What are Bedsores?
Many people rely on nursing homes or other long-term residential facilities to care for their elderly family members, especially when they’re ill or disabled and require increased supervision, assistance, or medical treatment.
Data from the Centers for Disease Control and Prevention (CDC) shows that in 2015, 1.3 million people resided in the 15,600 nursing homes (with 1.7 million available licensed beds) scattered throughout the United States. People trust that these establishments will adequately provide for and properly attend to their loved ones’ needs. However, underfunded facilities may be understaffed or fail to train their employees, leading to resident neglect and resulting illnesses or injuries, such as bedsores or pressure ulcers.
Bedsores, also known as pressure ulcers or pressure injuries, are open sores that can vary in severity. They may impact only the epidermis (the outer layer of the skin) or may reach down to the fat, muscles, and bones beneath. The disintegration of skin and tissues is caused by consistent pressure or shear, typically due to inadequate care and cleanliness. If left untreated, bedsores can cause serious complications, including skin, joint, and bone infections and even life-threatening conditions such as sepsis (an infection in the bloodstream). It is important that patients or residents who have mobility issues are properly positioned, rotated regularly, and provided with proper hygiene, nutrition, hydration, and treatments for underlying diseases or disorders.
However, the statistics on bedsores present a stark reality for elderly and disabled residents. The most comprehensive study done on the prevalence of bedsores in nursing homes was completed in 2004 by the CDC. It showed that nearly 11% of all nursing home residents across the United States developed pressure ulcers that year.
A 2019 study performed by Nursing Home Compare showed that the percentage of long-term residents with pressure ulcers varies by nursing home, but can reach up to 22%. These numbers indicate the need for a deeper understanding of bedsores. This article will help you understand the development of bedsores, prominent risk factors, commonly affected areas on the body, stages in severity of bedsores, effective treatments, and complication risks.
How do bedsores develop?
According to John Hopkins Medicine, bedsores occur when individuals are unable to move or have not been moved, if immobile, for long periods of time. As the individual is placed in a static position and pressure and weight are exerted onto key parts of the body, blood will decrease or cease to flow to those areas, killing cells and breaking down the skin. Alternatively, the individual may be positioned improperly, which leads to the skin pulling or rubbing to the point of injury. A lack of airflow and hygiene further accelerates tissue death and increases the risk of infection.
Bedsores can develop quickly—studies completed by the Agency for Healthcare Research and Quality indicate that they commonly occur within one week of being admitted to a hospital or within four weeks of being admitted to a long-term care home. Typical individuals in which bedsores develop include unconscious, injured, physically and mentally disabled or disordered, or elderly patients.
The individual may be bedridden, in a wheelchair, or in a cast. Under these circumstances, they rely heavily upon a caregiver or nurse to provide routine care. However, due to lack of staff, insufficient training, abuse, or neglect, the patient may not receive the necessary preventative care and treatment.
Etiology of Bedsores
It is beneficial to know the precise causes of bedsores in order to understand how nursing homes and hospitals may overlook their patients’ needs. In general, immobile patients must be rotated and repositioned on a regular basis to avoid pain, pressure, improper placement, and the various consequences that arise from these issues. According to the Agency for Healthcare Research and Quality, if these requirements are neglected, bedsores can begin to develop in 2 to 6 hours depending on the health of the patient.
As stated by the Indian Journal of Plastic Surgery, the causes of bedsores involve three main extrinsic factors: pressure, shear, and friction.
Bedsores Risk Factors
According to the Permanent Journal, along with extrinsic factors that increase the risk of developing bedsores, there are intrinsic risk factors that include age, immobility, incontinence and moisture, lack of sensory perception, malnutrition and dehydration, and certain medical conditions. When a patient is admitted to a hospital or residence home, the presence of these factors should be documented. The staff will then be responsible for attending to the corresponding needs. A patient who is at higher risk of bedsores should receive adequate care in order to prevent them from developing.
Incontinence or Moisture
Lack of Sensory Perception
Malnutrition and Dehydration
Malnutrition, and associated conditions such as anemia, can thwart healing or the ability of the body to fend off infections. Furthermore, as surmised by the U.S. National Library of Medicine, high rates of dehydration in nursing homes may correlate with the pervasiveness of bedsores because it affects blood volume and blood-oxygen levels.
Common Sites for Bedsores
Symptoms of Bedsores
Model Systems Knowledge Translation Center discloses that there are key warning signals that a bedsore is developing. As discussed, it may not be obvious to the patient as they may have a decreased or lack of sensory awareness; however, it should be clear to a medical professional when they are checking the status of a patient or resident. When a bedsore is initially developing, within the first few hours, a discolored or dark appearance to an area of the skin is typically present. It is indicative of pressure and poor blood circulation to the site. It may also feel hard and warm to the touch. At this point, the patient should be rotated into a different position or provided with pressure relief in some fashion. If the discoloration does not return to normal, a pressure ulcer has begun, and the site should be monitored and treated. For advanced bedsores, additional symptoms may include swelling, an open wound, or pus drainage, indicating a need for medical intervention and treatment.
Stages of Bedsores
If a bedsore has progressed to the secondary stage, it may now appear as a shallow open scrape or sore. There will be damage to the skin, and it may be increasingly painful.
At the third stage, a bedsore has advanced considerably, reaching through the epidermis and the dermis layers of the skin, creating a crater-like appearance.
At stage four, a bedsore has become a severe, large wound through all of the layers of the skin. Muscles, tendons, and bones may be visible. Infections are a serious risk.
There are various treatments available for bedsores. It is advantageous to recognize and intervene with bedsores at an early stage because advanced stages of bedsores carry a heightened risk for complications, require extensive treatment, and demand a lengthy healing period.
There are four main treatment options.
The wound must be thoroughly cleaned and dressed. In the event that removing contaminated and dead tissues is necessary, medical professionals or surgeons can use surgical, mechanical, enzymatic, or biological debridement. After the wound has been cleaned, a dressing will be applied in order to protect the wound and promote proper healing.
Antibiotics should be prescribed to a patient if the wound was infected. It must be accompanied by medical intervention to remove contaminated and dead tissues surrounding the wound.
In order to promote deep wound healing, negative pressure wound therapy can be applied to the area. It is particularly advantageous for pressure ulcers that have reached stage 4 in severity or for bedsores that have become infected. It involves a suction pump and a vacuum-assisted closure in order to draw fluid from a wound.
When a bedsore has developed, especially past stage 1, it can take a considerable length of time to heal properly. The healing process depends on the health of the patient, any underlying health issues and how they have been managed, the severity of the bedsore, and if there were any complications resulting from the bedsore. If a pressure ulcer is not treated in a timely manner, there may be serious health consequences. Bedsores can lead to the following conditions:
- cellulitis (skin infection)
- septic arthritis (joint infection)
- periostitis (infection of the layer over the bone)
- osteomyelitis (swelling and inflammation of the bone)
- sepsis (blood infection)
Many of these conditions can be life-threatening, demonstrating the importance of preventative care and recognizing the signs of stage 1 or stage 2 pressure ulcers.
Are Bedsores Preventable?
Based on observations made by Elizabeth A. Ayello PHD, bedsores can be largely prevented with attentive care to the patient, observation of the patient’s body and behavior, and communication with medical professionals. In a nursing home setting, nurses are the primary caregivers who observe, monitor, care for, and treat patients. It is important that patients are provided with routine repositioning, adequate nutrition and hydration, sufficient cleanliness and skincare, and accurate treatment and management of underlying health issues.
Any neglect to these duties could result in serious and severe health consequences for patients, including the development of bedsores. There is significant reason to believe that the high number of bedsore incidents in nursing homes is due to nursing home neglect or abuse. As such, nursing homes that were complicit in you or your loved one developing bedsores should be investigated and held accountable for their actions or inactions.
If you suspect that nursing home neglect led to or worsened a case of bedsores, contact a lawyer today to receive assistance with this sensitive matter.
Dr. Jacques Fontaine