caregivers with their elderlys at the park

Mr T. S. became wheelchair-bound in his seventies after his left leg had to be amputated due to diabetic complications. Within one week of starting to use the wheelchair, he began to complain of pain in his buttocks. His daughter, who was looking after him, initially thought that he was just unaccustomed to sitting in the wheelchair all day. But then she noticed some blood-flecked discharge on the seat of his pants. On checking, she found that a large, crater-like hole had appeared in the skin of his left buttock, exposing the raw flesh.

The long hours of sitting immobile in the wheelchair, combined with poor circulation caused by diabetes, had caused Mr S. to develop a pressure ulcer, also known as a pressure sore or bedsore. Bedsores are common among elderly patients who have reduced activity or become immobile, and they can present a serious health problem if they become infected or reach an advanced stage.

Related: Home Modifications

Keeping Patients’ Skin Healthy

A senior patient showing her surgical scars to the nurse

Preventing bedsores requires care and attention. Firstly, bedridden or wheelchair-bound patients need to move regularly to redistribute pressure on their skin and help their blood circulation. Pressure that impairs their circulation for as little as two hours can cause a bedsore. Hence, caregivers need to ensure that patients change their position frequently – at least three times when sitting and if the patient is lying down or sleeping.

Elderly patients also need extra care as the skin becomes more fragile with age. Their skin must be kept clean and dry, and if necessary, moisturising creams or lotions should be applied.

When they move around, care must be taken to prevent too much rubbing or friction on the skin. Patients who are incontinent or have trouble using the toilet should also use barrier ointment to protect the skin from being irritated by urine and other waste.

Most importantly, patients should try to lead a healthy lifestyle. Although patients with low mobility may have difficulty staying active, they should still eat a balanced diet and refrain from smoking or drinking alcohol.

Related: Skin Problems In The Elderly

Recognising the Signs

A senior man in a wheelchaire enjoying a day in the park with his caregiver

Not all patients are able to tell their caregivers when they suffer from bedsores. Others may have numbness or reduced sensation in some parts of their bodies, and hence do not know when bedsores have developed.

Caregivers should, therefore, be aware of the symptoms of bedsores. These include:

  • Redness on parts of the body that are in contact with the surface on which the patient rests, especially buttocks, heels, elbows, shoulder blades, and even the back of the head
  • Bruising and swelling in these areas
  • Rashes or dry skin
  • Cracks in the skin, scabs, or blisters

Contact areas where pressure sores can occur

Bedsores typically begin as red patches that may feel different from the surrounding skin. If not attended to, they develop into shallow wounds that may resemble blisters. The wound will continue to deepen and become crater-like, exposing subcutaneous fat. If it continues to progress, even more tissue will be lost, sometimes exposing muscle, tendon or even bone. Sometimes, acutely ill or terminally ill patients can develop bedsores in as short a time as two hours due to poor circulation and poor nutrition.

Related: End-Of-Life Care

Getting the Right Treatment

A nurse helping an elderly woman get up from her bed

While a bedsore is still in its early stages, treatment is much the same as prevention. Pressure should be kept off the wound, either by frequently changing the patient’s position or by adding more padding and cushioning to the surfaces the patient rests on. Dressings that cushion the affected part(s) of the body can also be used. The wound site should also be kept clean and dry.

If the bedsore has developed to a point where there is significant tissue loss, additional procedures may be needed. For example, the wound may have to be debrided to stimulate healing or, if the damage is severe enough to expose bone, reconstructive surgery may be needed to fill up the wound. Antibiotics may also be prescribed if the wound has become infected.

Ultimately, prevention is better than cure. The majority of bedsores develop while patients are at home, in nursing homes, or in community hospitals. Caregivers and patients alike need to be aware of the risk and play a role in maintaining their own health.

Change sleeping position every two hours


Read these next: