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Risk factors
By Mayo Clinic staffAnyone with limited mobility — unable to easily change position while seated or in bed — is at risk of developing pressure sores. Immobility may be due to:
- Generally poor health or weakness
- Paralysis
- Injury or illness that requires bed rest or wheelchair use
- Recovery after surgery
- Sedation
- Coma
Other factors that increase the risk of pressure sores include:
- Age. The skin of older adults is generally more fragile, thinner, less elastic and drier than the skin of younger adults. Also, new skin cells are usually generated more slowly. All of these conditions of the skin make it more vulnerable to damage.
- Lack of sensory perception. Spinal cord injuries, neurological disorders and other conditions can result in a loss of sensation. An inability to feel pain or discomfort can result in not being aware of bedsores or the need to change position.
- Weight loss. Weight loss is common during prolonged illnesses, and muscle atrophy and wasting are common in people living with paralysis. The loss of fat and muscle results in less cushioning between bones and a bed or wheelchair.
- Poor nutrition and hydration. An adequate amount of fluids, calories, protein, vitamins and minerals in the daily diet are important for maintaining healthy skin and preventing the breakdown of tissues.
- Urinary or fecal incontinence. Problems with bladder control can greatly increase the risk of pressure sores because the skin may frequently be moist, making it more likely to break down. Bacteria from fecal matter can cause serious local infections and lead to life-threatening infections affecting the body in general.
- Excess moisture or dryness. Skin that is moist from sweat or excessively dry is more likely to be injured in general and increases the friction between the skin and clothing or bedding.
- Medical conditions affecting circulation. Because certain health problems, such as diabetes and vascular disease, affect circulation, parts of the body may not receive adequate blood flow, increasing the risk of tissue damage.
- Smoking. Smoking impairs circulation and reduces the amount of oxygen in the blood. Therefore, smokers tend to develop more severe wounds, and their wounds heal more slowly.
- 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.
- Muscle spasms. People who have muscle spasms or other involuntary muscle movement may have an increased risk of pressure sores from frequent friction or shearing.
References
- Bluestein D, et al. Pressure ulcers: Prevention, evaluation, and management. American Family Physician. 2008;78:1186.
- Dealey C. Skin care and pressure ulcers. Advances in Skin & Wound Care 2009;22:421.
- Black J, et al. National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system. Dermatology Nursing/Dermatology Nurses' Association 2007;19:343.
- Pressure ulcers. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec10/ch126/ch126a.html. Accessed Jan. 25, 2011.
- Abrams GM. Chronic complications of spinal cord injury. http://www.uptodate.com/home/index.html. Accessed Jan. 28, 2011.
- Dorner B, et al. The role of nutrition in pressure ulcer prevention and treatment: National Pressure Ulcer Advisory Panel white paper. Advances in Skin & Wound Care 2009;22:212.
- Langemo DK, et al. Pressure ulcers in individuals receiving palliative care: A National Pressure Ulcer Advisory Panel white paper. Advances in Skin & Wound Care. 2010;23:59.
- Jaul E. Assessment and management of pressure ulcers in the elderly: Current strategies. Drugs & Aging. 2010;27:311.
- 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, 2011.
- Berlowitz D. Treatment of pressure ulcers. http://www.uptodate.com/home/index.html. Accessed Jan. 30, 2011.
- Berlowitz D. Prevention of pressure ulcers. http://www.uptodate.com/home/index.html. Accessed Jan. 30, 2011.
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