Recognising the Signs of Pressure Sores in a Loved One

Unfortunately, there are times when you have to take extra precautions to ensure that your elderly relative is being looked after properly if he or she is in a residential care facility or hospital. Some signs that things are not as good as they should be are easy to spot on a casual visit, but others are much harder. If you don’t notice, are the staff who are paid to do exactly that on top of potentially fatal problems like pressure sores or are they ignoring them?

Why pressure sores are so important yet often remain invisible on a casual visit

Pressure sores are really ulcers, nasty sores that develop in sensitive parts of the skin that become under pressure from prolonged contact with a harder surface, particularly an underlying bone such as a shoulder blade, hip bones, elbows and skull. Pressure sores are also called bed sores, pressure ulcers and pressure injuries. The names belie just how serious these injuries can be if left untreated.

The residential home or hospital that your elderly relative lives in or is being cared for should have a well developed pressure sore mitigation and treatment programme in place that is designed to prevent the development of pressure sores to the stage that they threaten the health of the person. Sometimes, care workers are not trained sufficiently or the turnover is so high that these programmes become abandoned or are not in place at all.

On your next visit, apart from checking out the physical appearance of your relative that you can see and the emotional response you notice, ask the manager or supervising staff to describe the pressure sore programme that they have in place. Then ask about pressure sores that have been noticed on your relative. Ask them to show you what they have noticed and what they are doing about it. The more you know about the onset of pressure sores yourself and how they can be prevented and treated the less likely that your relative will be mistreated or ignored.

Where pressure sores develop

Pressure sores may develop whenever someone is confined to a wheelchair or a bed without regular movement. There are specific points where friction between the skin and underlying bone can start to lead to deterioration. These are usually predictable from where the person is sitting or lying. The areas of skin under the hip, heels, elbows, ears and the back of the neck are typical pressure sore concerns. The length of contact without movement, the physical state of the skin, nutritional deficiencies and general cleanliness all affect pressure sore development.

Early signs of pressure sores

Care workers or nurses should make regular examinations of at risk patients and residents. There are clear early signs that pressure sores are developing. These are discolouration of the skin, particularly a red, blue, purple or black colour. At this stage, a treatment plan should be put in place and the sores checked regularly to ensure they don’t progress. Two hourly movements of the position of wheel chair or bedridden patients or residents help to relieve pressure in just one area.

Keeping the skin clean and dry as well as maintaining a healthy diet are important aspects of a good pressure sore mitigation programme.

Pressure sores if left to develop

At a later stage, the skin under pressure may start to deteriorate and thin. Blood circulation is restricted and can lead to progressive necrosis (death) of the skin that is immediately above the point of pressure. An ulcer is beginning to develop at this point but is still treatable. The pressure sore area should be kept moist and padded out with protective bandaging with surrounding skin areas kept dry. The sore progression should be checked regularly to make sure it improves.

Serious consequences of unchecked pressure sores

Once the ulcer develops to maturity it can allow sepsis (bacterial infection) into the bloodstream and surrounding tissue, especially muscle and bone in the vicinity of the ulcer. Despite widespread knowledge of pressure sore prevention and treatment in British hospitals and nursing homes, these late stage ulcers are still a major reason for preventable fatalities. Deaths from pressure sores in the twenty first century in a medical or residential institution are largely due to negligence.

If you visit a loved one who now resides in a nursing home, residential facility or hospital there are ways you can check on pressure sore treatment that can satisfy you that your relative is being properly cared for. It would be a pity for poor management to get to the stage that you have to take legal action.