Preventing Pressure Sores in the Elderly (often called BedSores or Decubitus Ulcers)

The Definition of a Pressure Sore

By definition a pressure sore is any lesion caused by unrelievedpressure that results in damage to the skin and underlying tissue.Often times a pressure sore is a symptom of neglect and/or abusewith patients that are wheel chair or bed bound, such as the elderly.The severity of a pressure sore varies. In general, the elderlyare at a higher risk of developing pressure sores because of normalaging changes to the skin. Long-term care facilities, such as nursinghomes, must recognize the resident's risk and take active preventivemeasures to avert these painful wounds. A pressure sore is alsoknown as a bed sore, a pressure ulcer or a decubitus ulcer.

Causes of Pressure Sores in the Elderly

Pressure sores are usually caused by unrelieved pressure to thebony parts of the body such as the heels and the hips. Typicallypressure sores occur when patients, especially the elderly, muststay in bed for prolonged periods of time due to aging, an injuryor illness.

Nursing staff is expectedto recognize and identify the many circumstances and conditionsthat contribute and cause pressure sores in patients and the elderly.Make note, pressure sores may be a sign of nursinghome abuse or neglect. Risk factors for developing pressuresores include the following:

• A patient or nursing home resident who is comatose, or semi comatose is highly susceptible to pressure sores.
• Skin surfaces rubbing together and forming sore spots.
• Urinary and bowel incontinence will promote pressure sores.
• Frequent, prolonged, or constant exposure to moisture, particularly irritating secretions related to incontinence leading to pressure sores.
• Severe peripheral vascular disease contributing to poor circulation and pressure sores.
• Decreased sensory perception, or inability to respond to the environment, including changes in pressure and temperature are known causes of pressure sores.
• Diabetes, severe congestive pulmonary disease (emphysema, asthma, chronic bronchitis, and other diseases can lead to bed rest thus pressure buildup.
• Immobility, limited mobility, or difficulty moving without assistance can cause discomfort for the elderly.
• Hemiplegia (paralysis on one side of the body) negates movement and may lead to pressure sores.
• Patients with Paraplegia (paralysis from the waist down) need assistance to move to prevent sores.
• Residents with Quadriplegia (paralysis from the neck down) are prime candidates for skin irritations like pressure sores.
• Serious infections will contribute to sores.
• Terminal cancer chronic or end stage renal, liver, and/or heart disease or drug related immune problems may lead to pressure sores.
• A full body cast invites skin problems.
• Steroid therapy, radiation therapy and chemotherapy have been known to breakdown the skin causing sores for all ages.
• Renal dialysis; or head of bed elevated the majority of the day can cause sores.
• Poor nutrition, malnutrition, dehydration or poor liquid intake contributes to poor skin development.
• Weight loss or being overweight leads to pressure sores.
• Any friction caused byimproperly moving the individual, shearing, or moving the individual in one direction while the skin stretches in the opposite direction; also a consequence of improper moving amongst the elderly or disabled can lead to pressure sores.

How to Prevent Pressure Sores for the Immobile and Elderly

1. Check the nursing home resident's skin for sores daily and pay particular attention to bony prominences.

2. Because dirty skin can lead to pressure sores, cleanse the skin immediately when soiled and at routine intervals; avoid hot water and use a mild cleansing agent.

3. Minimize environmental factors leading to drying. Moisturize dry skin daily.

4. Avoid massage over bony prominences and reddened areas, which may antagonize sore spots.

5. Minimize skin exposure to secretions and excretions such as incontinence, perspiration, or wound drainage. Apply barrier products and avoid powder or cornstarch, which can be irritating to the skin, causing sores.

6. Use proper positioning, transferring, and turning techniques to help prevent pressure sores. Avoid friction and shearing by lifting the elderly instead of dragging over the bed linen. Use lifting devices to move nursing home residents in bed whenever possible.

7. Provide adequate intake of fluid, protein, and calories to aide against sores.

8. Keep the elderly as active as possible.

9. If an individual is not active, reposition them every two hours, or more. Encourage individuals who can move to reposition themselves frequently.

10. Use props and positioning devices to keep bony areas from rubbing together. For example, if lying on the side, pad between the knees and ankles, using a bath blanket, pillow, or other positioning device.

11. A familiar technique to prevent sores is to keep heels elevated off the bed, or hanging over the end of the mattress.

12. Avoid positioning the elderly directly on the hips and shoulders. A slight side lying position is more comfortable and relieves pressure. Prop or pad behind the back to help support and maintain position.

13. Keep the head of the bed at the lowest degree of elevation possible. Elevating the head increases pressure on the sacrum, coccyx, and buttocks.

14. Apply pressure reducing mattresses and pads to bed and chair. The most common pressure relieving devices are made of foam or gel. Sheepskin prevents friction and shearing, but does not relieve pressure.

15. Keep the bed clean, dry and free of wrinkles or food crumbs.

16. Reposition individuals sitting in chairs hourly. If able, the person sitting in the chair should be taught to shift his or her weight every 15 minutes to avoid pressure sores.

17. Ensure that the elderly receive adequate calories and protein to meet the resident's needs. Increase fluid intake. Provide supplements and snacks. A registered dietitian can make recommendations.

18. Provide restorative nursing programs to maintain or improve mobility and activity among aging residents.

19. Assist residents to the bathroom every two hours, or more often. Avoid use of diapers and pads, if possible. Use other types of bladder management options, such as incontinence management, or a bowel and bladder retraining program.

20. Avoid the use of restraints as much as possible.

Commitment to Nursing Home and Personal Injury Clients

Be aware that pressures sores may be a sign of nursing home abuse or neglect. Nursing home lawyer Jeffrey H. Rasansky has one mission: to fight for the rights of nursing home residents and their family, people just like you. If you feel your loved one has developed pressure sores due to the negligence of a nursing home, contact an experienced nursing home lawyer at the law offices of Jeff Rasansky. We can help.

Jeff Rasansky is licensed to practice before all state courtsin Texas, the United States District Courts in the Northern andEastern Districts of Texas and the Fifth United States CircuitCourt of Appeals.

Click here to contact The Law Offices of Jeff Rasansky

Pressure Sores - Resources

TheLurking Dangers of Pressure sores

American Academy of Wound Management

SPINALCORD: Prevention of Pressure Sores thro...

MayoClinic.com - Bedsores: How to prevent them

ClinicalTrials.gov - Information on Decubitus Ulcer

Pressure Sores -- familydoctor.org