Bed sores, pressure sores, or pressure ulcers are all words used to describe a condition that people often think of as a small problem for a caregiver to handle if they think of it at all. However, this condition is anything but small. Complications from pressure sores can cause death. The Candid Caregiver asked Sharon Roth Maguire, M.S., R.N., a board-certified gerontological nurse practitioner, and the chief clinical quality officer at BrightStar Care®, to help us understand more about this potentially serious condition. Roth Maguire has an extensive healthcare background including more than 35 years of experience working with seniors.
The Candid Caregiver: Sharon, what is a bedsore or pressure sore? Is there a difference?
Sharon Roth Maguire: A bedsore is one type of pressure sore. It is the common non-medical term used by many people for a pressure sore that has occurred due to prolonged time in bed, lying in the same position.
TCC: What causes these sores?
SRM: Pressure sores, sometimes called pressure ulcers, are caused by pressure from an object or a firm surface compressing the tissue over a bony prominence which leads to inadequate blood flow to the tissue being compressed. Ultimately, the skin begins to weaken and will breakdown. A pressure sore may initially begin as a reddened area over a “pressure point” that does not blanche (whiten) when gently pressed on.
Over time, and without relief of the source of pressure, this reddened area will open, leading to the need for treatment of the open wound. The sources of pressure can be the bed surface, a wheelchair or chair seat, a bed pan, an overly tight or ill-fitting shoe or brace, or anything else that causes prolonged, unrelieved pressure to the skin.
Other contributing factors to the development of a pressure sore include poorly controlled moisture on the skin from incontinence, for example; overall poor health including specific conditions, such as those that compromise mobility and make movement and changing positions difficult or impossible for the individual; or poor nutrition, especially inadequate protein intake.
TCC: Why are pressures sores so serious?
SRM: Pressure sores are a serious concern as they can be much worse than what is seen on the surface, since damage to underlying tissue from the lack of blood flow may have caused more damage than what the eye can see. In addition, any break in the skin puts one at risk for infection. The risk of infection is significant, and once infected, a pressure sore can be even more difficult to heal. Infection in the open area itself can lead to a more significant infection of the surrounding tissue, known as cellulitis, and in worst-case scenarios, depending on the location of the pressure sore and the underlying condition of the patient, it can lead to even more serious infections like osteomyelitis, or even sepsis, which can be life-threatening.
The impact on quality of life should also be considered since when one has a pressure sore it can be associated with discomfort as well as a time-consuming and sometimes painful or costly treatment.
TCC: How can family caregivers prevent pressure sores from happening?
SRM: It is critical to institute a program of frequent repositioning to alter pressure points and reduce the potential damage to skin. In addition, a pressure reducing cushion or mattress overlay should be considered. Lastly, keeping your loved one well-hydrated and well-nourished is vital. Ensuring adequate protein intake is especially critical.
TCC: Does it take a nurse or other medical professional to treat pressure sores?
SRM: Once a pressure sore develops, it is very important to have someone who understands how to manage pressure sores involved in your loved one’s care, ideally a nurse who specializes in the management of wounds.
TCC: Do you think that good skincare, including prevention and/or treatment of bedsores, is something that families can monitor if their loved one is moved to a nursing home?
SRM: Regardless of where your loved one resides, it is imperative that family be tuned into overall skin condition and regularly inquire as to the status of their loved ones skin condition. Pay particular attention to the areas of the body where bedsores may develop due to lack of repositioning coupled with prolonged pressure, such as the tailbone, buttocks, hip bones, and heels.
TCC: There are some incontinence pad liners and special sheets that are being touted as helpful. Do you have any experience with these products?
SRM: Managing moisture is an important aspect in the overall approach to good skin health. Moisture that is not well-managed can put the skin at greater risk of injury including rashes, and skin breakdown. A good quality incontinence product that is changed regularly is very helpful in reducing the risk of skin breakdown.
TCC: Thank you, Sharon! You provided your expertise for our popular slideshow on medication management for seniors and have now helped us out again. We appreciate you.
Products that could prove helpful in preventing pressure sores
Researchers are working on products that can help with all types of skin issues, however pressures sores are one of the most serious conditions that need addressing. These products below may be worth investigating.
- Bedding: Ashley Wall, one of HealthCentral’s eczema writers, tells us about special sheets in the article Eczema-Friendly Bedding. This bedding, tested by the National Institutes of Health, should be helpful for maintaining healthy skin when a person must remain in bed for long periods, or as Ashley points out in her article, for someone with eczema or other issues that make skin extra sensitive.
- Incontinence: Another innovative product that could be incredibly useful is intended for those who must wear incontinence briefs. RashEndZ Inc has developed a skin-aeration liner. Founder and CEO Nigel Parker says that: “It’s (pressure sores) a serious concern for both nursing homes and hospitals. REZair ™ is a skin-aeration liner for incontinence garments that prevents and treats those rashes.” Their website says that the product is useful in all care settings and does not require a prescription or clinician when used with air sources for moisture reduction.