Family members with someone in long-term care need to be knowledgeable and vigilant about decubitus ulcers -- the dreaded bedsores. Also called pressure sores, pressure ulcers or decubitus ulcers, bedsores are skin wounds that result from prolonged pressure on the skin that's in contact with a bed or wheelchair. painful, take a long time to heal and are often a precursor of life-threatening complications such as skin and bone The human body is designed to be in constant movement, evenWe constantly shift positions, always unconsciously readjusting ourselves in bed, at the computer station, watching TV or whatever active or inactive pursuit engages us. Bedsores form in the areas where we have the least padding of muscle and fat, especially right over a bone. (coccyx), shoulder blades, hips, heels and elbows are common sitesTotal immobility, even for as little as 12 hours, can Circulation is impeded when blood flow slows or stops in the
compressed area between bone and the surface of a bed orWhen the tissue is deprived of oxygen and nutrients, the skin can die in as little as half a day, although the evidence may not be obvious for days or even weeks. When surgery, injury to the spinal cord, or an illness causes immobility the pressure of the immobilized body on certain areas can break down the skin. In bed, the most dangerous areas are the tailbone or buttocks and the heels. The toes, ankles, knees, hipbones, shoulders and shoulder blades, and even the rims of the ears are also at risk. In a wheelchair, the locations at highest risk are again the tailbone and buttocks, as well as shoulder blades and the spine, and the backs of arms and legs where they touch the chair. Problems such as arthritis or injury that make movement painful or impossible increase the probability of bedsores. paraplegics who have no sense of feeling in their feet are especially at risk.
Two additional causes of bedsores are shear and friction: Good skin hydration with lotion can be helpful, and of course it is important to keep all skin clean and dry. Age is the greatest risk factor for bedsores; person, the more vulnerable their skin. In an immobilized older person, even a small skin tear, which could easily occur during routine activities such as transferring from bed to a wheelchair, might quickly develop into a bedsore. Other risk factors include smoking, lack of pain perception, urinary or fecal incontinence, malnutrition, dementia and other medical conditions such as Repositioning the body at least every two hours in bed, or every 30 minutes in a wheelchair, can help prevent bedsores, as can special beds, pillows and mattresses. can cause its own problems. It is miserable to be awakened every two hours, especially if you are recovering from illness, surgeryMoving anyone every two hours, or especially every
30 minutes, is an enormous staff challenge for any facility providing personal care services, particularly in a busy hospital Avoid lying directly on the hipbones and support legs correctly with a foam pad or pillow (never a doughnut-shaped cushion or any type of rubber pad). Put the support under the legs from the middle of the calf to the ankle and keep knees and ankles from touching. It's helpful to have a little tent over the toes, and to use Foam, air, gel or water in a bed that can be automatically or manually readjusted on a regular schedule can work well. consult an expert, especially if a person is paralyzed or has other Inspection is crucial to detecting bedsores in the early stages of formation, when they are much easier to cure. caregivers to get up close and personal with patients, it's a Often the situation that precipitates a bedsore makes it veryConditions such as diabetes, thin skin and immobility make healing difficult.
As noted, Stage I bedsores will usually disappear if repositioning is prompt and consistent. physician's written orders can help this happen. Stage II, when a wound is present, calls for a multi-disciplinary approach coordinating the physician, the nurses, the aides and perhaps a physical therapist. worker can help manage the personal care services provided. careful analysis of how the wound was precipitated will helpA change of bed, cushioning, skin care and/or clothing may be effective. Support surfaces are particularly important, and special padding such as sheepskin or waffle foam canLow-air-loss beds use inflatable pillows for support; air-fluidized beds suspend the patient on an air-permeable mattress that contains millions of silicon-coated beads. There are several things that can aid with healing: Dark red, orange and green vegetables are especially rich in the needed nutrients, and nutritional supplements of Vitamin C and zinc
can also be helpful. Regular Wound Cleaning & Debridement Open sores may be treated with a saline (saltwater) solution each time the dressing is changed. Debridement is the removal of damagedSurgical debridement is often recommended to remove dead, damaged, or infected tissue. irrigation with pressurized water, hydrotherapy in a whirlpool bath, using the body's own enzymes, or applying topical debriding The right bandaging can help speed healing and protect the wound. It is crucial to keep surrounding skin dry and the wound moist. Transparent, semi-permeable dressings can help retain moisture and encourage new skin to grow. Infected wounds may be treated withAgain, it is crucial to also treat the pain in Even with the best medical care, bedsores may require surgery. Healthy tissue may be taken from one part of the body to use in reconstructing the damaged area. Recovery is long and arduous withPrevention is still the best
Bedsores & Nursing Homes The highest percentage of people with bedsores are in nursingSome bedsores may have been acquired in the hospital, and then persisted when the person transferred to a skilled careThe prevalence varies from study to study, and facility to facility, but anywhere from 3 to 28% of the people in a nursing home may have bedsores. It's a chicken and egg situation: which came first, the bedsoreOften frail older people come to live in a nursing home because this injury is so difficult to prevent andSometimes the conditions that necessitate living in a nursing home, such as advanced dementia or paralysis, create the Federal regulations are particularly stringent about preventing, documenting, and treating bedsores. The website www.medicare.gov (click on "Compare Nursing Homes in Your Area") gives the ratings for every nursing home and tells you the percentage of residents with bedsores and how that compares with the national average.