Bed sores (also known as pressure sores or decubitus ulcers) can occur when a person is bedridden, unconscious, unable to sense pain or immobile. Bed sores are ulcers that occur on areas of the skin that are under pressure from lying in bed, sitting in a wheelchair and/or wearing a cast for a prolonged period of time. Bed sores can be a serious problem among frail older adults. The occurrence of bed sores can be related to the quality of care the person receives. Bed sores can develop if a person is not turned, positioned correctly and provided with adequate nutrition and skin care. People with diabetes, circulation problems and malnutrition are at a higher risk.
A bed sore develops when blood supply to the skin is cut off for more than two to three hours. As the skin dies, the bed sore first starts as a red, painful area that eventually turns purple. The skin can break open and become infected if untreated. A bed sore can deepen into the muscle and bone, and it is often very slow to heal once developed. Depending on the severity of the bed sore, the person's physical condition, and the presence of other diseases (such as diabetes), bed sores can take days, months, or even years to heal. The time to heal from bed sores can range from days to years. Recovery is largely dependent on the severity of the bed sore, a person’s physical condition and the presence of other disease (such as diabetes).
Bed sores often occur in the buttocks area (on the tailbone or hips), or on the heels of the feet. The shoulder blades, the back of the head and the backs and sides of the knees are also frequent bed sore sites.
Bed sores are divided into four stages, from least severe to most severe:
- Stage 1 - The area looks red and feels warm to the touch. With darker skin, the area may have a blue or purple tint. The person may also complain of sensations: burns, pain or itching.
- Stage 2 - The affected area looks more damaged and may have an open sore, abrasion or blister. The person complains of significant pain and the skin around the wound may be discolored.
- Stage 3 - The area has a crater-like appearance due to damage below the skin's surface.
- Stage 4 - The affected area is severely damaged and a large wound is present. Muscles, tendons, bones and joints can be involved. Infection is a significant risk at this stage.
A wound is considered unstageable when there is full-thickness tissue loss and the base of the ulcer is covered by slough or eshar is identified in the wound bed. Slough my be tan, grey, green, brown or yellow in color and eschar is usually tan, brown or black.
Specific treatment of a bed sore is determined by your physician and wound care team and based on the severity of the condition. Treatment may be more difficult once the skin is broken and may include:
- Removing pressure on the affected area
- Protecting the wound with medicated gauze or other special dressings
- Keeping the wound clean
- Ensuring adequate nutrition intake
- Debriding the wound (removal of damaged, infected or dead tissue)
- Transplanting healthy skin to the wound area (skin grafts)
- Negative pressure wound therapy
- Medication (i.e., antibiotics to treat infections)
- On-going monitoring of the bed sore to document size, depth and response to treatment