What are pressure sores?

Pressure sores, also known as pressure ulcers or bed sores, are injuries to the skin and the tissue underneath which can be caused by long periods of immobility.

In everyday life, when we are sitting in a chair or asleep in our beds, we frequently and subconsciously change our position and shift our weight. This is so that we don’t develop pressure sores.

How are pressure sores caused?

When our natural ability to move is restricted, through age or illness, we are reliant on others to assist us to move in our bed or chair frequently. If this doesn’t happen, we can develop pressure sores.

Pressure caused by our own weight through our bones to the tissue can reduce blood flow to that area. Over a sustained period, a loss of blood supply to the tissue can cause it to die and a debilitating ulcer to form.

Where do pressure sores form?

Pressure sores can form on any part of the body that is subjected to a sustained period of pressure and loss of blood supply. However, the most common areas are around the ‘bony prominences’. We therefore commonly see pressure sores developing on the buttocks and heels, for example.

Who is at risk from pressure sores?

Anyone who is unable to move properly or who has reduced sensation is at risk of developing a pressure sore. However, it is most common to see such injuries:-

• In people who are confined to bed or a wheelchair for an extended period of time
• In people who have an injury (such as a spinal injury) that prevents them from moving certain areas of their body
• In older people
• In diabetics
• In people who have reduced mental awareness, such as those with dementia or Alzheimer’s disease
• In malnourished people

Some residents of aged care facilities can fulfil all of the above criteria, and so sadly we frequently see these people developing debilitating and life-threatening sores.

How are pressure sores treated?

This depends on the severity of the sore. Pressure sores are classified as:-

• Stage I: A reddened area on the skin that does not turn white when pressed. This indicates that a pressure sore might be developing.
• Stage II: The skin blisters and an open sore forms. The skin around the sore might be inflamed, red and irritated.
• Stage III: The skin now develops an open, deep hole called a crater. There is damage to the tissue below the skin.
• Stage IV: The pressure sore has deepened so much that it has damaged muscle and bone below. Sometimes other vital stuctures like tendons can be seriously damaged too.

In early developing pressure sores, the treatment can be simply to ensure that the patient moves regularly and effectively. Special mattresses are available to prevent vulnerable areas of skin being damaged.

Specialist tissue viability nurses can treat some stages of pressure sores with regular use of highly specialised dressings and ointments.

In later stages, treatment in this way is not always possible, and surgery is necessary to remove the dead tissue and encourage healing. Otherwise, complications such as blood poisoning and gangrene can develop.

In more vulnerable aged care patients, we have commonly seen pressure sores leading directly to death.

Are pressure sores preventable?

Absolutely! We have known since the time of Florence Nightingale that frequent changes of position are usually all that it takes to prevent these serious sores from developing in the first place. In more patients with more complex needs, special mattresses and beds can be employed to prevent them developing.

Although pressure sore prevention is basic nursing care, we see them all too frequently. A recent study predicted an annual occurrence of pressure sores in Australia of 95,695 (N & Birrell F and Whitby, 2005) Our view is that this is largely a resources and education issue. Health care services are stretched, leading to more perfunctory nursing care and less time per patient available to nurses. Sometimes, less qualified health care assistants are employed to cover gaps in healthcare services. Such individuals simply do not have the training to ensure that pressure sores are avoided, or treated appropriately in their early stages.

In aged care facilities, the resource problems experienced by hospitals are, in our experience, often heightened. Often, we see only one Registered Nurse in each facility, with the majority of care being undertaken by less well qualified health care assistants. This, combined with the fact that aged care residents are at very high risk for the development of pressure sores, means that they are depressingly frequent problems for aged care patients, leading to extended periods of hospitalisation and, tragically, death.

What can we do to help?

Pressure sore injuries are very serious and highly preventable with basic nursing care.

We are frequently instructed to bring claims for compensation against hospitals or aged care facilities in which they occur, and have experience in recovering hundreds of thousands of dollars in compensation for our clients and their families as a result.

Please contact us for more information.