Pressure ulcers (also called bedsores) are common in older people who live immobilized or bedridden in assisted-living care. They are caused by unrelieved pressure on an area of the body, typically the back, buttocks, or hips. Pressure ulcers can provoke infections, sepsis, and loss of muscle. If left untreated, even the slightest pressure ulcer can develop into a critical and sometimes fatal condition.
Sitting in a chair or lying in bed for long periods can decrease the flow of blood to the skin, which can cause the skin tissue to deteriorate and eventually die. The erosion of necrotic tissue from the area can form a hole in the skin. The ulcer becomes vulnerable to bacteria, allowing infection to destroy healthy tissue while infecting the bones and blood.
The good news is that bedsores can be easier to prevent than they are to heal. Below, we discuss five ways to prevent pressure ulcers in assisted-living facilities.
1. Individually-Tailored Movement
When a person is immobilized or bedridden, facilities tend to have a one-size-fits-all approach to caring for pressure ulcers. One standard policy is to move and reposition all patients every two hours to prevent pressure from building up on the skin. However, evidence shows that the need to do that is dependent on the patient’s tissue tolerance. A two-hour turning may not necessarily be effective for all immobile patients. Therefore, creating a turning and positioning schedule that coincides with the patient’s unique risk factors is critical to preventing bedsores from occurring.
Moreover, studies indicate that exercise, ambulation, and range of motion exercises that promote circulation help prevent the formation of pressure sores. Pressure sores can also develop on the tailbone, hip, shoulders, or heels from prolonged sitting in a wheelchair. So, variety in movement is vital, and seniors should have recliners or other more-cushioned chairs to sit in as well.
2. Cleanliness and Proper Nutrition
Incontinence is one of the most significant factors associated with the development of pressure sores. When bowel movement or urine stays in contact with the skin, acids and enzymes begin to cause excoriation and degradation of the skin faster than usual. When combined with limited ability to reposition oneself, a senior may develop a pressure ulcer in the perineal area more quickly.
Keeping the body clean and dry, particularly the folds of the skin, becomes paramount to preventing bedsores. When drying patients, nursing staff should gently pat the skin dry and not rub vigorously as the friction can damage the skin.
The patient, along with their bedding, should be changed right away if they become wet. If a patient lies in urine or feces for even a few minutes, the risk of a pressure ulcer rises significantly. If an area appears to become reddened, it may be a sign of a stage I pressure sore. When this occurs, it is best to proceed with appropriate treatment, such as the use of barrier cream to help prevent further excoriation due to bodily substances.
Also, a well-balanced, healthy diet with plenty of hydration will enhance patients’ circulatory systems. Undernutrition, malnutrition, and insufficient fluid intake can weaken the skin even more.
3. Catch for Pressure Ulcers Early
Pressure ulcers can develop in as little as a few hours. Therefore, patients should be checked frequently for signs of evolving bedsores.
Preventing pressure ulcers requires intensive care and constant vigilance. Patients should be inspected daily by assisted-living caregivers. Caregivers can administer and document checks when performing perineal care, providing showers, or during other assessments of skin integrity.
The first stage of a bedsore is a red spot, which feels hard and causes discomfort for the patient when touched. If caught early, bedsores can be treated by keeping the patient off the area and applying medicated cream.
4. Use Specialty Bedding or Materials to Reduce Pressure
Depending on the needs of each senior, specialty beds, such as water or air mattress toppers, or cushioned padding, such as heel protectors, may be needed to reduce the amount of pressure placed on sensitive areas of the body. These additional materials should not be limited to mattresses or footwear modifications. All options should be kept open for what may and may not be the most comfortable and beneficial to the needs of elderly patients.
For example, a memory foam pillow may be a great idea but becomes ineffective if always placed in the same position. Soft, pillow-like wedges help seniors remain on their sides while lying in bed between repositioning times.
Some newer beds may come with automatic turning functions. However, these systems do not completely reposition a person. As a result, it is best to use these systems in conjunction with manually repositioning a person.
Maintaining the lowest possible head elevation reduces the impact of shearing. Caregivers should position the patient to minimize pressure over bony prominences and shearing forces over the heels and elbows, base of the head, and ears. It’s best to implement appropriate offloading or pressure-redistribution devices, as well.
5. Use a Team Approach
Many issues—from comorbidities to nutritional factors—can play a role in the formation of pressure ulcers or can impede their healing. Staffing an interdisciplinary wound care team can help ensure the implementation of a consistent, appropriate management process for ulcer prevention and optimal treatment based on scientific protocols.
Such a team may include a designated wound care nurse, a nurse assistant, a dietitian, a physical or occupational therapist, a nurse practitioner, and a team member specially trained in wound care.