A recent study published in the September 2012 issue of the Journal of the American Geriatrics Society has found that seniors who are bedridden, have little physical activity who develop bedsores (pressure ulcer) have an increased rate of mortality. Although the study primarily addressed “hospital-acquired” pressure ulcers, this also applies to elderly individuals living at home.
Bedsores are the result of continuous pressure on the skin and underlying tissue. They usually form on the hips, buttocks, legs, or ankles. They can form when a person has limited ability to turn in bed or if they sit in a wheelchair for long periods of time in the same position. When the pressure between the skin and the bone becomes too great the flow of oxygen rich blood is reduced and cells begin to die.
The risk of infections developing in bedsores is increased if they are not treated immediately and effectively. Individuals that are at risk for developing bedsores and need to have preventative steps taken are those that:
- Do not have the ability to respond to pressure-related discomfort
- Are at risk for exposing the skin to moisture such as urine
- Are not physically active
- Are not able to change and control body position
- Have poor nutrition
- Have a medical condition such as diabetes, renal failure, sepsis, malnutrition, stroke, etc
A family member or caregiver must be made aware that they are a key part to bedsore prevention. To help prevent bedsores, the individual needs to change position at least every 1-2 hours. Doing wheelchair “push-ups” that lift the hips and buttocks off the seat can be helpful. A wheelchair that can tilt at different angles will also relieve pressure and restore blood flow to the affected areas. For those that are bedridden and still have upper body strength pulling up on a “trapeze bar” mounted over the bed will relieve pressure.
Once a bedsore develops the family or facility must insure that the individual is provided with appropriate nursing care and a pressure-reducing surface such as:
- Pressure reducing wheelchair cushion
- Gel overlay for the bed
- Passive low air loss mattress replacement
- Active alternating pressure mattress replacement
- Wound vac
What is chosen depends on the severity of the bedsore. If the individual is using a pressure-reducing surface and the bedsore still persists then more aggressive measures must be taken.
Brandon O’Brien, RRT
Sources:
J Am Geriatr Soc 60:1603-1608, 2012
http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2012.04106.x/abstract
