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Understanding Pressure Ulcers in Elderly Care

Pressure ulcers, commonly referred to as bed sores, pose a serious health risk to elderly individuals in long-term care and hospital settings. According to the National Pressure Injury Advisory Panel (NPIAP), approximately 2.5 million patients develop pressure ulcers annually, with 60,000 resulting in fatalities. Elderly individuals who are immobile or spend prolonged periods in bed or chairs without position changes are particularly vulnerable. Although initially seeming insignificant, minor skin irritation can swiftly escalate into a severe medical issue for frail elders.



Dr. Louise Aronson, a geriatrician and author of "Elderhood: Redefining Aging, Transforming Medicine, and Reimagining Life," clarifies that terms such as bed sore, pressure sore, pressure ulcer, and decubitus ulcer all denote the same condition. "Pressure ulcer" is the preferred term, emphasizing pressure as the primary cause, though these wounds can occur beyond bed surfaces.



Why Do Seniors Get Pressure Ulcers?

Pressure ulcers emerge when skin and underlying tissues sustain damage, leading to irritated or open wounds.


"Compression between a bed or chair surface and bones inside the body cuts off blood supply to tissues," explains Dr. Aronson. "This results in tissue injury akin to a heart attack or stroke."


Three Causes of Pressure Ulcers - Damage to skin and blood flow interruption can result from:


  1. Prolonged sitting or lying without position changes.

  2. Friction during movements, like when bodies drag across bedsheets.

  3. Shearing, causing skin to slide or separate from underlying tissues during chair or bed adjustments.



Dr. Aronson emphasizes pressure as the primary cause, noting elderly skin offers less protection than younger skin, heightening injury risk. Those with paralysis or severe mobility constraints may lack subtle movement ability, hindering blood flow adjustment. Aging skin thinning, reduced elasticity, and increased fragility exacerbate vulnerability. Family caregivers must exercise caution with bedridden or wheelchair-bound seniors to prevent pressure ulcer development.


Moisture from fever perspiration or incontinence can weaken senior skin, escalating irritation risk. Lifestyle and chronic health conditions affecting circulation, mobility, and sensory perception heighten pressure ulcer risk. Common contributors include cancer, stroke, multiple sclerosis, Parkinson's disease, Alzheimer's disease, diabetes, malnutrition, chronic obstructive pulmonary disease (COPD), peripheral artery disease (PAD), heart failure, and hip fractures. Studies identify smoking, urinary and bowel incontinence as significant pressure ulcer development factors.



Warning Signs of Elderly Skin Breakdown Early detection and prompt intervention are crucial to preventing extensive skin damage. Early skin irritation detection allows effective intervention and care to prevent painful wounds.



Look out for:


  • Skin color changes (blue/purple in darker skin, pink/red in lighter skin).

  • Skin temperature fluctuations (excessive warmth or coolness indicating inflammation or reduced blood flow).

  • Tissue consistency changes (soft or boggy areas compared to surrounding tissue).

  • Sensory changes (numbness, burning, itching, pain, or tingling in vulnerable areas).

  • Minor skin injuries (blisters, abrasions, indicating initial superficial damage).

  • Deep bruises over vulnerable areas, signifying significant underlying tissue damage post-fall.



Common Pressure Ulcer Sites

Various body positions align with pressure ulcer-prone areas. Sitting risks include bottom and back sores, while lying risks affect:


  • Sacrum (base of spine above tailbone)

  • Coccyx (tailbone)

  • Heels

  • Hip sides (femoral trochanters, iliac crests)

  • Pelvic sit bones (ischial tuberosity)

  • Back (vertebrae protrusions)

  • Head areas (bed surface, pillow contact points)



Preventing Pressure Ulcers in Elderly


Effective preventive measures rely on regular skin checks and appropriate product usage.

Dr. Aronson suggests:


  • Repositioning every two hours minimizes immobility risks.

  • Cushioning at-risk areas with pillows or specialized mattress overlays aids pressure reduction.

  • Consistent skin checks identify emerging issues, allowing early intervention.

  • Moisture control with suitable lotions and creams enhances skin resilience.

  • Nutrient-rich diets support skin health and healing, preventing weight loss or excessive body pressure issues.



Treating Pressure Ulcers


Treatment aligns with ulcer severity, classified into stages:

  • Stage 1: Surface skin color, temperature, or sensation changes. Gentle cleansing, moisturizing, and barrier cream application suffice.

  • Stage 2: Shallow ulcers with pink tissue or fluid-filled blisters. Saline rinses, special gels/creams, and wound covers aid healing.

  • Stage 3: Deeper ulcers to fat layers with yellow slough or scabs. Moist wound care and potential debridement manage healing.

  • Stage 4: Deep ulcers to bone/muscle, necessitating debridement, wound packing, and intensive care.

  • Unstageable Ulcers: Covered base precluding clear staging, needing wound management post-eschar removal.

  • Deep Tissue Injury: Purple/maroon skin, needing expert monitoring and early pressure relief.



Complications and Care


Delayed or improper care exacerbates ulcers, fostering infections, muscle/nerve damage, or death. Specialist care manages complex wounds, supporting patient comfort and priority-based care decisions.


Pressure ulcers' preventability and treatability mandate vigilant monitoring and early care. Family caregivers must prioritize skin health checks, adopting preventive strategies to ensure senior comfort and safety.





For more information about care services and support, please visit AmoryCare or contact us at:


Phone: 908-854-3220

Fax: 908-854-3221



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