A nursing home caregiver holding a patient's hand wondering "when do bedsores start?"

When Do Bedsores Start?

Bedsores, also known as pressure sores, pressure ulcers, or decubitus ulcers, are a persistent and common problem affecting nursing home residents across the country. More severe bedsores are associated with higher mortality rates, longer hospital stays, and costly treatment.

According to the 2004 National Nursing Home Survey, out of 1.5 million nursing home residents that year, 159,000, or 11 percent of them, developed bedsores. About half of the patients developed Stage 2 ulcers, which can include open sores, scrapes or blisters, while the other half of the ulcers were in Stages 1, 3 and 4, with Stage 4 being the most severe.

When Do Bedsores Start?

Bedsores are so ubiquitous and problematic in part because they can develop remarkably quickly, depending on the condition of the individual patient and factors in the environment. According to John Hopkins University Medicine’s online Health Library, bedsores can develop when the blood supply to an area of the body is cut off for more than two to three hours. At this point, the affected area can grow red, warm and/or itchy, although the skin remains intact in Stage 1.

Repositioning Nursing Home Patients for Bedsore Prevention

Repositioning completely and partially-immobilized bed and wheelchair-bound nursing home patients every two hours has been recommended by multiple clinical guidelines for the prevention of bedsores, and is often considered the standard of care.

However, the results of a 2013 randomized clinical study in multiple nursing homes known as “Turning for Ulcer ReductioN,” or the TURN Study, challenged the two-hour repositioning standard. The study was conducted by the University of Texas School of Nursing and funded by the National Institutes of Health.

Nearly 1,000 nursing home residents deemed to be at moderate and high risk of bedsores were turned at 2-hour, 3-hour and 4-hour intervals on high-density foam mattresses. Over a three-week observation period, the study found no significant difference in the incidence of bedsores, which was 2 percent among all three groups. Only stage 1 and stage 2, the less severe stage bedsores, developed.

Whether guidelines are for turning every 2-hours, every 4-hours or some other yet-to-be-determined interval, the important factor is whether nursing homes are implementing these guidelines, and that’s something that nursing home visitors need to pay close attention to when it concerns their loved ones.