Risk Factors for Pressure Ulcers

There are several risk factors for pressure ulcers, the skin sores that typically develop over bony areas, such as the lower spine, hips, and elbows. Also known as bedsores, pressure ulcers are a common problem for palliative care patients as mobility decreases and patients spend more time in bed.

Pressure ulcers are painful and can be difficult to treat. Preventing pressure ulcers is critical to maintaining comfort and treating them promptly is essential. But how do you know if your loved one is at risk of developing one? Should you be concerned?

People at the greatest risk of developing pressure ulcers are those who are immobile. Once a person losses the ability to move and becomes inactive, the risk of developing a bedsore increases.​

Patients who have experienced loss of sensation as the result of spinal cord injury or neurological disease have an increased risk of developing pressure ulcers. A person without sensory loss can feel pain and will generally feel uncomfortable after spending a lot of time in one position. When the sensory loss occurs, a person may not feel uncomfortable or the need to be repositioned.

Likewise, a person with an altered level of consciousness may not feel discomfort or may not be awake enough to physically reposition themselves if they do.

Shear is the rubbing of skin and fatty tissues across bones, and it is caused by the combination of gravity and friction. Shear most commonly occurs when a patient is lying with the head of the bed raised. The person’s skeleton may slide down in the bed while the skin and fatty tissues stay in place. This type of force causes damage to the underlying blood vessels, resulting in ulcers with a large area of internal tissue damage and less noticeable damage at the surface of the skin.

Friction occurs when two surfaces move across one another. Friction decreases the skin's tolerance to pressure by causing abrasions and compounds the effect of shear. This can happen when a patient slides down in bed or is repositioned in bed the wrong way.

Moisture is a common problem in people who have become incontinent and have to wear diapers. Moisture from sweat can also be a problem. Moisture removes oils from the skin that normally act to protect it and softens the skin’s connective tissues, making the effects of shear and friction more damaging.

As above, incontinence of bowel movements and urine create moisture on the skin and increase the risk of breakdown. Fecal incontinence has the added risk of damage to the skin from bacteria and enzymes in the stool and also increases the risk of infection.

Poor nutrition can lead to weight loss which can then increase the pressure on bony areas of the body. Proper nutrition is also important to the healing of pressure ulcers.

As a person ages, the skin becomes thinner and more fragile, increasing the risk of skin breakdown.

If your loved one has any of these risk factors, it's important for you to take steps to prevent a pressure ulcer from developing.

Sources:

Ferrell BR, Coyle N. Textbook of Palliative Nursing, 2nd Edition. Oxford Press, 2006.

Kinzbrunner BM, Weinreb NJ, Policzer JS. 20 Common Problems: End of Life Care. McGraw-Hill, 2002.

Kayser-Jones J, et al. Pressure Ulcers Among Terminally Ill Nursing Home Residents. Research in Gerontological Nursing 2008;1(1):14-24