Pressure Sores: What are They and Why are They Important?

Pressure sores are a condition where the skin breaks down due to sitting or lying too long in one position. Pressure sores, sometimes called pressure ulcers or bed sores, are a significant risk for people who are bed-ridden and may cause death in extreme cases. This includes many elderly, especially those in nursing homes and rehab facilities where they lie in bed or sit in a wheelchair for extended periods.

For people who are bedridden, common places for pressure sores are the back or sides of the head, rim of the ears, shoulders or shoulder blades, hip, lower back or tailbone, heels, ankles and skin behind the knees. For people who use a wheelchair, common places for pressure sores are on the buttocks, shoulder blades, spine, and backs of arms and legs where they rest against the chair.

Per the Nursing Home Abuse Center and others, there are four different stages of pressure sores.  A doctor should be consulted when any of the following symptoms are evident.

Stage I – The beginning stage of a pressure sore has the following characteristics: The skin appears red on people with lighter skin color, and the skin does not briefly lighten when touched. On people with darker skin, there may be no change in the color of the skin. The skin may appear ashen, bluish or purple, and does not briefly lighten when touched. The site may be painful, firm, soft, and warmer or cooler compared with the surrounding skin.

Stage II – The pressure sore is an open wound with damage to the outer layer of skin and part of the underlying layer of skin. The pressure sore may appear as a shallow, pinkish-red, basin-like wound. It may also appear as an intact or ruptured, fluid-filled blister.

Stage III – The sore is a deep wound, the loss of skin usually exposes some amount of fat; the ulcer has a crater-like appearance. The bottom of the wound may have some yellowish dead tissue. The damage may extend beyond the primary wound below layers of healthy skin.

Stage IV – The sore exhibits large-scale loss of tissue, the wound may expose muscle, bone and tendons. The bottom of the wound likely contains slough or dark, crusty dead tissue. The damage often extends beyond the central wound site below layers of healthy skin.

MedlinePlus, a service of the National Library of Medicine in Bethesda, Maryland, references an excellent article  that speaks to recognizing, preventing and caring for pressure sores or ulcers. The article offers advice in several important areas:

  • Skin Care (for intact or normal skin)
  • Moving and changing position
  • Nutrition and Hydration
  • Relieving pressure on the area near the ulcer.

Communication and close coordination with the medical community are extremely important in dealing with pressure sores: first, to prevent the pressure sores from occurring, second, to recognize them early on, and third, to aggressively manage them when found.