Bed Sores: What Are They, and What Are the Risk Factors?

Anyone with elderly family members needs to be aware of the threats posed by bed sores, which are also known as pressure sores and decubitus ulcers. Bed sores are skin wounds that develop when continuous pressure on a particular area of the body damages the skin. Such pressure generally results from long periods of lying in bed or sitting in a wheelchair with little to no movement. Left untreated, these wounds can be life-threatening, so it’s critical that they be quickly recognized and addressed.

Bed sores most commonly develop on skin that covers bony areas that tend to have the least padding of muscle and fat. The areas at greatest risk include the tailbone (coccyx), heels, ankles, elbows, hips, and shoulders.

Lack of movement for extended time periods places added pressure on these regions. Constant pressure prevents blood from flowing normally. When blood supply slows or stops for as little as two to three hours, the tissue is starved of oxygen and nutrients, causing the skin to break down and bed sores to form.

Bed sores develop in stages, with Stage I being the least serious and Stage IV being the most severe.

Stage I:  In a Stage I bed sore, the skin is not broken, but there is an area of redness or discoloration that may itch or hurt. In darker skin, the patch may look blue or purple, or seem flakey. The area may also show changes in hardness or temperature compared to the surrounding skin. If the pressure on the area is relieved, these wounds generally disappear quickly.

Stage II:  Failure to relieve the pressure will result in progression to Stage II. By this point, the top layer of skin (epidermis) is broken. The second layer (dermis) may also be broken. A shallow open wound with the appearance of a blister or abrasion will be visible, and the area surrounding it may be discolored. Stage II bed sores can quickly be healed if treated promptly and if the patient is otherwise healthy.

Stage III:  If a bed sore progresses to Stage III, the wound extends through the second layer of skin (dermis) into the fatty subcutaneous tissue below the skin. In other words, the skin has completely broken down to the muscle. Some of the signs of infection that may appear are redness around the edge of the sore, odor, pus, fever, greenish drainage, and necrosis (black, dead tissue). Tissue in the region is likely to have been permanently destroyed, and treatment of the wound is difficult in this stage.

Stage IV:  Stage IV is the most advanced stage. The wound extends into the muscle, and possibly even as far down as the bone. Bed sores that have progressed to this point have destroyed muscle, bone, tendons, and joints. Dead tissue and drainage should be readily apparent. These bed sores are life-threatening because they pose a high likelihood of infection. Stage IV bed sores are also very difficult to treat.

In bedridden patients, the areas at highest risk are the tailbone and the heels. Also at risk are the toes, ankles, knees, hipbones, shoulders and shoulder blades, and the rims of the ears. The highest risk areas for individuals in a wheelchair are the tailbone, shoulder blades, spine, and the areas of arms and legs that touch the chair.

A number of risk factors affect one’s chances of developing a bed sore. The most significant risk factor is age, as skin becomes more vulnerable as one gets older. Smoking, lower pain sensitivity, urinary or fecal incontinence, malnutrition, and dementia are also important risk factors.

Bed sores most commonly develop in nursing home settings. Studies show that anywhere from 3 to 28% of the residents in a given nursing home may be suffering from bedsores. If you are looking into nursing homes, you can view their ratings on the website www.medicare.gov. The website also lists the percentages of residents with bedsores and where those percentages fall in relation to the national average. If you’re interested in a nursing home with a high percentage, do some more research to find out whether the statistic reflects a poor track record for quality of care.

This is the first in a series of posts on the importance of diagnosing and responding to bed sores. In my next post, I’ll discuss recommendations for preventing and treating bed sores.