Bedsores Health Article

Definition

Bedsores, also called decubitus ulcers, pressure ulcers, or pressure sores, begin as tender, inflamed patches that develop when a person's weight rests against a hard surface, exerting pressure on the skin and soft tissue over bony parts of the body. For example, skin covering a weight-bearing part of the body, such as a knee or hip, is pressed between a bone and a bed, chair, another body part, splint, or other hard object. This is most likely to happen when the person is confined to a bed or wheelchair for long periods of time and is relatively immobile. Usually, mobile individuals, when either conscious or unconscious, will receive nerve signals from the compressed part of the body and will automatically move to relieve the pressure. Pressure sores do not usually develop in people with normal mobility and mental alertness. However, people compromised through acute illness, heavy sedation, unconsciousness, or diminished mental functioning, may not receive signals to move, and as a result of the constant pressure, tissue damage may progress to bedsores in these individuals.

Demographics

Each year, about one million people in the United States develop bedsores at a treatment cost of $1 billion. Pressure sores are most often found in elderly patients; records show that two thirds of all bedsores occur in people over age 70. People who are neurologically impaired, such as those with spinal injuries or paralysis, are also at high risk. Pressure sores have been noted as a direct cause of death in about 8% of paraplegics.

In 1992, the Federal Agency for Health Care Policy and Research reported that bedsores afflict:

• 10% of all hospital patients
• 25% of nursing home residents
• 60% of quadriplegics

Description

Bedsores range from mild inflammation to ulceration (breakdown of tissue) and deep wounds that involve muscle and bone. This painful condition usually starts with shiny red skin that quickly blisters and deteriorates into open sores. These sores become a target for bacterial contamination and will often harbor life-threatening infection. Bedsores are not contagious or cancerous, although the most serious complication of chronic bedsores is the development of malignant degeneration, which is a type of cancer.

Bedsores develop as a result of pressure that cuts off the flow of blood and oxygen to tissue. Constant pressure pinches off capillaries, the tiny blood vessels that deliver oxygen and nutrients to the skin. If the skin is deprived of essential oxygen and nutrients (a condition known as ischemia) for even as little as an hour, tissue cells can die (anoxia) and bedsores can form. Even the slightest rubbing, called shear, or friction between a hard surface and skin stretched over bones, can cause minor pressure ulcers. They can also develop when a patient stretches or bends blood vessels by slipping into a different position in a bed or chair.

Since urine, feces, or other moisture increases the risk of skin infection, people who suffer from incontinence, as well as immobility, have a greater than average risk of developing bedsores.

Unfortunately, people who have been successfully treated for bedsores have a 90% chance of developing them again. While the pressure sores themselves can usually be cured, about 60,000 deaths per year are attributed to complications caused by bedsores. They can be slow to heal, particularly when the patient's overall status may be weakened. Without proper treatment, bedsores can lead to:

• gangrene (tissue death)
• osteomyelitis (infection of the bone beneath the bedsore)
• sepsis (a poisoning of tissue or the whole body from bacterial infection)
• other localized or systemic infections that slow the healing process, increase the cost of treatment, lengthen hospital or nursing home stays, or cause death

Bedsores are most apt to develop on bony parts of the body, including:

• ankles
• back of the head
• heels
• hips
• knees
• lower back
• shoulder blades
• spine

Although impaired mobility is a leading factor in the development of pressure sores, the risk is also increased by illnesses and conditions that weaken muscle and soft tissue, or that affect blood circulation and the delivery of oxygen to body tissue, leaving skin thinner and more vulnerable to breakdown and subsequent infection. These conditions include:

• atherosclerosis (hardening of arteries) that restricts blood flow
• diabetes
• diminished sensation or lack of feeling, unable to feel pain
• heart problems
• incontinence (inability to control bladder or bowel movements)
• malnutrition
• obesity
• paralysis
• poor circulation
• infection
• prolonged bed rest, especially in unsanitary conditions or with wet or wrinkled sheets
• spinal cord injury