The most serious consequences of improper skin care in people lying down are bedsores. Bedsores (pressure ulcers) are defects of various depths of dead skin and subcutaneous tissue, they arise as a result of ischemia caused by prolonged pressure, e.g. when a person lies down for too long without changing position.
Bedsores most often develop on skin that covers bony areas of the body, such as the heels, ankles, hips and tailbone. Bedsores can develop over hours or days. Most sores heal with treatment, but some never heal completely. You can take steps to help prevent bedsores and help them heal.
Warning signs of bedsores are:
Unusual changes in skin color or texture
Swelling
Pus-like draining
An area of skin that feels cooler or warmer to the touch than other areas
Tender areas
Bedsores fall into one of several stages based on their depth, severity and other characteristics. The degree of skin and tissue damage ranges from red, unbroken skin to a deep injury involving muscle and bone.
Common sites of pressure ulcers
For people who use wheelchairs, bedsores often occur on skin over the following sites:
Tailbone or buttocks
Shoulder blades and spine
Backs of arms and legs where they rest against the chair
For people who need to stay in bed, bedsores may happen on:
The back or sides of the head
The shoulder blades
The hip, lower back or tailbone
The heels, ankles and skin behind the knees
If you notice the above warning signs of a bedsore, change the elderly person position to relieve the pressure on the area. If you don’t see improvement in 24 to 48 hours, contact your doctor.
Seek immediate medical care if you see signs of infection in the elderly person, such as a fever, drainage from a sore, a sore that smells bad, or increased redness, warmth or swelling around a sore.
Bedsores Causes
Bedsores are caused by pressure against the skin that limits blood flow to the skin. Limited movement can make skin vulnerable to damage and lead to development of bedsores.
Three primary contributing factors for bedsores are:
Pressure. Constant pressure on any part of your body can lessen the blood flow to tissues. Blood flow is essential for delivering oxygen and other nutrients to tissues. Without these essential nutrients, skin and nearby tissues are damaged and might eventually die.
For people with limited mobility, this kind of pressure tends to happen in areas that aren’t well padded with muscle or fat and that lie over a bone, such as the spine, tailbone, shoulder blades, hips, heels and elbows.
Friction. Friction occurs when the skin rubs against clothing or bedding. It can make fragile skin more vulnerable to injury, especially if the skin is also moist.
Shear. Shear occurs when two surfaces move in the opposite direction. For example, when a bed is elevated at the head, you can slide down in bed. As the tailbone moves down, the skin over the bone might stay in place — essentially pulling in the opposite direction.
Bedsores risk factors
The risk of developing bedsores is higher if the elderly person have difficulty moving and can’t change position easily while seated or in bed. Risk factors include:
Immobility. This might be due to poor health, spinal cord injury and other causes.
Incontinence. Skin becomes more vulnerable with extended exposure to urine and stool.
Lack of sensory perception. Spinal cord injuries, neurological disorders and other conditions can result in a loss of sensation. An inability to feel pain or discomfort can result in not being aware of warning signs and the need to change position.
Poor nutrition and hydration. People need enough fluids, calories, protein, vitamins and minerals in their daily diets to maintain healthy skin and prevent the breakdown of tissues.
Medical conditions affecting blood flow. Health problems that can affect blood flow, such as diabetes and vascular disease, can increase the risk of tissue damage such as bedsores.
Prevention
You can help prevent bedsores by frequently repositioning of the elderly person to avoid stress on the skin. Other strategies include taking good care of your skin, maintaining good nutrition and fluid intake, managing stress, and exercising daily.
Tips for repositioning: Consider the following recommendations related to repositioning in a bed or chair:
Shift the elderly person’s position frequently – about once an two hour.
Select cushions or a mattress that relieves pressure. Use cushions or a special mattress to relieve pressure and help ensure that your body is well positioned.
Adjust the elevation of bed of the elderly person. If the bed can be elevated at the head, raise it no more than 30 degrees. This helps prevent shearing.
Tips for skin care: Consider the following suggestions for the elderly person’s skin care:
Keep skin clean and dry. Wash the skin with a gentle cleanser and pat dry. Do this cleansing routine regularly to limit the skin’s exposure to moisture, urine and stool.
Protect the skin. Use moisture barrier creams to protect the skin from urine and stool. Change bedding and clothing frequently if needed. Watch for buttons on the clothing and wrinkles in the bedding that irritate the skin.
Inspect the skin daily. Look closely at your skin daily for warning signs of a pressure sore.
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