Bedsore Causes

Causes of Bedsores in Nursing Homes

Quick Answer

Bedsores are usually caused by prolonged pressure on one part of the body. They are also commonly caused by shear and friction on the skin. In some cases bedsores develop due to neglect. Patients with limited mobility sometimes cannot feel when too much pressure is being put on certain part of their body, or do feel the pressure but aren’t able to readjust without assistance.

Certain risk factors can make someone more likely to develop bedsores. The main risk factor is limited mobility. Most people at risk rely on caretakers to maintain their health. Caretakers need to take special care with at-risk patients to prevent bedsores. To help avoid bedsores, caretakers should perform regular repositioning and head-to-toe skin assessments.

Cause #1: Pressure

Bedsores are commonly referred to by doctors as pressure sores or pressure ulcers. Prolonged pressure on one part of the body is the most common cause of bedsores. People with limited mobility may sit or lie in one position for long periods of time. In these cases, they may be positioned to put too much weight on one part of their body.

Anyone who spends a long time in one position is at risk of developing bedsores from pressure. Regular movement is important to prevent these sores. Even patients who are totally immobile for just a few hours are at risk of developing bedsores.

Circulation can be impeded with excessive pressure. When lying or sitting for too long, tissue is compressed between the bone and the surface of the bed, seat, or wheelchair. This causes blood flow to slow or stop, depriving the tissue of the necessary oxygen and nutrients carried in the blood.

Lack of circulation can cause skin to die within half a day. After that, the damage spreads to deeper layers of tissue. Pressure usually causes bedsores in areas that lack padding from muscle or fat.

Body parts at risk of developing bedsores from extended pressure include:

  • Spine
  • Tailbone
  • Shoulder blades
  • Hips
  • Heels
  • Elbows
  • Toes
  • Ankles

Cause #2: Shear

Shear describes the movement of two surfaces in opposite directions. On the body this could mean the skin moving in one direction and the underlying bone moving in another. This can happen when someone is being repositioned or moved from one location to another. Shearing can kink blood vessels, keeping tissue from receiving proper nutrients from the blood.

Patients who have limited mobility may need help moving from one location to another, such as from a wheelchair to a bed. The movement may help prevent bedsores from the pressure of sitting or lying down for too long. However, caretakers need to be careful when moving the patient because bedsores can also develop if skin is damaged by shear in the moving process.

Another way bedsores can develop from shear is if a patient has their head elevated in bed. The elevation may help avoid bedsores from pressure but could cause shearing. If the patient slides down on the bed, the tailbone will move down while the skin over it will stay in place. To avoid shear, elevation should be kept at 30 degrees or lower.

Cause #3: Friction

Friction occurs when skin rubs up against clothing or bedding. Residents at nursing homes are at a high risk of bedsores from friction because they are usually older. Skin can become more fragile with age, causing it to be more vulnerable to injury. Friction can harm blood vessels, inhibiting circulation.

Patients with limited mobility need to be repositioned regularly to avoid a bedsore developing from pressure. This repositioning needs to be done carefully to avoid sliding or rubbing. Even gentle readjustments can harm fragile skin.

Skin needs to be properly moisturized to stay healthy, however excess moisture can raise the risk of friction. To avoid friction from moisture, skin should be kept clean and dry. Talcum powder may be helpful to keep high friction points dry.

Sheepskin boots can help reduce friction on heels and elbow pads can be used to protect elbows. Crumbs, particles, or folds in sheets can all rub against skin. Caretakers should carefully maintain the areas that their patients stay in. Bedding and clothing may need to be changed frequently.

Bedsores Caused by Neglect

In a nursing home, it’s important that caretakers are well educated about bedsores and treat residents accordingly. Bedsores are almost always preventable. Proper care, readjustments, assessments, nutrition, and hydration are all imperative to prevent and treat bedsores.

Position changes should be done as often as possible for anyone who has difficulty moving on their own. Nursing homes should identify which patients need readjustments and take care of their needs.

Skin assessments are also important for at-risk residents. Head-to-toe checks should be done at least once a day, preferably more. During these assessments, nursing home attendants should check for any signs that bedsores are developing. Attendants performing these checks should be educated about the warning signs of bedsores.

Nursing homes should monitor residents’ skin for signs of bedsores, including:

  • Reddish or discolored skin
  • Lack of blanching (lightening of skin when pressure is put on it)
  • Blisters
  • Open wounds
  • Skin that is unusually soft or firm
  • Painful or irritated skin

Nursing homes are also responsible for feeding and hydrating their residents properly. One major risk factor for developing bedsores is improper nutrition or hydration. Fluids, vitamins, and minerals help bodies to maintain healthy skin. Healthy skin is less likely to become damaged and will protect the tissues below it from harm.

Dehydration and malnutrition are serious signs of neglect in a nursing home. Bedsores may be caused by these factors or a lack of attentiveness. Nursing homes should know the best practices for patients who lack mobility to avoid bedsores. In serious cases, nursing homes may be guilty of neglect or even nursing home abuse.

When nursing homes fail to take proper care of their residents they should be held responsible. Loved ones may need to take legal action. Do not hesitate to contact us for more information and to receive a free case evaluation.

The Nursing Home Abuse Center Team

The Nursing Home Abuse Center (NHAC) was founded to bring justice to those affected by nursing home and elder abuse. Our mission is to educate and empower victims of abuse and their families to take a stand against this unlawful mistreatment. We work to return dignity back to those who have been broken down by nursing home abuse and neglect.

Last modified: November 21, 2019

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