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Risk factors
By Mayo Clinic staffPressure sores are more likely to occur if you are are:
- Immobilized by acute illness, injury or sedation — even for a brief time such as after an operation or accident
- Living with long-term spinal cord injuries
Because the nerve damage from spinal cord injuries is often permanent, compression of skin and other tissues is ongoing. Exacerbating the problem are thinning or atrophied skin and decreased circulation, both of which make tissue damage more likely and healing more difficult. And because spinal cord injuries reduce or eliminate sensation, you don't receive the body signals that tell you to shift your position or that a sore is developing.
If you're unable to move certain parts of your body without help for any reason, one or more of these factors may increase your risk of pressure sores:
- Age. Older adults tend to have thinner skin than younger people do, making them more susceptible to damage from minor pressure. They're also more likely to be underweight, with less natural cushioning over their bones. And poor nutrition, a serious problem among older adults, not only affects the integrity of the skin and blood vessels but also hinders wound healing. Even with optimum nutrition and good overall health, wounds tend to heal more slowly as you age, simply because the repair rate of your cells declines.
- Residence in a nursing home. In general, nursing home residents have higher rates of bedsores than do people who are hospitalized or cared for at home, in part because nursing home residents may be especially frail. On the other hand, rates are even higher for hospitalized people who are immobilized, such as people who are recovering from a hip fracture or who are in a coma.
- Lack of pain perception. Spinal cord injuries and some diseases cause a loss of sensation. 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.
- Natural thinness or weight loss. You tend to 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.
- Malnutrition. You may be more likely to develop pressure sores if you have a poor diet, especially one deficient in protein, zinc and vitamin C.
- 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. And bacteria from fecal matter not only can cause serious local infections but also can lead to life-threatening systemic complications such as sepsis, gangrene and, rarely, necrotizing fasciitis, a severe and rapidly spreading infection.
- Other medical conditions. 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 tend to develop more severe wounds and heal more slowly, mainly because nicotine impairs circulation and reduces the amount of oxygen in your blood.
- Decreased mental awareness. People whose mental awareness is lessened by disease, trauma or medications are often less able to take the actions needed to prevent or care for pressure sores.
References
- Berlowitz D. Pressure ulcers: Staging; epidemiology; pathogenesis; clinical manifestations. http://www.uptodate.com/home/index.html. Accessed Jan. 30, 2009.
- Pressure ulcers. The Merck Manuals: The Merck Manual for Healthcare Professionals http://www.merck.com/mmpe/sec10/ch126/ch126a.html. Accessed Feb. 2, 2009.
- Bluestein D. Pressure ulcers: Prevention, evaluation, and management. American Family Physician. 2008;78:1186.
- Abrams GM. Chronic complications of spinal cord injury. http://www.uptodate.com/home/index.html. Accessed Jan. 30, 2009.
- Garcia AD. Assessment and management of chronic pressure ulcers in the elderly. The Medical Clinics of North America. 2006;90:928.
- Tleyjeh I. Infectious complications of pressure ulcers. http://www.uptodate.com/home/index.html. Accessed Jan. 30, 2009.
- Berlowitz D. Treatment of pressure ulcers. http://www.uptodate.com/home/index.html. Accessed Jan. 30, 2009.
- Berlowitz D. Prevention of pressure ulcers. http://www.uptodate.com/home/index.html. Accessed Jan. 30, 2009.
- Reddy M. Treatment of pressure ulcers: A systematic review. Journal of the American Medical Association. 2008;300:2647.
- Phillips TJ, et al. Decubitus (pressure) ulcers. In: Wolff K, et al. Fitzpatrick's Dermatology in General Medicine. 7th ed. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aID=2980481. Accessed Feb. 5, 2009.
- Wolff K, et al. Skin signs of vascular insufficiency. In: Wolff K, et al. Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology. 5th ed. New York, N.Y.: McGraw-Hill Medical Pub. Division; 2005. http://www.accessmedicine.com/content.aspx?aID=753150. Accessed Feb. 5, 2009.
- Johnston C, et al. Geriatric disorders. In: McPhee SJ, et al. In: Current Medical Diagnosis & Treatment. Los Altos, Calif.: Lange Medical Publications; 2009. http://www.accessmedicine.com/content.aspx?aID=348. Accessed Feb. 5, 2009.
- Pressure ulcer stages revised by NPUAP. National Pressure Ulcer Advisory Panel. http://www.npuap.org/pr2.htm. Accessed Feb. 16, 2009.
