Why Bed Sores in the Elderly Should Concern Caregivers

Rita Dichele - August 23, 2011 11:35 AM

One day Mom was sitting quietly reading.  I noticed she was more restless than normal and in fact it seemed as if she was struggling to find a comfortable position.  Suddenly, mom remarked, “It hurts when I sit.  What do you think it might be? This has never happened before.”    But we both shrugged it off, laughing together and deciding, “Not enough meat where you need it . . . got to get some more padding.”   Mom only weighs around 86 pounds.  This continued for a period of time and her discomfort increased.  Nevertheless, we continued to make light of it.

But in time it was no longer a laughing matter but became a serious medical issue.  I had taken Mom to the doctor who was treating a hip problem. During the examination, the doctor’s demeanor suddenly changed and she caught me off guard when she said, “This is not good.”  In fact she lowered her voice -almost speaking in a whisper.  The doctor showed me a tiny sore on my Mom’s bottom.  Also, Mom’s bottom was quite red and raw.

The doctor’s concern caught me totally off guard. I didn’t want to be flippant about this but honestly what was the big deal? I thought perhaps she was overreacting.  After all, it was just a tiny sore.   Couldn’t this go away with over-the-counter ointment? 

But the doctor immediately assured me of the seriousness of the matter.  An open pressure sore such as the one my Mom had, if left untreated, can become toxic, poisoning the blood, followed ultimately by death.

I thought to myself – WOW . I just didn’t have a clue.  I had always thought bed sores only happened in hospitals, and when it did, it was because of poor nursing or if the patient was in a coma. 

So, Mom had a pressure ulcer.  In medical terms this is known as a decubitus ulcer.  I have often heard it referred to as a bed sore but most will call it a pressure sore.   The pressure sore was actually a tiny open wound in a very precarious spot on her bottom.

I am sharing this story so that other caregivers will understand the seriousness of the problem.   I do not pretend to be an expert on pressure sores, but my intent is to help others be mindful of a very common problem among the elderly.

After doing my research and consulting with healthcare providers, I found out some basic information I’d like to share with you.

Essentially, pressure sores can surface as a result of inactivity, sedentary lifestyles, and/or sitting/lying/leaning in one position too long.  They can be present on any part of the body although typically they are found at the pressure points such as at the sacrum, the base of the spine, as in my Mom’s case.   Common pressure sores also develop from lying on your side, standing on your heels, or even leaning on your elbow for periods of time.

Keep in mind that pressure sores are not limited to nursing home facilities or acute hospital settings.   Persons of any age can get one especially if they sit idle for long periods of time or even persons who live sedentary lifestyles can get one.  For instance, someone in a wheelchair is susceptible.

However, bed sores are more common in the elderly.  The elderly tend to have transparent skin and not as much “fat” or “meat” on their bones.  As a result, because their skin is thinner due to years of wear and tear, it is not uncommon for the skin not to be tough enough when there is undue pressure.   Also, when we age, the blood flow to the skin is reduced which can further worsen the problem, literally killing skin tissue.  Subsequently, it doesn’t take much for an elder to get a bed sore.  In fact in our country, about 20% of all bed sores happen outside institutions - those who reside in their homes.  Approximately 70% of those individuals who do get sores are 70 years and older.

There are several things you can do to COPE (Check; Oversee; Prevent; Educate) with pressure sores.

CHECK for sores, especially important if your loved one remains home.  Be sure to observe anything unusual in terms of sitting, standing, and walking.  Also, listen carefully.  Do not be dismissive.  Think the worse.  Furthermore, you should also be vigilant about detecting pressure sores when your loved one is in an institutional setting such as a skilled nursing facility, hospital, or assisted living program.  I would highly recommend asking the nursing staff whether or not bed sores were being checked for.  Better to be safe than sorry.  Also, it is better to be skeptical of nursing homes that don’t check for this.  Even contact with sheets can cause sores.

OVERSEE the care. Supervise the wound treatment by making sure your loved one is using the prescribed cream or treatment. Provide nutritional foods high in protein and Vitamin C tablets.  Make sure your loved one is eating regularly. Most importantly, you need to follow-up with the doctor, updating him on her progress.

PREVENT future sores from surfacing.  Buy gel cushions but avoid donut –like cushions since you want to make sure that the elder can sit comfortably on an even surface.  Also, donuts can cause irritation since you are placing more pressure on other parts.   Furthermore, encourage your loved one to move around.  Even if the she is unable to walk outside or walk long distances, have her take short walks in the home every 30-60 minutes. 

EDUCATE your loved one.  Tell her to let you know if she is having reoccurring incontinence; feeling uncomfortable sitting for short periods of time; noticing something unusual in any part of the body such as skin irritations that are new or different.

In conclusion, it is important to be mindful of what our loved ones say to us.  Don’t automatically assume that it is nothing.  Always report to the doctor any unusual complaint/concern.  It is so important to be mindful of pressure sores, since many of our loved ones are remaining in their homes under our watch.  

And above all, don’t feel guilty if your loved one does gets a pressure sore.  It doesn’t mean poor care on your part.  In fact, you shouldn’t feel that institutional care contributes to them either.  Sometimes, even with all the vigilance of mindfulness care, a pressure sore will happen.  If for no other reason, sores can result from the physiological aging process.  Pressure sores are treatable but can lead to death if untreated.  However, and perhaps most important, pressure ulcers can cause a huge discomfort and interfere with an elder’s routine, sacrificing quality of life.

To read Rita Dichele’s article on Senior Dental Hygiene, click here.

Rita Dichele holds Masters’ degrees in Counseling and Healthcare Administration.  Currently, she is an advanced doctoral learner at Capella University where she is writing her dissertation on successful aging.  She is also an adjunct instructor at A.T Still University in Kirksville, Missouri and teaches courses in geriatric health.  Rita resides in Shrewsbury, Massachusetts and serves as a board member on the Council on Aging and Elder Services. She is a town appointee for the Shrewsbury Cultural Council, facilitates two groups at the Shrewsbury Senior Center, and is a certified SHINE Medicare/Medicaid counselor.  Rita is also a past presenter at the 2009 American Society on Aging Conference.

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