Pressure ulcers, also know as "bedsores" or "decubitus ulcers" are a common problem among the elderly. Pressure ulcers are tissue injuries that occur as a result of excessive pressure, shear or friction They are frequently found in soft tissues over a bony prominence exposed to prolonged compression of tissues. More than 50% of all pressure ulcers are found in persons over age 70. Two out of three pressure ulcers develop during a hospital stay for acute illness and about 70% occur in the first two weeks.

Pressure ulcers are a significant cause of mortality. They are costly to treat and the cost increases as the severity of the wound increases. Cost estimates to heal one pressure ulcer range from $14,000 to $40,000. The development of a pressure ulcer can lengthen a patient's stay in the hospital by up to 5 times. The total estimated national costs of pressure ulcer treatment exceed $1.3 billion. Not all pressure ulcers heal and many heal very slowly.

Most pressure ulcers are caused by injury to the skin from pressure, shear or friction. Secondary factors that contribute to pressure on the area or decrease the tolerance of the skin to injury include moisture, nutrition, and age.

Risk Factors for Pressure Ulcers

• Poor nutritional status
• Restricted physical activity (e.g. bedfast or chairfast)
• Mobility impairment
• Damp skin (e.g., incontinent, perspiration)
• Requires assistance to move (e.g. slides down in chair, contractures, spasticity)
• Sensory impairment (e.g. unresponsive, communication difficulty)
• Certain diseases (e.g. diabetes, low blood pressure, vascular disease)

Individuals at risk for pressure ulcers need to be identified so that measures to prevent pressure ulcers can be initiated. Prevention efforts include regular turning or repositioning at least every 2 hours to minimize pressure on bony prominences, and managing problems related to moisture, nutrition, friction and shear.

The treatment of pressure ulcers can vary depending on the severity. A clean pressure ulcer should show signs of healing (e.g. decreased size, less drainage, granulation tissue) within 2 to four weeks. Pressure ulcers need to be assessed at least weekly. Any deterioration in the pressure sore calls for a reevaluation of the treatment plan.