Recognizing Bed Sores in the Elderly

Bed Sores Can Be Serious

Sitting or lying in one position for too long usually causes bed sores in the elderly or in immobile patients. Bed sores are easier to prevent than they are to treat. The first sign of a bed sore is a reddened area that does not go away within 30 minutes of pressure relief. Avoid rubbing or massaging red areas, which damages underlying tissues further.

When a patient or nursing home resident doesn't shift enough while at rest, blood supply gets too low and a "bed sore" forms. Bed pressure can reduce the blood supply to the skin and the underlying tissue causing sensitivity and eventually a tough-to-treat sore.

Areas at risk for bed sores include the base of the spine, the shoulder blades, and the side of the knees, back of the head, heels and the hips. Bed sores appear on the parts of the body that don't have fat to cushion them. Bed sores are also referred to as pressure sores, pressure ulcers and decubitus ulcers.

Recognizing the Stages of a Bed Sore

Bed sores are classified according to stages. You should learn to recognize the stages of a bed sore. Each stage of a bed sore represents a greater degree of tissue damage than the previous stage. Bed sores can develop quickly and progress to become Stage IV Bed Sores within a very short time. They do not necessarily progress from Stage I to Stage IV or heal from Stage IV to Stage I.

In the long-term care facility such as a nursing home with aging residents, bed sores should be measured weekly, or more often. This includes a metric measurement of length, width, and depth. Other observations, such as odor, drainage, presence of nonviable tissue, and the appearance of surrounding tissue are recorded on the medical record.

Stage 1 Bed Sores:

A stage one bed sore is a reddened skin area that does not fade within 30 minutes after pressure is removed. The sore can be large or small, and may be irregular in shape.

Stage 2 Bed Sores:

A stage two bed sore is a superficial open sore in the upper layer of skin. The bed sore may look like a blister, abrasion (scrape), or shallow crater.

Stage 3 Bed Sores:

A stage three bed sore occurs when a full layer of skin is destroyed. At this stage, the bed sore extends into the underlying subcutaneous fat or tissue layer. The sore reaches, but does not go through, the muscle. Nonviable (dead) tissue may be present. This is commonly black in color, but occasionally appears to be hard red or white tissue. The nonviable tissue, called eschar, must be removed from the sore before healing can occur.

Stage 4 Bed Sores:

A stage four bed sore occurs when there is full thickness skin loss with extensive destruction. Tissue necrosis occurs, and damage often extends from the sore to the muscle, bone, and supporting structures (such as tendon or joint capsule). Note: Undermining and sinus tracts may also be associated with Stage IV bed sores. These areas are not visible from the surface of the wound. They are deep tunnels that may extend far back under the resident's skin. Like a Stage III bed sore, if eschar is present, it must be removed before healing can occur.

How to Treat a Bed Sore in the Elderly

Three key treatments will help heal bed sores in the elderly.

1. Immediately relieve the pressure that is causing the bed sore by redistributing the weight.
2. Treat the bed sore with either topical ointments or antibiotics.
3. Improve an elder's environment and conditions such as improving nutrition, hygiene, mobility, activity and positioning.

Products Used to Treat Bed Sores

Many products are used to treat pressure sores. Matching the product type to the sore is best for the elderly. Avoid using harsh cleansers such as betadine or hydrogen peroxide to clean bed sores, as these products destroy healing tissue. Normal saline or pH neutral cleansers are best.

Use a dressing to avoid drying the bed sore. Dressings that keep the sore moist help promote healing. Some sores become infected and produce copious amounts of drainage, which is often foul smelling. An infected bed sore will not easily heal on the elderly, so measures must be taken to eliminate infection. If the infection is limited to the sore only, topical products may be used to eliminate it. If the infection is systemic, antibiotics are used. In general, use of antibiotics should be avoided whenever possible.

Take note, bed sores may be a sign of even greater problems for aging patients. Bed sores on a resident are sometimes signs of nursing home abuse and neglect.

Commitment to Nursing Home and Personal Injury Clients

Nursing home and personal injury lawyer Jeffrey H. Rasansky has one mission: to fight for the rights of nursing home and personal injury victims, people just like you. Jeff has successfully represented victims of: personal injury, nursing home abuse, nursing home neglect, nursing home negligence, medical malpractice and product liability. If you feel a loved one has suffered from unnecessary pain due to bed sores that should have prevented, contact experienced nursing home laywer Jeff Rasanaky today.

Jeff Rasansky is licensed to practice before all state courts in Texas, the United States District Courts in the Northern and Eastern Districts of Texas and the Fifth United States Circuit Court of Appeals.

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