Pressure Sores:

How to Assess and Prevent Pressure Sores for Geriatric Patients

Sponsored by: Mason Medical

• By Joseph Duffy
• Jul 01, 2010

Pressure sores (also called bedsores or pressure ulcers) are localized injuries to the skin and underlying tissue, usually over a bony prominence, which result from pressure, or pressure in combination with shear or friction.

Pressure sores are characterized in six staging categories: Suspected Deep Tissue Injury, Stage I, Stage II, Stage III, Stage IV and Unstageable. Pressure sores that are left untreated can be life threatening.

When it comes to the elderly, pressure sores become more prominent. According to Luciano Sbuttoni, director of wound care at New York Home Health Care, 50 percent of pressure ulcers occur to individuals 70 and older. Typical age range is 65 and older. Also, studies have found that as many as one in four nursing home patients experience pressure sores and the cost of treating them is more than $1.3 billion annually, says the Agency for Healthcare Research and Quality.

“Generally a pressure ulcer develops due to an individual’s lack of movement,” says Sbuttoni. “The geriatric population slows down; therefore, the prevalence is greater with a geriatric individual.”

Here is what you need to know about assessing and preventing pressure sores for geriatric patients.

Risk factors and assessment

Older patients have thinner skin, which makes them more susceptible to damage from even minor pressure. Sbuttonisays that pressure sores in geriatric patients are more likely to occur if patients:

• Are bedridden or in a wheelchair
• Have fragile skin
• Have a chronic condition, such as diabetes or vascular disease, which prevents areas of the body from receiving proper blood flow
• Can’t move certain parts of their body without assistance, such as after spinal or brain injury or if they have a neuromuscular disease like multiple sclerosis
• Are malnourished
• Suffer from a mental disability such as Alzheimer's disease
• Are 70 or older
• Have urinary or bowel incontinence

“Pressure ulcers are assessed by a staging process that involve measuring the ulcer’s size and depth and a detailed description of the wound’s characteristics, such as color, odor and drainage,” says Sbuttoni.

Prevention

Sbuttonioffers the following key steps in pressure sore prevention for geriatric patients:

• Take care of the skin. The skin should be inspected daily. Pay close attention to any reddened areas that remain after changing positions and the pressure has been relieved. The patient’s skin should be cleaned as soon as it has been soiled. A soft cloth or sponge should be used to reduce injury to skin.
• Prevent dry skin by using creams or oils and avoid cold or dry air.
• Minimize moisture from urine or stool, perspiration, or wound drainage. When moisture cannot be controlled, use:
• Pads or briefs that absorb urine and have a quick drying surface that keeps moisture away from the skin.
• A cream or ointment to protect skin from urine, stool or drainage.
• Protect the skin from injury. Avoid massaging the skin over bony parts of the body. Massage may squeeze and damage the tissue under the skin and make it more likely to get pressure sores.
• Limit pressure over bony parts by having the patient change positions or have the caregiver change the patient’s position.
• If patient is in bed, his or her position should be changed at least every two hours.
• If patient is in a chair, his or her position should be changed at least every hour.
• Reduce friction (rubbing) by making sure the patients is lifted, rather than dragged, during repositioning. Friction can rub off the top layer of skin and damage blood vessels under the skin.
• Avoid the use of donut-shaped (ring) cushions. Donut-shaped cushions can increase a patient’s risk of getting a pressure sore by reducing blood flow and causing tissue to swell.
• Have the patient eat a balanced diet. Protein and calories are very important. Healthy skin is less likely to be damaged.
• Improve the patient’s ability to move. A rehab program can help regain movement and independence.

“Find a qualified caregiver who is capable of providing the proper round-the-clock care for the patient,” says Sbuttoni. “And find a qualified equipment company that specializes in wound care and has a full line of products that can be used for prevention and healing pressure ulcers.”

This article originally appeared in the July 2010 issue of HME Business.