If you’re facing a long period confined to a bed or a wheelchair, you run the risk of developing a bed sore, which can’t always be avoided even if you’re under the best of care. And being in a hospital or a long-term care facility increases your chances even more of developing a bed sore, also called a pressure sore or a pressure ulcer.
The consequences of a bed sore can be quite serious: Between 1990 and 2001, almost 115,000 deaths were associated with bed sores. The risk of bed sores is elevated in bedridden individuals with diabetes, peripheral vascular disease, cerebrovascular disease (such as a stroke), sepsis (blood infection), or low blood pressure.
“Prevention and timely treatment of pressure ulcers is crucial given the associated mortality and morbidity,” says Claudene George, M.D., R.Ph., assistant professor of clinical medicine, geriatrics, at Albert Einstein College of Medicine in New York. “It’s important for patients and caregivers to observe the skin for any areas of redness or skin breakdown so they can be treated promptly, and complications such as pressure ulcers and dangerous systemic infections prevented.”
Understanding bed sores
Bed sores can develop when persistent pressure on an area of your body that’s bony and without much fat padding—like an elbow—hampers blood flow in the capillaries (vessels that carry blood between the smallest arteries and veins). The lack of sufficient blood flow to the area causes the skin to die and a sore, or an ulcer, to form. Bed sores are more apt to develop on the heels, hips, elbows, ankles, shoulders, back, tailbone area and back of the head.
Bed sores initially appear as a red area on your skin that feels warm to the touch. Sometimes the area may be painful or itchy. If you’ve been immobile, let your doctor know as soon as you see or feel any of these signs so you can treat the area before it develops into a full-blown sore.
If left untreated, the wound’s damage can extend well into the skin, tissue, muscles, joints, tendons and bone. If the wound is deep enough, you can see the bone and muscles. The sore may become infected, and surrounding tissue can die. As a result, you may need to undergo hyperbaric (oxygen) therapy or surgery to remove dead tissue. In extreme cases, amputation may be necessary.
An ounce of prevention
The American College of Physicians introduced a guideline in the March 2015 edition of Annals of Internal Medicine to keep clinicians abreast of the latest evidence-based methods to prevent, assess and treat pressure sores. “Healthcare providers in clinical settings have a number of measures they take to prevent pressure ulcers in bedridden patients,” George says. “Some devices can, for example, regularly redistribute pressure or provide a supportive overlay to a mattress. But there are many ways patients who are homebound can help prevent bed sores, too.”
If you or a relative is confined to a bed or a wheelchair, try these suggestions to help prevent bed sores:
• Remove pressure from vulnerable body parts. Place pillows, foam cushions, or sheepskin under or between points of pressure, such as between your knees or ankles when you lie on your side, or under your heels when you’re on your back. Don’t place anything under your knees since that will put pressure on your heels. Instead place a pillow under the lower legs to protect your heels, or you can buy special heel protectors. Also, consider a foam, air, or gel mattress.
• Use a special foam, gel or air seat cushion. Don’t use doughnut- or ring-shaped cushions—they can restrict circulation.
• Change position often. If you’re in a wheelchair, aim for once each hour. If you’re in a bed, shift position about every two hours. Avoid making any slipping or sliding motions when moving, which can irritate skin.
• Make sure your wheelchair is the correct size. If you feel pressure anywhere or if you’ve gained weight, ask your doctor or therapist to check your wheelchair’s fit.
• Wear loose clothing. Also avoid clothes with buttons, zippers, or thick seams that can irritate your skin.
• Take care of your skin. Make sure to clean well after urination or a bowel movement. Wash your skin gently—don’t scrub—and keep it moisturized. Avoid harsh soaps and talcum powder.
• Get adequate calories and protein. Malnutrition can contribute to bed sore risk. Ask your doctor whether you need any food supplements.
• Stay hydrated. Drink 8 to 10 cups of water each day.
Learn more about How to Prevent Sepsis, What to Know About Joint Replacement, and How Often to See a Doc for Hypertension.