Understanding Why Do Elderly People Get Pressure Sores

According to research, hundreds of thousands of adults develop pressure sores, also known as bedsores, each year, with the elderly population being particularly vulnerable. Understanding why do elderly people get pressure sores is crucial for providing effective preventative care and ensuring the best possible quality of life for seniors.

Quick Summary

Elderly people are susceptible to pressure sores primarily due to reduced mobility, fragile skin, poor nutrition, and underlying health conditions that affect circulation and skin integrity. Constant pressure, friction, and moisture exposure compromise blood flow to the skin, leading to tissue damage and the development of these painful sores, particularly over bony areas.

Key Points

• Immobility is Key: The most significant factor is prolonged, unrelieved pressure on the skin due to limited movement, especially in those who are bedridden or in wheelchairs.

• Aging Skin is Vulnerable: Elderly skin is thinner, less elastic, and has less protective fatty tissue, making it more prone to damage from pressure and friction.

• Nutrition Matters: Poor nutrition and dehydration weaken the body's ability to heal and maintain healthy skin, increasing susceptibility to sores.

• Moisture is a Threat: Skin exposed to moisture from incontinence is prone to breakdown, which significantly increases the risk of pressure sore development.

• Underlying Conditions Worsen Risk: Medical issues like diabetes, poor circulation, and sensory loss hinder healing and the body's ability to signal a need to change position.

• Prevention is the Best Strategy: Proactive measures like frequent repositioning and proper skin care are far more effective than treating a developed sore.

The Core Reasons Elderly People Develop Pressure Sores

Pressure sores, or decubitus ulcers, are localized injuries to the skin and underlying tissue, typically over a bony prominence. They result from prolonged pressure, combined with friction or shear. The aging process, combined with chronic health issues and physical limitations, creates a perfect storm of risk factors that explain why do elderly people get pressure sores more frequently than younger individuals.

Immobility and Constant Pressure

At the heart of the issue is immobility. Many seniors, especially those with conditions like arthritis, dementia, or those recovering from surgery, are bedridden or wheelchair-bound. Constant, unrelieved pressure on a specific area of the body restricts blood flow to the capillaries. When this happens for extended periods, the skin and underlying tissues become deprived of oxygen and nutrients. This prolonged lack of blood flow, or ischemia, causes the tissue to die, resulting in a sore.

• Bedridden Patients: A person lying in bed for too long can develop sores on the heels, tailbone, elbows, and shoulder blades.
• Wheelchair Users: Seniors in wheelchairs are at high risk for sores on the tailbone, hips, and backs of their arms.

The Impact of Fragile Skin

As we age, our skin undergoes significant changes that make it more vulnerable to injury. These changes include:

• Thinner Epidermis: The outer layer of skin thins, offering less protection.
• Decreased Elasticity: The skin loses its ability to stretch and recoil, making it more susceptible to tearing from friction or shear.
• Reduced Fatty Layer: The protective layer of fat under the skin diminishes, offering less cushioning over bony areas.

This makes the senior's skin less resilient to external forces and internal pressures, accelerating tissue breakdown when exposed to risk factors.

Poor Nutrition and Hydration

Nutrition plays a vital role in maintaining skin health and promoting wound healing. Malnutrition, a common issue in the elderly, significantly increases the risk of pressure sores. A diet lacking in protein, vitamin C, zinc, and other essential nutrients can impair the body's ability to repair tissue. Dehydration also weakens the skin's integrity, leaving it dry and less elastic.

The Dual Threat of Incontinence and Moisture

Incontinence, both urinary and fecal, exposes the skin to moisture, which is a major risk factor. The combination of moisture, warmth, and bacteria from urine and feces can lead to skin breakdown, a condition known as skin maceration. This softened, fragile skin is highly susceptible to damage from friction and pressure. Proper hygiene and diligent skin care are essential to mitigate this risk.

Underlying Medical Conditions and Other Factors

Several health issues prevalent in the elderly can indirectly contribute to the formation of pressure sores:

• Diabetes: Poor circulation due to diabetes can impair blood flow to the skin, slowing wound healing.
• Peripheral Vascular Disease: This condition affects blood circulation in the limbs, increasing vulnerability to skin damage.
• Sensory Impairment: Conditions that cause numbness or reduce a person's ability to feel pain can prevent them from noticing the discomfort that signals a need to shift their position. Neuropathy, for example, is a significant risk factor.
• Cognitive Impairment: Patients with dementia or other cognitive issues may not be able to communicate their discomfort or understand the need to reposition themselves.

Prevention vs. Treatment: A Critical Comparison

Taking preventative measures is far more effective and less painful than treating a developed pressure sore. Here is a comparison of strategies:

Aspect	Prevention	Treatment
Focus	Proactive care to avoid skin breakdown	Reactive care to heal an existing wound
Key Activities	Frequent repositioning, daily skin checks, proper nutrition, moisture management, pressure-relieving devices	Wound cleaning, dressing changes, debridement (removing dead tissue), infection control, nutritional support
Best Practice	Reposition bedridden patients every 2 hours; wheelchair users every 15-30 minutes.	Follow physician's or wound care specialist's instructions precisely for dressing types and frequency.
Goals	Maintain healthy, intact skin and tissue	Promote granulation and epithelialization (new skin growth)

Essential Preventative Steps for Caregivers

Taking a proactive approach is key to preventing pressure sores in the elderly. Caregivers can implement several simple yet effective strategies:

1. Regular Repositioning: Following a schedule for repositioning is the most critical step. Use pillows or wedges to support and offload pressure from vulnerable areas.
2. Daily Skin Inspections: Check the skin daily, especially over bony areas. Look for redness, warmth, or blisters, which are early warning signs.
3. Moisture Management: Keep the skin clean and dry, especially after episodes of incontinence. Use barrier creams to protect the skin from moisture.
4. Optimal Nutrition and Hydration: Ensure the senior is consuming a balanced diet rich in protein, vitamins, and minerals. Encourage adequate fluid intake.
5. Use Pressure-Relieving Equipment: Utilize specialized mattresses, seat cushions, and heel protectors to reduce pressure points.
6. Encourage Mobility: If possible, help the senior with range-of-motion exercises to improve circulation.
7. Address Underlying Health Issues: Ensure all chronic conditions are well-managed.

For more detailed guidance on wound management and preventative care, consider consulting a reliable resource like the National Pressure Injury Advisory Panel (NPIAP).

Conclusion

Understanding why do elderly people get pressure sores reveals a combination of physiological and circumstantial factors inherent to the aging process. By focusing on preventative strategies like frequent repositioning, vigilant skin care, proper nutrition, and moisture control, caregivers can significantly reduce the risk and impact of these painful and debilitating sores. Proactive care is the most effective approach to ensuring the comfort and well-being of the elderly.

Frequently Asked Questions

What is the very first sign of a pressure sore in an elderly person?

The first sign is often a patch of red, purple, or dark skin that does not turn white when touched. This discoloration indicates restricted blood flow. In lighter skin tones, it may appear as redness, while on darker skin, it may look purple, blue, or darker than the surrounding skin. The area might also feel warm or painful.

Can pressure sores be prevented entirely in the elderly?

While it is difficult to prevent them entirely in high-risk individuals, proactive and diligent preventative care can significantly reduce the risk. Regular repositioning, skin checks, proper nutrition, and using pressure-relieving devices are crucial steps.

How often should an elderly person be repositioned to prevent pressure sores?

Bedridden individuals should be repositioned at least every two hours. For those in a wheelchair, shifting weight and repositioning should occur every 15 to 30 minutes. A caregiver or family member can use a timer to help maintain this schedule.

What role does nutrition play in the formation of pressure sores?

Nutrition is critical for skin health and tissue repair. A lack of protein, calories, vitamins (especially C), and minerals (like zinc) can lead to malnutrition, slowing the body's healing processes and making skin more fragile and prone to damage.

Does incontinence directly cause pressure sores?

While incontinence does not directly cause pressure sores, the prolonged skin exposure to moisture from urine and feces creates an ideal environment for skin maceration, where the skin becomes soft and breaks down. This significantly increases the risk of pressure sores developing from friction and pressure.

How can I tell if a pressure sore is getting worse?

A pressure sore is getting worse if it appears larger, deeper, or has more redness, swelling, or warmth around the edges. Signs of worsening also include pus-like drainage, a bad odor, increased pain, or if the sore changes color, indicating tissue death.

Are all elderly people at the same risk for developing pressure sores?

No, the risk varies based on individual health status. Factors such as a person's level of mobility, nutritional state, circulation, and the presence of chronic diseases like diabetes or peripheral artery disease all influence their susceptibility to pressure sores.