Bed Sores (pressure Ulcers)

What Are Bed Sores (pressure Ulcers)? What Causes Bed Sores?

Bed sores, also known as pressure ulcers, pressure sores or decubitus ulcers are skin lesions which can be caused by friction, humidity, temperature, continence, medication, shearing forces, age and unrelieved pressure. Any part of the body may be affected; bony or cartilaginous areas, such as the elbows, knees, ankles and sacrum are most commonly affected. The sacrum is a triangular bone at the base of the spine and the upper and back part of the pelvic cavity (like a wedge between the two hip bones).

If discovered early, bed sores are treatable. However, they may sometimes be fatal. According to health authorities in the UK and USA, bed sores are the second iatrogenic cause of death, after adverse drug reactions. Iatrogenic cause of death means unexpected death caused by medical treatment - death caused by the action of a physician or a therapy the doctor prescribed.

In the 1950s, Doreen Norton (1922-2007), a British nurse, used research to demonstrate that the best treatment and prevention of bedsores was removing the pressure by turning the patient every two hours. Norton is seen as instrumental in changing nursing practices to effectively treat pressure ulcers, which was a major killer of hospital patients.
According to Medilexicon's medical dictionary:

A decubitus ulcer is "a chronic ulcer that appears in pressure areas of skin overlying a bony prominence in debilitated patients confined to bed or otherwise immobilized, due to a circulatory defect." An acute decubitus ulcer is " a severe form of bedsore, of neurotrophic origin, occurring in hemiplegia or paraplegia." (Hemiplegia = paralysis on one side of the body. Paraplegia = paralysis of the lower part of the body, including limbs.

Pressure ulcers (bed sores) develop when the skin and the tissue below it becomes damaged. In severe cases the muscle and the bone may be damaged too. Pressure ulcers are much more common among patients who are unable to move because of paralysis, illness or old age. Sustained pressure can cut off circulation to vulnerable parts of the body, especially the skin of the buttocks, hips and heels - the affected tissue dies if it does not receive an adequate flow of blood.

According to the National Health Service (NHS), UK, it is estimated that between 4% and 10% of all hospitalized patients develop at least one pressure ulcer. Up to 70% of UK elderly patients with mobility problems develop bed sores.

Experts say that even with excellent medical and nursing care, bed sores can be hard to prevent, especially among vulnerable patients. Anyone, not only those living with paralysis, can develop bed sores - any person who cannot change position without help can develop bedsores. The bedsores can develop and progress rapidly and are frequently difficult to heal. Doctors say that with proper preventive measures the skin's integrity can more easily be maintained, resulting in better healing of bedsores.

What are the risk factors for bed sores?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

• Patients who are immobilized because of injury, acute illness or sedation. Their immobile state does not have to occur for long for bed sores to develop.
• Individuals with long-term spinal cord injuries. Because the nerve damage is often permanent, compression of the skin and some tissues is constant; damaged or atrophied skin as well as poor circulation increases the risk of damage and lowers the chances of proper healing. Patients with long-term spinal cord injuries also have reduced sensation, so they often do not receive the body signals (pain, discomfort, etc) which would make them automatically change positions - i.e. patients do not feel a developing bed sore and lie on it, resulting in a rapidly-developing sore.

Patients who cannot move specific parts of their body unaided may have a greater risk of developing pressure ulcers if:

• They are elderly - elderly people have thinner skin, which is more vulnerable to damage from minor pressure. If a very elderly individual is underweight (often the case), there will be less padding around their bones. Another common problem among very elderly patients is poor nutrition, which may affect skin and blood vessel quality, resulting in less effective healing.
  
  Experts say that even if a very elderly patient eats properly and enjoys good overall health, healing is much slower when compared to younger people.
• The patient resides in a nursing home - the incidence of bed sores in nursing homes is significantly higher than in hospital or at home (very elderly cared for at home). This could be due partly to the fact that those in nursing homes tend to be especially frail.
• Is in a coma - hospitalized patients who are in a coma are especially vulnerable to bed sores. The reasons are obvious; they cannot move unaided and do not respond to or acknowledge pain like other people do.
• Is not perceiving pain - some diseases, as well as most spinal cord injuries, can reduce or eliminate the patient's sensation of pain. Somebody who does not feel pain does not take steps to relieve it, such as changing position or asking somebody to move him/her, and also may not know that a pressure ulcer is developing.
• Loses weight in hospital - people who are hospitalized often lose weight because of their condition, especially if they are unable to move. The loss of fat and muscle leaves the bones more exposed to damage.
• Is not eating properly - patients who are not eating properly, especially those whose diets are poor in protein, vitamin C and zinc have a higher risk of developing bed sores.Learn More....