Understanding the Risk Factors for Pressure Ulcers

Pressure ulcers, also called bedsores or decubitus ulcers, are areas of localized damage to the skin and underlying tissue. They result from unrelieved pressure on the skin, friction, shear, or a combination of these. Pressure ulcers mostly develop on the skin covering bony areas, such as ankles, elbows, heels, hips, and tailbone.

In the United States, over 2.5 million people experience pressure ulcers annually, which occur across various healthcare settings, including acute care, in-home care, and long-term care facilities. Pressure ulcers are a cause of morbidity, limited mobility, and even mortality, especially among Black and African American populations that lack access to quality healthcare.

Extrinsic and Intrinsic Risk Factors for Pressure Ulcers

Pressure ulcer risk assessment is vital to the prevention of pressure ulcers, as well as better results in wound care. Various factors put certain patients at higher risk of developing pressure ulcers. These risk factors are generally categorized as extrinsic and intrinsic. Some of the extrinsic risk factors of pressure ulcers include pressure, friction, moisture, and shear force.

While these are well known, some people may not be aware of intrinsic risk factors of pressure ulcers. Below, we take a look at these factors, which may be less considered.

Immobility

Individuals who have limited mobility due to a health condition or advanced age may be at risk of developing pressure ulcers. This is especially the case with patients who spend most of their time in a bed or on a chair, and can hardly change positions.

Prolonged hours of immobility results in the exertion of pressure over the bony prominences, causing reduced blood flow to the tissues. If you lose the ability to move and become inactive, there is a greater risk of developing pressure sores.

Incontinence

Lack of voluntary control over urine and bowel movement creates moisture on the skin, increasing the risk of breakdown. Further, fecal incontinence adds the risk of damage to the skin due to bacteria and enzymes in the stool. This also increases the risk of infection.

Skin damage due to incontinence makes it more difficult for health care professionals such as podiatrists to recognize the early symptoms of pressure ulcers. Such signs include discoloration of the skin and patches of the skin that feel warm or spongy.

Compromised Sensation

Patients who experience loss of sensation due to neurological disease or spinal cord injury also have an increased risk of developing bedsores. Without sensory loss, one will feel pain and generally feel uncomfortable after maintaining the same position for a long time. When there is sensory loss, a person may not feel uncomfortable or need to reposition, which puts the skin under intense pressure.

Support Surfaces

The surface upon which a patient sits or lies can significantly influence the amount of pressure over the bony prominences. Support surfaces should be assessed to ensure that they don’t exert too much pressure on the patient’s body part. By using the right kind of surface, pressure on the skin can be minimized, reducing the risk of pressure ulcers.

Mental Status

Patients with an altered sense of consciousness, or those suffering from dementia or any other cognitive disorder, may lack the capacity to comprehend instructions. In addition to the lack of comprehension, such patients may fail to recognize discomfort and may remain in the same position for a long time, increasing the risk of developing pressure ulcers.

Poor Nutrition

Now more than ever, people are turning to high-caloric, overly processed foods. A diet consisting of such foods is not only nutrient-poor but also a risk factor for many diseases. While there is a need for more studies, poor nutrition puts patients at a higher risk of developing pressure ulcers.

Poor nutrition may also lead to weight loss, which may in turn increase pressure on the bony parts of the body. Eating a nutrient-dense diet is important to wound healing and is therefore vital for pressure ulcers patients.

Age

Numerous diseases and conditions come with advanced age. As individuals age, collagen production decreases, leaving the skin thin and fragile. This increases the risk of skin breakdown. A good way to prevent the development of age-related pressure ulcers is maintaining a healthy diet and a physically active lifestyle.

Compromised Blood Flow

Whenever blood doesn’t flow efficiently to the body tissues, there is a risk of pressure ulcer development. Peripheral arterial disease (PAD) and venous insufficiency are common culprits of compromised blood flow.

Pain

A condition that results in pain prevents a patient from moving. Generally, pain reduces the physical activity and mobility of a patient, which could, in turn, cause the development of pressure ulcers. The continuous use of pain medication often sedates patients, and they may not be able to change their position as often as they should.

Leveraging Technology for Amputation Prevention

The Wound Docs brings together Black healthcare professionals, including podiatrists and wound care specialists, from across the country to advance the lower limb amputation prevention efforts in Black and African American communities. The Wound Docs is leveraging the power of AI and advanced biologics (skin substitutes) to achieve better patient outcomes in wound care among Black and African American patients.