Bedsores – Pressure Sores – Decubitus Ulcers – Elder Abuse


Bedsores, also called pressure sores or decubitus ulcers, develop on areas of the body where the skin overlaps bony areas such as the lower spine and tailbone. The causal mechanism is when body pressure is asserted upon the skin and the underlying derma is pressed against the bone. (Photo Shows A Stage Four Bedsore)

The patient population that is most prone to this condition is the infirm and people over 70, especially those that are physically limited to sitting or lying in a single position for extended periods of time.

This is why it is critical for caretakers to examine the entire body, especially the lower back and tailbone region every time this type of patient population is changed or bathed.

The key to treating a developing bedsore is early detection, immediate wound care, and finally making sure the caregiver regularly repositions the patient to alleviate pressure on the sore. There are also special mattresses that can be purchased for people with bedsores or for those that are at high risk for developing bedsores. These float-based mattresses can be purchased at most medical equipment suppliers.

The Four Clinical Stages of A Bedsore

Bedsores are often degenerative conditions. This means that if left without treatment, they can get worse at an accelerated rate. It is not unusual to see rapid deterioration of a sore in as little as 48 hours.

Medically, bedsores are ranked in four stages: The first stage is the most benign and the fourth stage, the most severe. At stage four, the skin and subcutaneous tissue beneath the skin can be so damaged the wound actually exposes the ligament, muscle, and bone.

Stage One: This is the most benign state in which the skin evidences discoloration, usually redness or pinkish color. This stage is also associated with tenderness, irritation, and itching in and around the sore.

Stage Two: This is when the skin begins to open and blister. At this point, the sore is susceptible to further deterioration including infection.

Stage Three: The bedsore is now considered a fully “opened wound” and there is a cratering contour or slope to the wound which exposes the inner tissue of the skin. This is a very dangerous stage because the sores progression downward can be quite rapid and the chance of infection high. In many states, a Board & Care or Assisted Living Facility is legally prohibited from keeping a guest who has reached a stage three sore, since the wound requires immediate and ongoing medical treatment.

Trouble-Tip: A wound such as this can be difficult to distinguish between stages three or four. That is because the wound is filled with necrotic tissue, commonly known as “pus” brought on by infection and which will likely require debridement by a physician or wound care specialist. Debridement is a procedure in which the necrotic tissue is scraped out of the wound by a scalpel and the wound is antiseptically cleaned. Once the wound has gone through debridement, the wound can be viewed clearly and the doctor can determine the actual stage of the bedsore. If the wound is a stage three or four, the person must be treated medically which means being admitted to a hospital or skilled nursing facility.

Stage Four: This stage is very dangerous. The wound is now large and can be so deep it is now revealing the interior tissue, ligament, muscle, and bone. The wound is often very bloody and will let off a foul odor. Wounds such as these can result in Sepsis, which means the infection has begun to travel through the bloodstream and if not eradicated will infect different parts of the body. Sepsis can often cause fatal, especially in an elderly person.

Bedsores Can Indicate Elder Abuse

In most states, the development of bedsores is evidence of elder abuse. Conduct by the caregiver that consciously and knowingly places economic gain before over patient safety. This is a form of aggravated neglect and in most states is considered a form of elder abuse. This can be legally established by showing the caregiver acted with a conscious disregard towards the safety and welfare of the elder. For this to legally qualify as Elder Abuse, the evidence must demonstrate more than negligence or carelessness.

Trouble-Tip: Elder abuse must be distinguished from medical malpractice, which is usually characterized by negligence rather than intentional wrongdoing. States like California still impose draconian restrictions on medical negligence cases (referred to as MICRA laws) by statutorily limiting the amount of damage a patient may legally recover in cases of medical malpractice. States such as Florida have recently abolished these types of statutory restrictions.

Bedsores Require Immediate Attention

Finally, the best advice is for the patient advocate to contacting the doctor and demand that the sore be examined and staged. Those who work at assisted living facilities are not medically trained and are prohibited by law from performing medical wound care.

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