The real determination for for how rapidly a bed sore may develop is dependent upon factors such as:

• The type of surface a patient is lying on: Harder surfaces result in more pressure being put directly on the body.  As unrelieved pressure is the major reason why bed sores form, the type of mattress, wheel chair or operative table is important.

• Age: If you are over 70, you are at an increased risk for development of bedsores. Older adults tend to have thinner skin than their younger peers, making them more susceptible to damage from minor pressure. Older people also more likely to be underweight and have less natural cushioning over their bones. Even with optimum nutrition and good overall health, wounds tend to heal slower as you age, because the repair rate of your cells declines.

• Lack of Pain Perception: Loss of sensation is usually due to spinal cord injuries or disease. An inability to feel pain means you’re not aware when you’re uncomfortable and need to change your position or that a bedsore is forming.

• Malnutrition / Dehydration: You often lose weight when you’re sick or hospitalized, and muscle atrophy and wasting are common in people living with paralysis. In either case, you lose fat and muscle that help cushion your bones. Some experts say the best way to prevent skin breakdown is to have at least 2 inches of muscle over bony areas.

• Urinary or fecal incontinence: Problems with bladder control can greatly increase your risk of pressure sores because your skin stays moist, making it more likely to break down. The caustic nature of urine and feces also contributes to the rate of skin breakdown. When incontinent patients are left in their own feces, bacteria can enter the wounds causing serious local infections and life-threatening systemic complications such as sepsis, gangrene, osteomyelitis and necrotizing fasciitis, a severe and rapidly spreading infection.

• Diabetes /Vascular Disease: Because certain health problems such as diabetes and vascular disease affect circulation, parts of your body may not receive adequate blood flow, increasing your risk of tissue damage. And if you have muscle spasms (spastic paralysis) or contracted joints, you’re subject to repeated trauma from friction and shear forces.

• Smoking: Smokers have a higher incidence of pressure sores than nonsmokers do. They also tend to develop more severe wounds and to heal more slowly, mainly because nicotine impairs circulation and reduces the amount of oxygen in your blood. The risk increases with the number of years and cigarettes smoked.

Certainly, medical facilities such as: nursing homes, hospitals and long-term care facilities should be mindful of how rapidly a bed sore may form in some patients and implement preventative measures such as extra cushioning and turning patients to prevent the formation of bed sores.

Resource:

How Much Time Does it Take to Get a Pressure Ulcer? Integrated Evidence from Human, Animal, and In Vitro Studies, Ostomy Wound Management, Amit Gefen PhD

• Unrelieved pressure on the body
• Malnutrition
• Dehydration
• Staff failing to keep patients clean and dry

However, many relatively healthy and young people who enter skilled nursing facilities or designated rehab centers develop bed sores due an injury which may immobilize them and keep them confined to a bed or wheelchair for extended periods.  Staff in rehab facilities must be aware that rehab patients are indeed at risk for developing bed sores and should be diligent with their preventional programs.

Similarly, staff in rehab facilities must be aware that even relatively young patients are at an increased risk for developing bed sores particularly when they are immobilized from medical conditions such:

• Joint replacements
• Hip fractures
• Pelvis fractures
• Leg fractures
• Paralysis
• Coma

Related:

Lawsuit Claims That Nursing Home’s Negligence Resulted In Patient’s Decubitus Ulcers

In For Rehab. Out With Bedsores.

A venous skin ulcer (also known as a stasis leg ulcer) is a small wound that occurs when the veins in the legs do not properly return blood back toward the heart.  Venous skin ulcers usually develop on the sides of the lower leg, above the above the ankle and below the calf.

Venous insufficiency occurs when the valves that prevent blood from flowing the wrong way become damaged, allowing blood to flow backward and collect in the leg veins instead of flowing normally toward the heart.  This pooling of blood can cause the tissue to breakdown, forming an ulcer.

Causes of venous insufficiency include long-term high blood pressure inside leg veins and blood clots in leg veins (deep vein thrombosis or phlebitis).  Symptoms of venous insufficiency include swollen ankles, tight calves and aching in the legs.  These symptoms may be relieved by wearing compression stockings, elevating the legs, and avoiding standing for long periods of time.

There are certain risk factors for venous insufficiency and venous skin ulcers.  These include deep vein thrombosis (blood clot forms in the deep veins of the legs), obesity, pregnancy, family history of varicose veins, and lack of physical activity.  Nursing home patients may be at increased risk for venous skin ulcers because of little or no physical activity, poor blood circulation, and lying with legs below heart level.

A venous skin ulcer can be identified by the darkening of the skin (dark red or purple) where the ulcer is forming.  If left untreated, an ulcer can form, which can become infected.  A doctor should be notified immediately upon the first signs of a venous skin ulcer (darkening of skin) in order to prevent an ulcer from forming.  Venous ulcers can be prevented with the use of compression stockings and elevating the legs above the level of the heart in order to improve blood circulation.

A pressure ulcer (also known as a bedsore, pressure sore, or decubitus ulcer) is an area of damaged skin and tissue caused by sustained pressure, which cuts off blood flow to parts of the body resulting in areas of injured skin and tissue.  The areas of the body most vulnerable to pressure sores are the heels, hips, and buttocks.

Elderly nursing home patients are particularly vulnerable to pressure sores because of prolonged bed rest, limited mobility, and weakness.  Nursing home staff must turn residents who are bed ridden or have prolonged bed rest often enough so blood can circulate to areas that are under pressure.

Sources:

Merck Manuals: Pressure Ulcers

WebMD: Pressure Sores

WebMD: Deep Vein Thrombosis

MayoClinic: Deep Vein Thrombosis

WebMD: Venous Skin Ulcer

MayoClinic: Bedsores

A recent study conducted by the Agency for Healthcare Research and Quality determined that the rate of hospital-acquired bed sores has increased over the last decade.  According to the report, the rate of hospital-acquired bed sores (also called decubitus ulcers, pressure ulcers or pressure sores) has increased 80% from 1993 to 2006.   Among the more disturbing ‘highlights’ in the report are:

• In 2006, there were 503,300 hospital stays with pressure ulcers noted as a diagnosis–an increase of nearly 80% since 1993.
• On an annual basis pressure ulcer stays total $11 billion in hospital costs.
• More than 90% of the pressure ulcer-related hospitalizations were intended to be for medical conditions unrelated to pressure ulcer treatment.
• Compared to hospital stays for all other medical conditions, hospital stays related to pressure ulcers were more often discharged to and long-term care facility and more likely to result in death.
• 72% of adults hospitalized with a secondary pressure sore diagnosis were 65 or older.  In comparison 56.5% of adult patients had a principal diagnosis of pressure ulcers were 65 or older.
• Medicare was the biggest payer for hospital stays related to pressure ulcers- Medicare paid the bills for 3 out of 4 pressure ulcer stays.
• Paralysis and spinal cord injury were common co-existing conditions among younger adults hospitalized principally for pressure ulcers.

Related Information:

Over 500,000 Adults Suffer From Bed Sores In Hospitals, Nursing Homes Abuse Blog, December 10, 2008

Nursing Homes Abuse Blog: Hospital Bed Sores

• Anemia
• Infection
• Poor circulation
• Neuropathy
• Dementia
• Cancer
• Diabetes
• Stroke
• Spinal cord injury or paralysis

The following may indicate infection within the wound itself:

• Increased pain in the wound
• Edema (swelling)
• Reddening of the wound (erythema)
• Increased fluid accumulation
• Heat in the wound area
• Unusual smell

Occasionally, an infection that originates in the wound itself, can spread throughout the entire body.  These situations can pose a significant health risk to the individual.  Signs of systematic infection include:

• Elevated white blood cell count
• Elevated body temperature
• Cellulitis (skin infection)
• Osteomyelitis (bone infection)

Because infection is a frequent complication for people with bed sores, physicians and other medical professionals should make the monitoring of existing wounds a priority.  Wounds should be documented and photographed to assist in the evaluation of woulds as they heal.

If you have an existing bed sore and have any of the above conditions, contact your medical professional immediately.

A second (and generally overlooked) reason why bed sores tend to develop on the buttocks is that many facilities fail to educate their workers as to the proper positioning of beds for patients who may be prone to develop bed sores.  Individuals who may be at high risk for developing bed sores should be kept as level as possible when not eating or drinking.  Keeping patients levels in their beds minimizes the pressure that is put directly on buttocks– thereby minimizing the risk of developing bed sores.

Chances are, if you or your loved one developed a bed sore on their buttocks during an admission to a medical facility, errors where made at some point during their care.

Related:

• What Is It Like To Live In A 1-Starred Nursing Home?

Once an individual has developed contractures, little can be done to alleviate the problem aside from aggressive orthopedic surgery.  Consequently, medical facilities (hospitals and nursing homes) should provide physical and occupational therapy to people who are at risk for developing contractures and to keep the body flexible.

Once a person has developed contractures they are at a heightened risk for developing bed sores due to their bodies limited ability to move– with or without assistance.  The rigidity that accompanies contractures generally means that many of the repositioning techniques commonly used to prevent bed sores may be unfeasible.  As a general rule, the more immobile an individual is, the higher likelihood they have in developing bed sores.