Why the elderly are more susceptible to sores
The aging process introduces several physiological changes that make the skin more fragile and less resilient. Collagen and elastin production decrease, causing skin to become thinner, less elastic, and more prone to tearing. Additionally, the subcutaneous fat layer thins, reducing the natural cushioning over bony areas. These internal changes are compounded by external factors, increasing the overall risk of developing skin sores.
The primary causes of skin sores
Pressure, friction, and shear
Pressure ulcers, commonly known as bedsores, are a leading cause of sores in older adults with limited mobility. Constant pressure on a specific area of the body restricts blood flow, depriving tissues of oxygen and nutrients. This can lead to cell death and the formation of a sore in as little as a few hours.
- Pressure: Prolonged sitting or lying in the same position, especially over bony prominences like the tailbone, hips, heels, and elbows, can cause damage. The elderly who are bedridden or wheelchair-bound are at significant risk.
- Friction: This occurs when the skin rubs against another surface, like bed sheets or clothing. For fragile, thin skin, even a small amount of rubbing can cause a skin tear or abrasion.
- Shear: This is a combination of friction and pressure. It happens when the skin and underlying tissue are pulled in opposite directions. A common example is when a person slides down in a bed with the head elevated, causing the skin over the tailbone to stretch while the bone moves down.
Skin infections
Age-related changes and underlying health issues can weaken the immune system, making seniors more vulnerable to skin infections. Sores can be a result of or become infected by various pathogens.
- Cellulitis: A bacterial infection of the deep skin and underlying tissue, cellulitis can enter through cuts, dry skin cracks, or insect bites. It appears as a painful, warm, red, and swollen area.
- Fungal infections: Damp, warm areas like skin folds are prone to fungal infections like candidiasis. These can cause red, itchy, and sometimes blistered patches that can turn into open sores if scratched.
- Herpes zoster (shingles): The reactivation of the chickenpox virus can cause a painful, blistering rash that follows nerve pathways. The blisters can break open, leading to sores.
Chronic medical conditions
Several health issues prevalent in older age can contribute to skin breakdown and the development of sores.
- Diabetes: High blood sugar can damage nerves and blood vessels, leading to poor circulation and reduced sensation, particularly in the feet. This increases the risk of diabetic foot ulcers, which are slow to heal and prone to infection.
- Vascular diseases: Conditions like chronic venous insufficiency cause poor blood circulation, leading to fluid buildup and swelling (edema) in the legs. This can result in venous ulcers, which typically form around the ankles and are difficult to treat.
- Incontinence: Exposure to moisture from urine and feces creates a damp environment that can soften the skin (maceration) and make it more susceptible to breakdown. The acids and enzymes in waste can also irritate the skin, leading to excoriation and infection.
Malnutrition and dehydration
Proper nutrition is vital for maintaining healthy, resilient skin. A lack of essential nutrients can severely impact the skin's ability to repair itself.
- Protein deficiency: Protein is crucial for tissue repair. Inadequate intake can significantly impair wound healing.
- Vitamin and mineral deficiencies: Nutrients like vitamin C and zinc are essential for collagen formation and immune function. A lack of these can make the skin more fragile.
- Dehydration: Not drinking enough fluids causes skin to become dry, less elastic, and more prone to cracking and tearing.
A comparison of common sores in the elderly
| Feature | Pressure Ulcers (Bedsores) | Venous Ulcers | Diabetic Foot Ulcers |
|---|---|---|---|
| Cause | Prolonged pressure, friction, or shear restricting blood flow | Poor blood circulation due to venous insufficiency | Nerve damage and poor blood circulation due to diabetes |
| Location | Bony areas: tailbone, hips, heels, elbows | Lower legs, typically around the ankles | Feet, especially on pressure points or where injuries occur |
| Appearance | Stages vary from red, unbroken skin to deep, open wounds with visible muscle or bone | Shallow, irregularly shaped wounds with red, raw skin and some swelling | Often have a “punched out” appearance, sometimes with pus or black tissue |
| Sensation | Often painless in later stages due to nerve damage | Can be painful, especially when swollen, but not always | Often painless due to diabetic neuropathy (nerve damage) |
Prevention strategies for skin sores
Preventing sores in the elderly requires a proactive, multi-faceted approach focusing on pressure management, hygiene, nutrition, and regular skin assessment.
Pressure relief
For those with limited mobility, frequent repositioning is the single most important preventive action. Change the person's position at least every two hours in bed and every 15 minutes in a wheelchair. Use pressure-reducing mattresses and cushions, heel protectors, and pillows to offload pressure from bony areas.
Skin care and hygiene
- Cleanliness: Keep the skin clean and dry, especially after episodes of incontinence. Use mild, pH-balanced cleansers instead of harsh soaps, which can dry out the skin further.
- Moisture control: Use barrier creams to protect vulnerable skin from moisture associated with incontinence.
- Daily inspection: Conduct daily skin checks, paying close attention to bony areas. Look for signs of redness, warmth, or irritation and address them immediately.
- Moisturize: Apply moisturizers to dry areas to prevent cracking and maintain skin integrity. Avoid over-moisturizing or leaving skin damp.
Optimal nutrition and hydration
Ensure the elderly individual has a balanced diet rich in protein, vitamins, and minerals. If their intake is poor, consult a doctor or dietitian about nutritional supplements. Hydration is also key; encourage a consistent intake of fluids throughout the day.
Early intervention
Address any developing skin issues promptly. The earlier a sore is identified and treated, the better the outcome. Educate caregivers on the signs of skin breakdown and the importance of early reporting. Implement protocols for risk assessment using tools like the Braden or Norton scales.
The importance of professional medical advice
While this guide provides comprehensive information, any skin sore or persistent skin issue should be evaluated by a healthcare professional. A doctor can accurately diagnose the cause, stage the wound, and recommend the most effective treatment plan, which may include special dressings, antibiotics, or debridement. In severe cases, surgical intervention may be necessary. For reliable information on managing skin conditions, the Mayo Clinic's website offers helpful resources. This allows for professional-level wound care and management.
Conclusion
Sores in the elderly are a complex issue arising from a combination of age-related skin changes, pressure, moisture, underlying medical conditions, and nutritional factors. While their development can be serious, proactive care and informed vigilance can significantly reduce the risk. By understanding what causes sores on the elderly, caregivers and family members are empowered to implement effective prevention strategies. A focus on pressure relief, meticulous hygiene, proper nutrition, and quick response to any signs of skin irritation is paramount to promoting healthy aging and maintaining quality of life.
