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Bedsores

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People who are confined to bed rest or wheelchairs — particularly seniors — are at risk of developing bedsores, a preventable condition that can turn deadly if left untreated. If your loved one is staying in an assisted living or nursing home facility, bedsores may be a sign of negligence.

Bedsores are lesions that develop after the skin and underlying tissue face prolonged pressure from contact with another object. This pressure — such as that of body weight against a bed — causes decreased blood flow to the skin at the points of contact, which may lead to the development of a sore if left unrelieved for too long. Prolonged friction, also known as shear, can also cause these injuries. Bedsores are also called:
  • Pressure sores
  • Pressure ulcers
  • Decubitus ulcers
Immobility is the biggest cause of bedsores. People who are confined to beds and wheelchairs, such as senior citizens, are the most at risk for developing these ulcers. Seniors who are victims of nursing home abuse or neglect are vulnerable. Parts of the body where skin is in close contact with the bone are the most common places bedsores develop. Bedsores affect roughly 2.5 million patients per year in the U.S. They can cost $20,000–$150,000 per ulcer to treat. In 2007, Medicare estimated each sore added $43,000 in costs to a hospital stay. Bedsores are dangerous to a person’s health and are often deadly because they can lead to skin and bone infections that are difficult to treat. For this reason, most physicians recommend a regimented preventative strategy to avoid bedsores developing. Still, about 60,000 patients die each year due to pressure sores. Families of those who suffer complications because of neglect file nursing home abuse lawsuits.

Bedsores and Nursing Home Abuse

If your immobile loved one has been placed in the care of a home nurse or residential facility like a nursing home or assisted living home, it is their responsibility to prevent bedsores from developing. However, this is often not the case, and research shows people who are admitted to nursing homes are actually more likely than others to develop bedsores. A 2010 study concluded nursing home residency “is a potent marker for pressure ulcer risk.” Its data revealed:
  • 2 percent of people admitted to the hospital from a nursing home had pressure ulcers
  • 8 percent of people admitted to the hospital from another living situation had pressure ulcers
If you placed your loved one in a nursing home and they develop a pressure ulcer, experience complications or die because of a pressure ulcer, it’s likely the caregiving facility is at fault. This is a form of nursing home abuse or negligence, and can be the result of under-staffing, under-training or several other factors. In spite of national efforts to curb nursing home abuse, it remains a problem for elderly Americans.

Diagnosing Bedsores

Before examining a patient to determine if they have bedsores, doctors often identify patients and body parts that are the most likely to develop bedsores. Combined with a thorough understanding of the stages of bedsores, physicians can develop and implement a preventative strategy or perform treatment. In general, a bedsore diagnosis involves:
  • Examining the patient’s skin to determine the size and depth of an ulcer
  • Looking for blood or fluid in the wound
  • Checking for signs of infection such as odors, discolored flesh or debris in the wound
  • Examining the surrounding tissue for signs that the sore or infection is spreading
  • Looking for other sores on the body
If a person is diagnosed positively, a doctor may order tissue cultures to determine if or what kind of infection exists.

Risk Factors

While the number one cause of bedsores is immobility, there are several factors that make a person more likely to develop bedsores. Overall, bedridden seniors are at the greatest risk for developing these ulcers. Being aware of these factors can help family members stay vigilant and help minimize the risk of developing wounds.

Inactivity

Sedentary people — even if only temporarily — are the most at risk for developing pressure ulcers. Sedentary populations include:
  • Senior citizens
  • Paralytics
  • Coma patients
  • People in a wheelchair
  • People confined to bed rest due to a pregnancy or illness
  • People confined to bed rest while recovering from surgery

Age

The older skin gets, the thinner and more fragile it becomes.  This leaves it susceptible to developing ulcers after too much pressure, or tearing due to friction. Because of this, older or frailer people are at increased risk.

Weight

People who are severely overweight or obese have an increased risk of developing bedsores if they are sedentary because a higher body weight equates to increased pressure on the skin when it’s in contact with a hard surface. Obese people with large areas of folded over skin are also at risk of developing bedsores from shear. Conversely, those who lose a significant amount of weight have decreased padding between bones and skin, making them more likely to develop bedsores if they become sedentary.

Bladder and Bowel Incontinence

Moisture increases friction between a person’s skin and clothing or sheets, which can lead to bedsores. People who cannot control their bladders are at an increased risk for this occurring. Because many bedsores develop at the base of the spine or on the buttocks, people who cannot control their bowels are often exposed to fecal bacteria. This population is likely to develop severe pressure ulcer infections.

Mental Deficiencies

People who are not mentally alert — for reasons including medication, sedation, trauma and illness — typically do not have control over their bodies. Without moving themselves, shifting regularly or acknowledging when they are in pain, these people become high-risk for developing bedsores.

Sensory Deficiencies

Similarly, people who cannot feel pain, such as those affected by paralysis, are likely to develop bedsores because they are unaware of any symptoms. Caregivers need to pay extra attention to any signs of bedsores in this population since they will not be able to voice their concerns. Sores that go untreated are more likely to progress into more serious injuries.

Decreased Blood Flow

Some people with chronic illnesses are also more likely to develop complications from bedsores than other populations. The bedsore healing process requires good blood circulation that may be compromised in people with diabetes and hardening arteries, for example.

Body Parts at Risk

The body parts that are in constant contact with a hard surface, such as a bed or wheelchair, are the most at risk for developing pressure sores. This risk is heightened in body parts that don’t have much padding between the bone and skin. This anatomy includes the:
  • Head
  • Tailbone
  • Shoulder blades
  • Hips
  • Heels
  • Elbows
  • Buttocks
  • Backs of arms
  • Backs of legs
  • Ankles
  • Knees
  • Toes
  • Rim of the ears
  • Spine

Bedsore Stages

Since 1975, scientists have defined the progression of bedsores in four stages. In 2007, the National Pressure Ulcer Advisory Panel added two new stages to the list after more than five years of research on deep tissue injury. All of the descriptions depict the characteristics of the sores during varying stages of severity.

Stage I: Non-Blanchable Erythema

The skin, usually over a bony area, is intact. In patients with lighter skin tones, the area may be red. For patients with darker skin tones, the area may simply be a different color compared to surrounding skin. It does not lighten (blanch) when touched. Symptoms vary, but are identifiable if the affected area is different from surrounding skin. For example, if the red area is soft or firm, or warm or cool compared to surrounding skin, it may be an early sign of bedsores. Typically, the area is tender or painful for the patient.

Stage II: Partial Thickness

The skin in the affected area is broken, damaged or lost. The ulcer is shallow and may appear similar to a blister. The area will be pink or red. There is no yellow, brown or black tissue, scabs or bruising present.

Stage III: Full Thickness Skin Loss

Any remaining skin in the affected area has deteriorated. The ulcer is deeper, although the depth of the wound varies based on the location of the ulcer. A layer of fat is exposed. Yellow, brown or black tissue or scabs may have developed.

Stage IV: Full Thickness Tissue Loss

The sore has deepened further and now exposes bone, muscle or tendon. Yellow, brown or black tissue or scabs may be present. Tunneling (when an opening underneath the skin is formed) may also occur, which could lead to more tissue damage.

Unstageable Full Thickness or Tissue Loss

The ulcer has deepened past Stage I and II, but physicians cannot determine whether the patient is in Stage III or IV because the wound is covered with yellow, brown or black tissue or scabs. To determine the depth of the wound and assess its phase, the doctor must remove the obstructions. The only exception is in the case of dry and intact scabs that exist without redness, which should not be removed because they serve as the body’s natural cover of a wound.

Suspected Deep Tissue Injury

The skin is intact but is a deep purple or maroon color, or a blood-filled blister may exist, which suggests damage of underlying tissue. The area may feel firm or mushy compared to surrounding skin, and will feel painful to the patient. Deep tissue injury can be difficult to detect in patients with darker skin tones.

Complications

If a person’s bedsores reach the advance stages, they are likely to experience one or more complication, including various forms of infection and even cancer. While bedsores are a terrible affliction, complications from the wounds are more difficult to treat and may even be fatal.

Infection

Infection can delay the healing of a bedsore and can easily spread to other parts of the body in the meantime. A sore may be infected if it has a bad smell, has pus in it, is red or warm around the sore, or is swollen. If the infection is left unchecked, it can be fatal. Several different kinds of infection can occur:
  • Cellulitis – An infection of the skin and surrounding tissue.
  • Bone and Joint Infections – Joint infections impact tissue and cartilage. Bone infections can reduce joint and limb functions.
  • Blood Poisoning – An infection spread through the blood stream, also known as septicemia and sepsis.
  • Necrotising Fasciitis – Also known as flesh-eating bacteria.
  • Gas Gangrene – A rare infection that often requires amputation to treat.

Cancer

If left untreated, bedsores can also lead to the development of squamous cell carcinoma, a type of cancer.  This type of skin cancer develops in non-healing wounds. Squamous cell carcinoma is an aggressive disease that typically requires surgery.

Treatment

Treating bedsores varies based on the stage of the ulcer. Stage I sores, and possibly mild stage II sores, can be treated with preventative strategies. More serious sores may require medication, surgery and other methods to treat. Treatment may also require addressing certain risk factors, such as incontinence, if they can be directly identified as the sole cause of the sores. Some treatments include:
  • Dressing the Wounds – Dressings prevent infection, keep wounds clean and are often a way to administer topical antibiotics.
  • Removing Damaged Tissue – Also called debridement. This process involves removing any debris and dead tissue from the sore. Debridement can be accomplished several ways, including using chemical enzymes, pressurized irrigation or surgery.
  • Medication – Most infected bedsores cannot heal without antibiotics, which may be topical creams or pills taken orally.
  • Surgery – In some cases, the best way to treat a bedsore is surgically. Typically this surgery involves relocating a portion of the patient’s muscle and skin to pad the affected bone and cover the open wound.

Prevention

Because bedsores can develop quickly and can be difficult to treat, preventing their development is key. It can be difficult to prevent sores when trusting the care of a loved one to others. Family members should visit the nursing home frequently and pay attention to any changes in the patient's behavior, cleanliness and general demeanor. Residents who have frequent family visits are more likely to receive the care they need from nursing staff. There are a few simple precautions family members and caregivers can take.

Repositioning

Immobility is the main cause of many bedsores and moving and repositioning the body is a way to prevent their development. Repositioning includes:
  • Regularly turning bedridden patients
  • Regularly repositioning those in a wheelchair
  • Using special cushions and mattresses filled with gel, air or water
  • Using an adjustable bed so its user can lie or sleep at various angles
  • Using a specialty wheelchair so its user can sit at various angles

Skin care

Patients at risk for developing bedsores should take extra care of their skin. Some tips include:
  • Drinking plenty of water to ensure the skin is hydrated and doesn’t crack
  • Use baby powder to keep excessively wet skin dry and reduce friction
  • Bladder and bowel incontinence patients require special attention. It’s especially important to keep the skin clean, dry and free of bacteria
  • Keep existing bedsores clean by using a mild soap and warm water. Pay dry the area with a clean towel

Inspection

Nurses, caregivers and doctors should regularly inspect the skin of a person who is at risk of developing bedsores. If caught in the early stages, the advances of these ulcers can be reversed and the patient can be spared a painful and potentially life-threatening endeavor.

Studies and Research

The alarming trend of bedsores has caught the attention of many researchers and scientists in recent years. Despite efforts to stop these sores from occurring, they continue to be a problem for Americans in assisted living facilities and nursing homes. One of the most comprehensive studies of bedsores — the 2004 National Nursing Home Survey — revealed some startling statistics, including:
  • 11 percent of nursing home residents had bedsores
  • Stage II sores were the most common
  • People 64 years old and younger were more likely to have ulcers than older patients
  • The longer a person’s stay in a nursing home, the more likely they were to have an ulcer
  • 1 in 5 residents who had a recent weight loss developed ulcers
  • 35 percent of the bedsore patients affect with Stage II sores or higher received special wound care
Another study examined the financial costs of treating a Stage IV bedsore. Of the 19 patients they examined, 11 developed pressure ulcers during a hospital stay, and eight had community-acquired ulcers.
Average Treatment Cost Number of Admissions to Treat
Hospital-Acquired $129,248 1
Community-Acquired $124,327 4
In a 2011 study, scientists learned it’s 50 times more expensive to treat a bedsore than to prevent one.
Intervention Daily Prevention Cost (2009 Dollars) Daily Treatment Cost for Stage I/II (2009 Dollars)
Risk Assessment 2.50 2.55
Support Surfaces 0.69 148.56
Chair Cushion 0.17 0.17
Nutrition 1.10 1.10
Repositioning 12.02 12.27
Moisture/Incontinence 27.10 114.34
Topical Antibiotics - 15.40
Inpatient Costs - 1,922.04
Unforeseen Costs 11.09 544.11
Total Cost 54.66 2,770.54

Resources for Patients and Their Families

Bedsores are painful, endanger a person’s health, are costly to treat and emotionally taxing on the person affected and their loved ones. They are typically the result of nursing home abuse. But how do you know if your loved one was abused?
  • Browse the National Center on Elder Abuse website. This government organization is tasked with educating and preventing elder abuse. Its resources may help you determine if your loved one was abused, and guide you on next steps.
  • Read through resources from the U.S. Senate Special Committee on Aging. These resources have been vetted by the U.S. government and are a good starting point.
  • Report the abuse. You may do this by dialing 911, or contacting the National Adult Protective Services Association for help.
  • Research nursing homes before placing your loved one there. gov is home to the “Nursing Home Compare” feature, a database of all government collected information on Medicare- or Medicaid-certified nursing homes.
  • Read the Federal Nursing Home Reform Act. Passed in 1987, this legislation outlines a nursing home resident’s rights. If any of these rules have been violated, you may have grounds to sue.
  • Call an attorney. Many attorneys specialize in nursing home abuse and bedsore cases, and can help you determine whether your family can be awarded compensation for your pain and suffering.

Lawsuits

When bedsores develop, despite being easily preventable, it’s not uncommon for family members to sue on behalf of their loved one’s pain and suffering. These lawsuits can take time and may be emotionally difficult for family, especially if they are suing on behalf of a deceased family member, but can often result in significant payouts ranging from tens of thousands to millions of dollars. Research shows there are more than 17,000 bedsore lawsuits filed annually, second only to wrongful death suits.