When you place a loved one in a nursing home or care facility, you trust that they will be safe, comfortable, and looked after. But neglect happens, and bedsores are one of the most telling signs that something has gone wrong.
Bedsores are painful, progressive wounds that can develop quickly and spiral into life-threatening complications. Understanding what causes them, how they're treated, and what can happen when they go unaddressed is essential for anyone.
This guide covers everything you need to know about bedsores, from the underlying causes and risk factors to the stages, complications, and treatment options available. It also explains what prevention should look like in a proper care setting.
Key Takeaways About Bedsores
- Bedsores are preventable injuries caused by prolonged pressure on the skin and underlying tissue.
- Limited mobility, poor nutrition, and inadequate care are major risk factors for developing bedsores.
- Early symptoms include skin discoloration, tenderness, swelling, and changes in skin temperature or texture.
- Untreated bedsores can progress through four stages and lead to serious infections and other complications.
- Proper prevention and early treatment are critical to protecting nursing home residents from harm.
What Is Bed Sore Disease?
Bedsores are areas of damaged skin and underlying tissue caused by prolonged, unrelieved pressure. They can also be called pressure ulcers, pressure injuries, or decubitus ulcers. According to the Mayo Clinic, they most often form over bony areas of the body, where pressure is concentrated and padding is limited.
Bed sore disease is a progressive condition that begins with inflamed, unbroken skin and can advance to deep, open wounds involving muscle and bone. The people most at risk are those who cannot move or reposition themselves, especially individuals who spend most of their time in a bed or wheelchair.
MedlinePlus notes that bedsores can develop over hours or days. Many heal with proper treatment, but some may never fully close, which is why early recognition and prompt care is so critical.
What Is the Cause of Bedsores?
A bedsore forms when sustained pressure reduces blood flow to the skin. Without adequate circulation, the tissue is deprived of oxygen and nutrients. Over time, that tissue begins to break down.
There are three primary physical forces behind bedsores:
- Pressure: Constant pressure on any part of the body reduces circulation to the tissue below. Areas over bony prominences, such as the spine, tailbone, shoulder blades, hips, heels, and elbows, are vulnerable because they lack the cushioning of muscle or fat.
- Friction: When skin rubs repeatedly against clothing or bedding, it becomes fragile and prone to injury.
- Shear: Shear occurs when two surfaces move in opposite directions.
Beyond these physical forces, several underlying factors increase the risk. The full picture of bedsores’ causes often involves a combination of the following:
- Immobility: Limited mobility from illness, injury, or neurological conditions keeps pressure on the same areas for too long.
- Incontinence: Prolonged exposure to urine and stool weakens the skin and makes it far more prone to breakdown.
- Poor Nutrition and Hydration: The body needs adequate fluids, protein, vitamins, and minerals to maintain healthy skin and support tissue repair.
- Loss of Sensation: Conditions like spinal cord injuries or neurological disorders prevent a person from feeling the discomfort that normally triggers repositioning.
- Diabetes and Vascular Disease: Any condition that impairs blood flow raises the risk of tissue damage.
- Age: Adults over 70 have thinner, more fragile skin and are significantly more susceptible to pressure injuries.
Stages and Symptoms of Bedsores
Bedsores are classified into stages based on the depth and severity of tissue damage. Recognizing the early warning signs can help prevent a minor skin injury from developing into a serious wound.
Common signs of a bedsore include:
- Changes in skin color or texture
- Swelling in the affected area
- Unusual drainage or pus
- Skin that feels warmer or cooler than surrounding tissue
- Tenderness, pain, or persistent soreness
The location of a bedsore often depends on how a person spends most of their time. For wheelchair users, bedsores commonly develop on the tailbone, buttocks, shoulder blades, spine, and the backs of the arms and legs. For individuals confined to a bed, common pressure points include the back or sides of the head, shoulder blades, hips, lower back, tailbone, heels, ankles, and behind the knees.
Without proper treatment, bedsores can progress through four stages of increasing severity:
- Stage 1: The skin remains intact but appears red, purple, or discolored and may feel warm, cool, tender, or painful.
- Stage 2: The skin begins to break down, forming a shallow, open sore, blister, or abrasion.
- Stage 3: The wound extends through all layers of the skin and into the fatty tissue beneath, creating a deeper ulcer.
- Stage 4: The wound reaches muscle, tendons, or bone and carries a high risk of serious infection and other complications.
Potential Complications from Bedsores
The wound itself is only part of the problem. Once the skin barrier breaks down, the body is exposed to bacteria, and infections can spread rapidly to surrounding tissue, deeper structures, and the bloodstream. The following is recognized complications of bedsores:
- Cellulitis: An infection of the skin and connected soft tissue. Cellulitis causes warmth, swelling, and changes in skin color. In people with nerve damage, it can advance without any felt pain.
- Bone and Joint Infections: Infection from a bedsore can penetrate deep into joints and bones. Septic arthritis damages cartilage and surrounding tissue, while a bone infection can reduce the function of entire limbs.
- Bacteremia: Bacteria that enter the bloodstream from an open sore can lead to life-threatening conditions.
- Sepsis: While less common, a severe bedsore infection can trigger sepsis.
- Cancer: A Marjolin's ulcer is a long-term, non-healing wound that can transform into squamous cell carcinoma over time.
Bed Sore Treatment Options
The outlook for bedsores improves significantly with early, appropriate care. Bed sore treatment is most effective when it begins at the first signs of a wound and is tailored to the individual's needs and the severity of the injury.
Here is what comprehensive bed sore treatment typically involves:
- Repositioning: Regularly shifting the person's position remains the cornerstone of both treatment and prevention. Relieving pressure from the affected area gives tissue the chance to recover.
- Wound Care and Dressing: Keeping the sore clean and properly dressed protects against bacterial contamination and promotes healing.
- Debridement: Dead or damaged tissue must be removed to allow healing and reduce infection risk.
- Antibiotics: When infection develops, targeted antibiotic therapy is needed to stop bacteria from spreading to the bone or bloodstream.
- Pain Management: Bedsores are painful; managing that pain is an important part of treatment and overall well-being.
- Surgery: For advanced wounds that resist other treatments, surgery may be required. This often involves using the patient's own muscle, skin, or tissue to close the wound and protect the underlying bone.
- Nutritional Support: Adequate protein, vitamins, and minerals are essential for tissue repair. Nutritional intervention is often part of a complete treatment plan.
The most effective bed sore treatment plans are closely monitored and adjusted as the wound progresses. They require coordinated care from trained medical professionals, which is something every patient in a care setting is entitled to receive.
How to Prevent Bedsores
Bedsores rarely develop without warning. In most cases, they can be prevented when caregivers provide appropriate attention, monitoring, and support. Properly staffed care facilities are expected to take proactive steps to protect residents from pressure injuries and related complications.
Effective prevention measures include:
- Repositioning every two hours. For people who can't move on their own, caregivers must do this consistently.
- Using pressure-relieving surfaces. Specialized mattresses and cushions redistribute pressure and support proper body positioning
- Keeping the bed at a low angle. When possible, the head of the bed should stay below 30 degrees to reduce the shear forces that tear tissue.
- Daily skin care. Washing with a gentle cleanser, patting dry, and applying moisture barrier creams protects against urine, stool, and friction.
- Routine skin inspections. Checking every day for early warning signs allows caregivers to act before a sore progresses.
- Supporting nutrition and hydration. A balanced diet and sufficient fluids keep skin resilient and capable of withstanding pressure.
Bedsores are a recognized form of nursing home neglect. If you're unsure whether what your loved one experienced crosses the legal line, our guide on when to contact a nursing home abuse attorney can help you understand your options. You can also learn more about the different types of nursing home abuse and how facilities are held accountable when they fail the people in their care.
About DM Injury Law
Bedsores are one of the clearest indicators that a nursing home has failed in its duty of care. Your loved one deserved better, and you have the right to pursue accountability.
At DM Injury Law, we are here to stand by your side throughout the process. Our offices serve families across the Midwest, including:
- Kansas City bedsore attorney
- St. Louis bedsore attorney
- Oklahoma City bedsore attorney
- Wichita bedsore attorney
We also have offices in Tulsa, Topeka, Columbia, Denver, Omaha, Olathe, and Blue Springs. If you believe your loved one suffered harm due to neglect, contact us to learn how we can help.
