getting bed sores (aka pressure wounds) and from keeping them from getting worse. Or at least trying to.
12 Tips and Products To Help Avoid Pressure Wounds
The best way to prevent bedsores is by using special prevention measures that I list below.
1. Change Position Every 2 Hours or Less
Switching side of body means different posture which takes strain off weight bearing joints like hips, shoulders and neck.
Turn the person over any time their clothing gets wet or dirty or if it feels uncomfortable — turn them so that a dry section goes against cloth coverings instead of damp fabric irritating their skin.
Most nursing homes (at least all the ones I ever worked in) are grossly understaffed.
Although all of these types of facilities must follow specific federal regulations, the lack of personnel makes it very difficult for the CNA’s (Certified Nursing Assistants) who do the majority of direct patient care, to make sure that their patients are turned often.
It’s for this reason, I believe, that nursing home residents often develop pressure ulcers.
Of the 1.5 million current U.S. nursing home residents in 2004, about 159,000 (11%) had pressure ulcers of any stage. Stage 2 was the most common (5%), accounting for about 50% of all pressure ulcers. Stages 1, 3, and 4 made up about the other 50% of all ulcers.
Centers For Disease Control
2. Use Pillows and Wedges
One of the keys to avoiding bed sores is to get people in positions away from pressure areas where they lack feeling.
Place them on their side with a pillow between the knees and another one under their head.
This will avoid pressure at the sacrum (base of spine). Do this every 2 hours and make sure to wash the skin after each change, you’ll prevent breakdown.
Use foam wedges to help change their position throughout the day.
Be careful also to avoid rubbing their skin against the bed sheets as this could cause a skin breaks which could then become infected.
I haven’t tried these sheets myself but you may want to investigate the bedding made my DermaTherapy.
3. Be Careful Using Medical Devices
Many individuals who are ill (no matter what age they are) have compromised skin integrity.
What I mean is that they gets cuts and bruises easily and it doesn’t take much at all for these to get infected.
So, if you need to use gait belts or hoyer lifts – be extra careful.
4. Keep Up With Proper Skin Care Regimen
Skin care can be difficult when you are unable to move for extended periods of time or hospitalized.
But it is very important to keep up with skin care regimen and gently clean and dry your skin daily.
If you can shower that would be better but a proper bed bath would be sufficient.
Additionally, you may also want to use a cream like Terrasil Wound Care which may help to reduce the risk of breakouts.
I would recommend to speak to your physician about what product he/she recommends to use.
Do not let your skin stay wet or moist for long periods of time longer than 20 minutes after bathing – always pat dry thoroughly with a towel.
5. Avoid Sitting In Wet or Dirty Diapers
Whether it’s urine or fecal matter that is sitting next to your skin – either one of these can contribute to developing pressure ulcers.
So, take care of urinary tract infection issues and other toileting matters immediately.
6. Use An Alternating Pressure Pad Mattress
To prevent bedsores, consider using an alternating pressure pad mattress.
The term “alternating pressure” refers to the various air chambers in the mattress that inflate and deflate at different rates to provide traction and compression which is directly applied to your body’s weakest areas – like your hips, heels and elbows.
This helps to lower tissue temperature, produce less friction resulting in reduced shear stress on the skin as well as less tension on sore or weakened muscles.
7. Use Donut Cushions For Seats
If you are seated for long periods of time then adding a donut cushion can help to prevent bed sores.
Of course, changing your position frequently throughout the day is also strongly recommended.
I would recommend to use donut cushions on chairs and couches for relief so you may want to purchase more than one.
8. Use Heel Protectors
Many doctors advocate for patients utilizing heel cushion protectors to help reduce the risk of skin breakdown.
Heel protectors can help greatly to reduce the pressure and friction on the heel area of the foot that is associated with the bony protuberance of your heel.
These products are typically disposable or washable cushions that you wear while you are in bed and/or sitting.
9. Eat a Nutritious Diet
A diet full of healthy food choices can help to promote wound healing.
Again, I would recommend to speak to your physician about this issue.
But generally speaking – here are some tips on what a wound healing diet would look like.
- For diabetics – proper nutrition is even more important. Maintaining proper blood sugar levels is extremely important not only for overall health but to help prevent bed sores.
- If possible, include food groups of protein, fruits, vegetables, dairy and grains daily.
- Try eating more strawberries or spinach to enhance your intake of vitamin C. Get plenty of zinc by opting for whole grains and protein like eggs, meat, dairy, or seafood. Some wounds may need a higher dose vitamins and minerals in order to heal properly so consult with your healthcare provider before taking any supplements.
- It’s important to eat a protein rich diet when recovering from a bed sore. This will help you get your strength back sooner and ensure that the wound heals properly. Eat at least one source of protein per meal or snack, with breakfast consisting of scrambled eggs, lunch black beans tacos, yogurt for dessert after dinner chicken is served as well as cheese in between meals like during snacks.
10. Keep Properly Hydrated
Keep well hydrated! One of the more common side effects that can be caused by dehydration is bed sores.
Dehydration not only affects your overall health, but it also compromises skin integrity and increases one’s risk for developing a pressure ulcers (bed sores).
As long as there are no issues with swallowing difficulties, you can use any of these products we recommend to help keep liquids handy.
Another option is to purchase Jelly Drops which are bite sized balls of fruit juice. They are currently only available in England but will soon be available in the USA.
But in the meantime – Jell-O would be a good substitute for water to keep hydrated. If you make it in small silicone molds, they can be bite sized and easier to eat and swallow.
11. Avoid Smoking
Smokers are generally high risk patients anyway.
The reason you want to avoid smoking is because cigarettes cause decreased local blood flow which fatigues tissues more quickly and causes an increased risk of skin infections, which can become serious quickly when there’s no circulation to fight them off.
Nicotine also slows down healing from anything that has caused bleeding such as: hemorrhoids, varicose veins or wounds – so smoking will significantly increase bed sores.
12. Move As Much As Possible
Since one of the primary contributors to bed sores is lack of movement, it stands to reason that moving can help to prevent it in the first place.
Of course, this can be difficult if you are bed or wheelchair bound but it’s not impossible.
You may need someone to help to move your body, your legs, your arms but that is what is needed in order to help prevent further complications from pressure ulcers.
Conclusion
If you are concerned about bed sores due to nursing home neglect – I would urge you to speak with the administration in the nursing home.
If you are considering placement – then read our article on How To Choose A Nursing Home.
I do want to say to all nursing home staff and especially family caregivers that are providing home care that bedsores are sometimes unavoidable.
Medical issues can complicate someone’s skin integrity and it may be simply impossible to move someone who is confined to bed or a wheelchair the recommended every 120 minutes.
Follow these tips that I’ve mentioned above, speak to your physician about what he/she recommends and then you’ll know that you’ve done your best to prevent and care for any pressure ulcers for the senior loved one you are caring for.
