Why are older people at risk for pressure sores? An in-depth look at causes and prevention

Millions of older adults face the risk of developing pressure ulcers, also known as pressure sores. This authoritative guide provides a comprehensive explanation for why older people are at risk for pressure sores and details the interconnected factors that contribute to their development, from skin changes to chronic conditions.

Quick Summary

An increased susceptibility to pressure sores in older adults stems from age-related skin changes, reduced mobility and sensation, chronic health issues, and poor nutrition. This combination of factors weakens the body's natural defenses, leading to compromised skin integrity and making it harder for the body to withstand constant pressure and heal effectively.

Key Points

• Skin Fragility: With age, skin thins and loses elasticity, providing less natural cushioning over bones and making it more susceptible to damage and tearing.

• Immobility and Reduced Sensation: Limited movement and diminished nerve sensitivity in older adults prevent the relief of constant pressure, which restricts blood flow and can lead to tissue death.

• Malnutrition and Dehydration: Poor nutrition, particularly inadequate protein and vitamin intake, weakens skin integrity and slows healing, while dehydration reduces skin elasticity.

• Chronic Health Conditions: Diseases common in older adults, like diabetes and vascular disease, impair circulation and healing, compounding the risk of pressure sore formation.

• Moisture and Friction: Incontinence increases skin moisture, leading to breakdown (maceration), while friction and shear forces from movement can cause painful skin injuries.

• Vigilant Prevention is Key: Consistent care involving regular repositioning, daily skin checks, and nutritional support is crucial for mitigating the multiple risk factors seniors face.

Introduction

Pressure ulcers are painful injuries to the skin and underlying tissue, often resulting from prolonged pressure on the skin. While they can affect anyone, older adults are disproportionately at risk due to a number of physiological and lifestyle changes associated with aging. Understanding these contributing factors is the first step toward effective prevention and management.

Age-Related Skin Changes

As we age, our skin undergoes significant transformations that make it more vulnerable to damage. These changes directly impact its ability to resist pressure and heal from injury.

• Skin thinning: The epidermis and dermis layers of the skin become thinner, leading to a loss of the natural cushion that protects underlying bones and muscles. This means less padding is available to absorb the constant pressure over bony prominences like hips, ankles, and the tailbone.
• Loss of elasticity: Reduced collagen and elastin production causes skin to become less resilient and more fragile. This decreased elasticity makes the skin more prone to tearing and breaking down under strain.
• Slower healing: The rate of cell turnover and tissue repair slows down with age. What might be a minor scrape for a younger person can become a persistent and serious wound for an older individual.
• Decreased moisture and dryness: Aging skin loses some of its ability to produce natural oils, leading to increased dryness. Dry, scaling skin has a lower resistance to mechanical forces like friction and can be more easily injured.

Immobility and Reduced Sensation

One of the most significant risk factors for pressure sores is limited mobility. The inability to shift position independently means pressure is not relieved, and blood flow is cut off from a specific area.

• Reduced movement: For older adults who are bedridden, use a wheelchair, or have other mobility impairments, constant pressure on the same spot is a frequent problem. Even in short periods, this can restrict blood flow and lead to tissue death.
• Impaired sensory perception: Many older adults experience a reduction in sensation due to conditions like diabetes or neuropathy. This means they may not feel the discomfort or pain caused by constant pressure, failing to prompt a necessary repositioning that would prevent a sore from forming.
• Cognitive impairment: Conditions such as advanced dementia can diminish a person's awareness of their own body and their ability to communicate discomfort. They may not understand the need to change position or be able to express that they are in pain, leaving them vulnerable to pressure ulcers.

Malnutrition and Dehydration

A proper diet is essential for maintaining skin health and wound healing. Nutritional deficiencies are common in older adults and significantly increase the risk.

• Insufficient protein intake: Protein is a crucial building block for all body tissues, including skin. Inadequate protein intake can compromise skin integrity and hinder the body's ability to repair itself.
• Vitamin and mineral deficiencies: A lack of essential vitamins and minerals, such as Vitamin C and zinc, can impair the body’s healing processes and weaken the skin's protective barrier.
• Dehydration: Staying hydrated is vital for maintaining skin elasticity and health. Dehydration makes the skin more fragile and susceptible to injury.

Chronic Health Conditions and Other Factors

Underlying medical conditions can compound the risk for pressure sores by affecting circulation, skin integrity, and overall health.

• Diabetes: This chronic condition can cause poor circulation and nerve damage (neuropathy), reducing sensation and impairing blood flow to the skin and tissues. It also slows the healing process.
• Vascular disease: Any condition that affects blood flow, such as peripheral artery disease, means that tissues don't receive enough oxygen and nutrients, making them more susceptible to damage and less capable of healing.
• Heart failure: Edema, or fluid retention, is a common symptom of heart failure. Swollen tissues can restrict blood flow and increase pressure on the skin.

The Role of Moisture and Friction

Moisture and friction play a major role in skin breakdown, creating an environment ripe for pressure sore development.

• Incontinence: Exposure to moisture from urine or feces can soften and break down the skin, a process called maceration. This makes the skin more vulnerable to damage from friction and pressure.
• Friction and shear: Friction occurs when skin rubs against a surface. Shear is when skin remains in place but underlying bone moves, stretching and damaging blood vessels. This often happens when a person slides down in a bed or chair. Both forces can injure fragile skin and contribute to sore formation.

Prevention is Possible

Preventing pressure sores requires a multi-faceted approach involving consistent care and attention to risk factors. Caregivers and healthcare professionals should work together to implement preventative strategies.

1. Regular Repositioning: For bedridden individuals, changing position every two hours is recommended. For those in wheelchairs, repositioning every 15-30 minutes is critical.
2. Inspect Skin Daily: Regularly check the skin, especially over bony areas. Look for redness, warmth, or other signs of skin breakdown.
3. Ensure Proper Nutrition and Hydration: Encourage a diet rich in protein, vitamins, and minerals. Ensure adequate fluid intake to keep skin hydrated.
4. Use Pressure-Relieving Devices: Utilize special mattresses, cushions, and other equipment designed to redistribute pressure and reduce strain on vulnerable areas.
5. Manage Moisture and Hygiene: Keep skin clean and dry. Use barrier creams to protect skin from moisture due to incontinence.
6. Reduce Friction and Shear: Avoid dragging the person across surfaces. Use lifting devices or assistance to move them safely.

Conclusion

Understanding why older people are at risk for pressure sores is the cornerstone of prevention. The combination of fragile skin, limited mobility, nutritional issues, and underlying health conditions creates a perfect storm for pressure ulcer development. By focusing on proactive care, including regular repositioning, proper nutrition, and vigilant skin inspection, caregivers can significantly reduce the risk and improve the quality of life for seniors. For more comprehensive guidance, consult reliable resources such as the National Institute on Aging.

Skin Changes in Aging vs. Healthy Skin

Feature	Healthy Skin	Aging Skin
Thickness	Thick, plump layers of epidermis and dermis.	Thin, fragile skin layers.
Elasticity	High, springs back easily.	Low, loses resilience and sags.
Blood Flow	Robust, ensures rapid oxygen and nutrient delivery.	Reduced, slower circulation inhibits healing.
Moisture	Well-hydrated with natural oils.	Dry, less natural oil production.
Healing Time	Fast, rapid cell turnover and repair.	Slow, delayed cell regeneration.
Cushioning	Healthy subcutaneous fat protects bony areas.	Reduced fat and muscle, less padding over bones.

Frequently Asked Questions

What is the primary cause of pressure sores in older people?

The primary cause is prolonged pressure on the skin over bony areas, which restricts blood flow and deprives the tissue of oxygen. This pressure is especially damaging to older adults due to their naturally thinner, more fragile skin and often reduced mobility.

How can caregivers check for early signs of pressure sores?

Caregivers should perform daily skin checks, focusing on bony areas like the hips, tailbone, elbows, and ankles. Look for changes in skin color, especially redness or discoloration that doesn't fade after pressure is relieved, and feel for warmth or firmness in the area.

Does a poor diet contribute to pressure sore risk?

Yes, poor nutrition is a significant contributing factor. Deficiencies in protein, vitamins (especially C), and minerals can weaken skin tissue and impair the body's ability to repair and heal, making the skin more susceptible to breakdown.

How often should an older adult be repositioned to prevent pressure sores?

For those who are bedridden, repositioning every two hours is typically recommended. For individuals in a wheelchair, shifting weight or being assisted with repositioning every 15 to 30 minutes is crucial to relieve pressure.

Can pressure sores be avoided if an older person is incontinent?

Yes, prevention is possible with proper management. Keeping the skin clean and dry is critical. Caregivers should use absorbent pads and protective barrier creams to shield the skin from moisture caused by incontinence.

Are older adults with diabetes at a higher risk for pressure sores?

Yes. Diabetes can impair circulation and nerve function, which can both reduce sensation and hinder the delivery of vital nutrients to the skin. This combination makes diabetic older adults particularly vulnerable.

What is the difference between friction and shear in pressure sore development?

Friction is the rubbing of the skin against a surface, like bedsheets. Shear is the stretching of blood vessels and tissue when the skin remains stationary while the underlying bone shifts. Both are damaging to fragile skin and can cause or worsen pressure sores.