Preventing and Treating Bedsores of the Bed-bound

Image for bed sore article As we age, our risk of experiencing an illness or injury that will leave us bed-bound for long periods of time increases. If we're lucky enough to escape that fate, we are likely to care for someone else who may be confined in either a lying or sitting position for extended periods of time. Prolonged sitting or lying down may lead to bedsores, also known as pressure sores, pressure ulcers, or decubitus ulcers.

How Bedsores Form

Bedsores are areas of injured skin caused by sitting or lying in one position for too long. This happens because when you sit or lie in one position for too long, your body weight is distributed to specific areas of your body called pressure points. These pressure points will vary depending on whether you are bed-bound or wheelchair-bound. For example, bedsores are more likely to develop on the lower back in people who are lying down, and on the pelvic bone of people who are sitting. Over time, an increase in pressure to these areas, combined with a decrease in blood supply to the skin, may result in bedsores.

Bedsores usually begin as a slight discoloration. If the pressure is not relieved, they may worsen into actual sores. These sores can vary from minor (called stage I) wounds to deep wounds (called stage IV wounds), which affect all layers of the skin as well as the muscle and bone. If these sores are not treated, they may become infected and later lead to sepsis (a systemic infection) that may be severe enough to cause death. Every year thousands of Americans die from complications of pressure ulcers. Therefore, the best way to treat bedsores is to try to prevent them from occurring in the first place.

How to Prevent Bedsores Change Positions Often Pressure relief is the most important factor in preventing pressure sores. Turn or reposition someone who is bed-bound at least every two hours. This is best done successively, from the back, to the left side, to the right side, and then to the back again. If they are able to do it themselves, people who are wheelchair-bound should shift their position every 15 minutes. If they are not able to do this themselves, they should be turned at least every hour. People in wheelchairs should turn or be turned more frequently because there is greater pressure exerted in one concentrated area (the pelvic bone). Use Padding and Special Equipment Cushions or foam wedges used in a wheelchair or while lying in bed can help distribute weight and pressure on the skin more evenly. Your doctor can prescribe special cushions customized to reduce pressure to the skin. There are also special air mattresses that can redistribute weight off pressure points. Keep Skin Clean and Dry Moisture can promote skin breakdown, so if your loved one is incontinent , be sure to seek treatment quickly. If treatment fails or is not an option, make sure your loved ones undergarments are changed often and that the affected skin is thoroughly cleaned and dried.
Improve Nutrition Eating can sometimes be a challenge for people who are ill and immobile, in part because they may be unable to care for themselves and are likely to have poor appetites. Nonetheless, since impaired nutritional intake is an identified risk factor for developing bedsores, it is important they get the nutrition they need to maintain skin integrity. Older adults with missing teeth or swallowing problems may need a change in diet to improve their food intake. In some cases, a chopped or pureed diet may be needed to help them eat. To allow a person with poor intake to eat better, a doctor may remove certain dietary restrictions. For example, if a person is normally supposed to follow a low-sodium diet, their doctor may allow them to eat foods that are typically not allowed on a low-sodium diet as a means of improving their food intake. Another strategy for increasing dietary intake may be adding a dietary supplement drink. There are many different products to choose from and most provide extra calories and protein along with vitamins and minerals. (If dietary restrictions are necessary, consult a doctor and/or registered dietitian to help identify which supplement would be appropriate.)
In addition, vitamins and minerals such as vitamin C and zinc are important for skin health. Taking a daily multivitamin with minerals may be beneficial as it can offer nutrients missing from an inadequate diet. Quit Smoking Smokers have higher incidence of pressure ulcers. Also, smoking delays wound healing. What to Do If Bedsores Develop Seek Medical Help as Soon as Bedsores Develop If bedsores develop, your doctor may prescribe special wound dressings and medications to help bedsores heal and keep them from becoming infected. In addition, your doctor can tell you how best to relieve pressure with positioning and special padded equipment. Also, hydrotherapy (use of whirlpools) may assist in wound healing by removing dead tissue. Severe bedsores may require surgical treatment. Continue to Improve Nutrition Nutrition is even more crucial for would healing than it is for maintaining normal skin integrity. Healing wounds require additional calories and protein. Specifically, supplements containing the amino acids (protein building blocks) arginine and glutamine may be recommended by a doctor because they have been shown to be beneficial for wound healing. In addition, increased amounts of certain vitamins such as vitamin C, vitamin A, and zinc may help promote wound healing.
RESOURCES: American Academy of Family Physicians National Institutes of Health References: Berlowitz DR, Wilking SV. Risk factors for pressure sores. A comparison of cross-sectional and cohort-derived data. J Am Geriatr Soc . 1989;37(11):1043-1050. Breslow RA, Hallfrisch J, Guy DG, et al. The importance of dietary protein in healing pressure ulcers. J Am Geriatr Soc . 1993;41(4):357-362. Garcia AD, Thomas DR. Assessment and management of chronic pressure ulcers in the elderly (review). Med Clin North Am . 2006 Sep;90(5):925-44. . JAMA Patient Page: Skin conditions: pressure ulcers. The Journal of the American Medical Association website. Available at: . Accessed October 14, 2003. MacKay D, Miller AL. Nutritional support for wound healing. Alternative Medicine Review . 2003;8(4):359-377. Viehbeck M, McGlynn J, Harris S. Pressure ulcers and wound healing: educating the spinal cord injured individual on the effects of cigarette smoking. SCI Nurs . 1995 Aug;12(3):73-6.
Last reviewed November 2006 by Marcin Chwistek, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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