More than 1 in 10 seniors will develop bedsores, also known as pressure ulcers, while living in a nursing home.
Pursuant to federal law, nursing homes must ensure that a resident receives care consistent with professional standards of practice to prevent the formation and worsening of pressure ulcers unless unavoidable. A resident must receive care to promote healing, prevent infection and prevent new ulcers from developing.
When a resident doesn’t receive a proper care and attention, they’re more likely to develop bedsores. Patients and family members should be aware of the risks, signs and stages of bedsores.
What is a bedsore?
Bedsores, also known as decubitus pressure ulcers or pressure sores, are localized skin and tissue injuries caused by prolonged pressure, friction or shear. The skin and tissue injuries may be intact, or open, painful ulcers, potentially related to a medical device.
When a nursing home resident is left in the same position for an extended period, bedsores begin to appear on the bony areas of the body. Microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue may also affect the development of bedsores.
Bedsores affect bony prominences, such as the shoulders, knees, elbows, lower back, buttocks, hips and heels. Bedsores develop when decreased blood flow due to pressure, limits the delivery of oxygen and nutrients to certain areas of the skin, causing deep tissue damage that worsens over time.
Depending on the severity and stage, some individuals may experience a healing period absent complication, while others struggle with lasting infections and injuries. If left untreated, bedsores can become extremely painful and lead to serious complications and even death.
What are the risk factors for bedsores?
Seniors with limited mobility are the most likely to develop bedsores. However, there are certain risk factors that make any nursing home resident more vulnerable to bedsore injuries.
The Braden Scale for Predicting Pressure Ulcer Risk is a tool used to assess a patient’s risk by examining six specific criteria. Nursing homes should identify bedsore risk factors and develop a comprehensive care plan focused on prevention.
Sensory Perception – Caregivers should measure a patient’s level of consciousness, ability to communicate and responsiveness to painful stimuli to assess whether each individual can cognitively react to pressure and discomfort.
Moisture – Caregivers should measure excessive and continuous skin moisture, which may be linked to perspiration or urine, to assess how frequently linens must be changed.
Activity – Caregivers should measure if a patient walks occasionally or frequently, or if they are confined to a bed or chair, to assess if little or no activity is contributing to muscle atrophy.
Mobility – Caregivers should measure if a patient has the ability to change or control their body to assess how frequently patients need assistance with moving and repositioning.
Nutrition – Caregivers should measure nutritional status and daily eating patterns to assess how frequently meals are being consumed, and if patients require increased protein intake, dietary supplements or tube feeding.
Friction and Shear – Caregivers should measure if patients slide against sheets, chairs or other devices while lifting and repositioning to assess the movement and breakdown of skin.
Friction and shear can rub and pull the already sensitive skin, making seniors more vulnerable to debilitating injuries. Impaired sensory perception, linked to spinal cord injuries, neurological disorders and other conditions, may cause a loss of sensation that makes patients unaware of developing bedsores.
Additional Risk Factors
Diabetes, vascular disease and other chronic illnesses may reduce a patient’s blood flow and increase the risk of bedsores. In addition, malnutrition and dehydration may also weaken the skin, muscle health and immune system.
Patients having risk factors for bedsores require additional care to avoid these preventable life-threatening injuries.
Where do bedsores develop?
Bedsores most often develop on skin that covers bony areas of the body that is consistently exposed to unchanging pressure. Areas with minimal natural padding from muscle or fat are most likely to develop pressure sores. For seniors using wheelchairs, pressure sores often appear on the spine, tailbone, buttocks, shoulder blades and the back of arms and legs.
When seniors spend a lot of time in bed, pressure sores develop on the tailbone, hips, lower back, shoulder blades or back or sides of the head. Bedsores may also appear on the heels, ankles or the skin on the backs of the knees.
According to the National Pressure Ulcer Advisory Panel, pressure injuries are staged as follows:
Stage I Pressure Sores – Non-blanchable erythema affecting the upper layer of the skin.
Stage II Pressure Sores – Partial-thickness skin loss with exposed dermis.
Stage III Pressure Sores – Full thickness tissue loss with potentially visible subcutaneous fat.
Stage IV Pressure Sores – Full thickness tissue loss with exposed bone, tendon or muscle.
What are the major complications of bedsores?
Bedsores can lead to serious complications that may result in severe injury and infection. In some cases, complications from bedsores may lead to amputation or death.
Bone and Joint Infections – Infections, such as septic arthritis and osteomyelitis, may burrow into the joints and bones. This can cause long-term damage.
Cellulitis – A serious infection known as cellulitis can spread from the site and cause pain, redness and inflammation. Though it is treated with antibiotics, it may be difficult to diagnose.
Cancer – Non-healing wounds, such as Marjolin’s ulcers, can develop into a form of cancer called squamous cell carcinoma.
Sepsis – Sepsis is a potentially life-threatening illness cause by the body’s response to pervasive infection causing injury to tissue and organs. In the most serious cases of blood poisoning, damage to multiple organs can lead to a large drop in blood pressure, known as septic shock. Septic shock can be fatal.
Infections can damage the cartilage, tissue and bone. They may also affect the functioning of the joints and limbs. Antibiotics are required to treat bone and joint infections. In the most serious of cases, infected bones and joints may need to be surgically removed.
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