By Nursing Home Law Center
As with many aspects of medicine, an individuals propensity to develop a medical complication– such as a a bed sore, is dependent on a number of factors that are unique to the individual and the type of medical care they receive. Nonetheless evidence suggests, that individuals who remain in one position (such as lying in bed or during an extended surgery) for several hours are at risk for developing bed sores. The unrelieved pressure on the body results in changes to the underlying tissue and skin. The physiological changes to the skin and tissue form the basis for developing a bed sore (also known as: pressure sore, pressure ulcer or decubitus ulcer).
The real determination for for how rapidly a bed sore may develop is dependent upon factors such as:
The type of surface a patient is lying on: Harder surfaces result in more pressure being put directly on the body. As unrelieved pressure is the major reason why bed sores form, the type of mattress, wheel chair or operative table is important.
Age: If you are over 70, you are at an increased risk for development of bedsores. Older adults tend to have thinner skin than their younger peers, making them more susceptible to damage from minor pressure. Older people also more likely to be underweight and have less natural cushioning over their bones. Even with optimum nutrition and good overall health, wounds tend to heal slower as you age, because the repair rate of your cells declines.
Lack of Pain Perception: Loss of sensation is usually due to spinal cord injuries or disease. An inability to feel pain means you’re not aware when you’re uncomfortable and need to change your position or that a bedsore is forming.
Malnutrition / Dehydration: You often lose weight when you’re sick or hospitalized, and muscle atrophy and wasting are common in people living with paralysis. In either case, you lose fat and muscle that help cushion your bones. Some experts say the best way to prevent skin breakdown is to have at least 2 inches of muscle over bony areas.
Urinary or Fecal Incontinence: Problems with bladder control can greatly increase your risk of pressure sores because your skin stays moist, making it more likely to break down. The caustic nature of urine and feces also contributes to the rate of skin breakdown. When incontinent patients are left in their own feces, bacteria can enter the wounds causing serious local infections and life-threatening systemic complications such as sepsis, gangrene, osteomyelitis and necrotizing fasciitis, a severe and rapidly spreading infection.
Diabetes / Vascular Disease: Because certain health problems such as diabetes and vascular disease affect circulation, parts of your body may not receive adequate blood flow, increasing your risk of tissue damage. And if you have muscle spasms (spastic paralysis) or contracted joints, you’re subject to repeated trauma from friction and shear forces.
Smoking: Smokers have a higher incidence of pressure sores than nonsmokers do. They also tend to develop more severe wounds and to heal more slowly, mainly because nicotine impairs circulation and reduces the amount of oxygen in your blood. The risk increases with the number of years and cigarettes smoked.
Certainly, medical facilities such as: nursing homes, hospitals and long-term care facilities should be mindful of how rapidly a bed sore may form in some patients and implement preventative measures such as extra cushioning and turning patients to prevent the formation of bed sores.
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