© Jan Schneckenhaus | Dreamstime.com
Bedsores—also known as pressure sores or pressure ulcers—are a big risk for people who spend an extended time either prone or in a wheelchair due to illness, frailty, injury, surgery, or disability.
Lying or sitting in in one position places pressure on certain areas of the body. This pressure reduces the flow of oxygen-rich blood to the skin and underlying tissues, and if the blood supply isn’t restored, a bedsore may develop. Bedsores also can develop due to the friction of skin rubbing on bedding, particularly if the skin is moist.
Seniors Are Especially Vulnerable to Bedsores
Older adults are especially vulnerable because their skin is thinner and can sustain damage even from fairly light pressure. If you have a health condition that affects your circulation, such as heart disease or diabetes, you’re at even greater risk of developing bedsores.
Stroke, spinal cord injuries, and neurological disorders like Parkinson’s disease and amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease) also make you vulnerable because you may not be able to feel pressure or pain from a developing sore. Another risk factor is wearing a cast if you have broken a bone.
How Bedsores Develop
Bedsores develop in stages. Initially, the skin becomes red and warm to the touch, and an itchy, tender patch develops that is not relieved by shifting position to reduce pressure on the area.
The next stage is the development of a painful blister—the skin then breaks to form a wound surrounded by reddened skin. If the area is not treated, the wound may deepen to affect the underlying muscle and bone.
While bedsores are treatable, research shows that they can cause infections and serious complications, such as sepsis, if they are not treated immediately and effectively. In one 2012 study, older adults who developed bedsores were more likely to die during a hospital stay. They were also more likely to have a longer hospital stay, and be readmitted to the hospital within 30 days of their discharge. The study suggests it is incumbent on hospitals to identify people who are at the greatest risk for bedsores, and to implement preventive interventions immediately upon their admission to a hospital or nursing home. Unfortunately, these steps don’t always happen.
How bedsores are treated depends on their severity. Minor bedsores should be cleaned with a saline solution and dressed to provide a barrier against infection. Painkillers can help relieve discomfort, and if an infection does develop, you will need oral or topical antibiotics to help fight it.
More serious bedsores may need to be debrided (this involves having damaged or dead tissue removed, which can be done by flushing the wound with saline or cutting out dead tissue). An approach called “negative pressure wound therapy” also may be employed; it involves the use of a suction tube that draws moisture out of the bedsore to speed healing.
In some cases, severe bedsores require surgery to cover the wound with a pad of muscle and/or skin from elsewhere in the body—however, this approach is typically reserved for younger people.
Strategies to Help Prevent Bedsores
Bedsores are most likely to develop over bony areas of the body that have less fat to pad them—for example, the shoulder blades, hips, base of the spine, and heels—so try to avoid prolonged pressure on these areas, particularly if you are underweight. Follow these tips:
- If you’re on bed rest or in a wheelchair, aim to shift position every 10 to 15 minutes to avoid pressure on the same area for too long. If you find you’re forgetting to do so, set an alarm on your watch or cellphone to remind you.
- If you need to use a wheelchair, ensure that the seat, back, and calf rests (if it has them) are adequately padded. Also consider purchasing a tilting wheelchair, since these allow you to change your position more easily if your body strength is limited.
- If you have to lie prone, use pillows or supportive foam wedges as extra padding, and place a pillow under your calves to raise your heels off the mattress. Change your resting position at least every hour—ask for help to do so if necessary.
- Make sure bed sheets remain smooth underneath your body, and ensure they are changed frequently.
- It’s also vital that your skin remains dry, so ask that the bedding be changed if it becomes damp or wet. Applying talc to your skin also can help it stay dry.
- Frequently check (or ask a nurse or family member to check) vulnerable areas each day. Signs that a sore may be forming include spots and reddish, darker-colored (or grayish if you’re Hispanic or African-American) areas of skin right on the bone, and patches of skin that itch or feel hot to the touch.
- Think about your diet: You should be following a nutritious eating plan to boost your immune system and help your body fight infection.
- Quit smoking, since this impedes healing.