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Pressure Sores (Bedsores) in the Elderly

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Acute

What is Pressure Sores (Bedsores) in the Elderly ?

Pressure sores, also known as bedsores or pressure ulcers, are injuries to the skin and underlying tissue caused by prolonged pressure, often over bony areas such as the heels, sacrum, hips, or elbows. They are a common concern in elderly individuals with limited mobility or chronic illness.

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Symptoms

  • Redness or discoloration of the skin that does not fade with pressure
  • Pain or tenderness at the affected site
  • Swelling or warmth in the area
  • Blisters, open wounds, or ulcers
  • In advanced stages: deep wounds exposing fat, muscle, or bone, with signs of infection (pus, odor, fever)

Complications

  • Infections Cellulitis, bone infection (osteomyelitis), or sepsis
  • Delayed healing and chronic wounds
  • Pain and discomfort impacting quality of life
  • Increased risk of hospitalization and mortality in frail elderly

Causes

  • Continuous pressure on the skin, especially over bony prominences
  • Shear and friction from sliding in bed or a wheelchair
  • Moisture from sweat, urine, or feces causing skin breakdown
  • Poor nutrition, dehydration, or circulation problems

Prevention

  • Regular repositioning Turn bedridden patients every 2 hours; wheelchair users every 15–30 minutes
  • Use of pressure-relieving devices Cushions, mattresses, heel protectors
  • Skin care Keep skin clean and dry, apply moisturizers
  • Good nutrition and hydration to promote skin integrity and healing
  • Daily skin inspection, especially in high-risk areas

Risk factor

  • Immobility due to illness, paralysis, or sedation
  • Advanced age
  • Poor nutritional status
  • Incontinence (urine or fecal)
  • Chronic conditions like diabetes or vascular disease
  • Cognitive impairment (e.g., dementia)

Treatment

  • Wound care Cleaning, dressing, and debridement of the ulcer
  • Pressure relief Use of special mattresses and regular repositioning
  • Pain management Appropriate analgesia to reduce discomfort
  • Nutrition support High-protein, high-calorie diet with vitamins and minerals
  • Infection control Antibiotics if there is an active infection
  • Multidisciplinary team involvement
    • Geriatrician To assess risk factors, overall health, and guide management
    • Wound care nurse or dermatologist For proper wound care and staging
    • Physiotherapist To aid in mobility and prevent further ulcers
    • Dietitian To address nutritional deficiencies

How is it diagnosed?

How is it diagnosed?
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