What Are the Risk Factors for Nursing Home Patients Developing Bed Sores?

By Nursing Home Law Center

Risk FactorA person is at risk for developing a bedsore when constant pressure to a part of the body inhibits the flow of blood. This can occur in a number of circumstances. While older patients are more susceptible, bedsores can occur in anyone.

What is a Bedsore?

A bedsore, also called a pressure sore, is known medically as a decubitus ulcer. It refers to an area of the body which develops a wound due to constantly applied pressure. This pressure cuts off the blood flow to that area, and the skin and underlying tissue begins to die. If left untreated, the area is an infection risk and can result in the death of the patient.

Bedsores are graded based on their severity. There are four categories of bedsores.

  • Stage I. At the beginning, the bedsore presents as a red area which may also be swollen. It could be hard to the touch and warmer than the rest of the body as well.
  • Stage II. The next stage sees the beginning of the break down of the skin. There may be an abrasion and possibly some blistering.
  • Stage III. The integrity of the skins has completely broken down. The underlying tissue beneath the skin is exposed and the necrosis of the skin and tissue can spread.
  • Stage IV. In the final stage, the tissue has been worn away to reveal the muscle and bone underneath. Infection is an extreme risk. A stage IV bedsore is considered life-threatening.

A pressure sore can occur anywhere in the body, but they are most likely to occur where there are few fat deposits to cushion against the pressure of a mattress or a wheelchair. High-risk areas include:

  • Back of the head
  • Ankles
  • Heels
  • Hips
  • Lower back
  • Knees
  • Spine

The principle risk factor is an inability to relieve pressure on a body part which cuts off blood flow and causes the tissue to die. Old age is a risk factor inasmuch as it increases the likelihood that a person cannot properly fend for themselves. There are three main reasons a person may not be able to shift position and relieve pressure on a body part.

  • Paralysis. A quadriplegic cannot move him or herself, and a paraplegic may have great difficulty or lack the discipline to do so.
  • Coma. A comatose patient, whether medically induced or naturally occurring, is not like a sleeping person. They will not roll over naturally in bed and thus are at risk for pressure sores.
  • Weakness. Some patients are too sick to move, or lack the energy. This is particularly true of elderly patients.

If illness or disability confines someone to a bed or wheelchair, there are further aggravating factors which can increase the risk of developing a bedsore, including:

  • Smoking. Smokers have a diminished capacity to heal. Once a bedsore starts, it is more likely to progress more quickly in a smoker than in a non-smoker. Staff caring for smokers should take extra care to prevent bedsores.
  • Diabetes. Diabetes patients also have a reduced ability to heal. In addition, they may have neuropathy and be unable to feel their extremities. This may prevent them from becoming aware of a developing bedsore.
  • Atheroma. Arterial buildup can reduce blood flow, thus exacerbating any blood flow restriction due to pressure. Even when pressure releases, the reduced flow of blood can make healing more difficult.
  • Dehydration. Dehydrated skin is more susceptible to breaking down.
  • Incontinence. Any incontinent patient is at special risk of bedsores. Wet skin is more likely to wear down, and the presence of feces increases the likelihood of infection.

The above factors, combined with a failure to properly monitor and care for a patient, increase the odds that a person will develop one or multiple bedsores. Proper vigilance is a must for any patient confined to a bed or wheelchair.

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