What Are Bedsores and How It Impacts Quality of Life
What are bedsores?
Bedsores, also known as pressure ulcers, are ulcerated (broken) areas of the skin which has been subjected to prolonged pressure and irritation. This is the reason they are mostly common found in areas where the skin lies close to the bone (bony prominences) such as heels, lower back, shoulders and bottom. What starts as an area of damaged skin can spread to underlying tissues causing permanent damage to bones and muscles in that area.
Who is at risk?
Bedsores are most likely to develop in:
- People who are seriously ill and are admitted in hospitals for prolonged periods of time.
- Patients who are immobile/confined to wheelchairs or beds forcing them to remain in the same position for long periods and in patients who find it difficult to shift positions without the help of a care-taker.
- Patients who suffer from incontinence of the urine or stool, which leads to constant dampness in the lower part of the body rendering it a bedsore prone area.
- People who have suffered spinal cord injury which hampers the feeling and mobility of limbs.
- Chronic diabetics who often have affected skin sensation and ability to feel pain over some parts of body.
- People having poor blood circulation in legs or arms caused by narrowing of arteries
- People wearing prothesis which puts additional pressure on the skin below.
- People who have other chronic health conditions such as Alzheimer’s disease, Parkinson’s disease, rheumatoid arthritis etc.
A detailed look at how a bedsore develops.
- Skin is under constant pressure from the weight of the body pressing against skin surfaces that are prone. At this stage, there is redness but no breakage.
- The skin becomes hard, warm to touch and slightly swollen. This may cause the affected skin to appear dark/purplish blue in colour.
- Constant pressure and friction cause skin to break and develop into a superficial ulcer. At this stage it looks like a blister or abrasion.
- Compression of skin and underlying tissues occur, which lead to damage of blood vessels. The ulcer penetrates the full thickness of the skin at this stage
- Friction between the skin and surface, exacerbates the development of a sore.
- Finally, in the most severe form, the ulcer is deep enough to cause damage to the bone and the underlying tissues and become very painful. At this stage, it takes very long for a sore to heal.
How does it affect quality of life?
Quality of life does not mean just good physical health but is broad spectrum that involves physical and emotional well-being and social functioning. It refers to being able to lead an active, fulfilled and productive life through the whole lifespan.
Most patients suffering from chronic illnesses will most likely experience pain, discomfort and altered functioning or sense at some point during the course of the illness. Quality of life relating to health is influenced greatly by personal characteristics such as gender, age, educational status, ethnicity etc.
Concerns over health – Developing bedsores can add to the emotional trauma a patient is already experiencing due to an existing health condition. They may be concerned about the pain caused by a sore, whether the wounds will heal and how long they will need treatment. They may need assurance that with proper treatment the sores will eventually heal and they will be able to resume their normal lives. When wounds take months to heal, they may become pessimistic which leads to non-compliance when it comes to treatment and proper nutrition.
Dependency and depression – Due to the nature of pre-existing conditions that have rendered them immobile, patients with bedsores are hard to handle because of their dependency on care-takers to shift positions frequently. Frustration can set in easily because they may have to ask or wait for help for their basic needs. Isolation from their social circle can also make them depressed.
Pain management – In addition to any pain that could have been caused by their other health conditions, bedsores may cause significant pain and can be hard to manage if not treated at the right time. Most patients report that their sores cause significant pain even while resting, with some reporting even unbearable pain. Pain can also be caused during changing of dressings or even shifting positions resulting in hindrance to effective resting and recovery. Administering prescribed pain medication for sores is essential for effective pain management and a better quality of life.
Embarrassment – Presence of microorganisms in sores can result in characteristic odours. In cases of exudation and odour, patients may have psychological reactions such as a sense of embarrassment or guilt and a need to isolate.
Financial impact - Professional reorientation, cost of long-term treatment plans and in cases of working people, a need for long sick-leave, can all adversely impact the financial stability and become stressful.
Bedsores can have a significant negative impact on not only physical but also psychological, emotional, spiritual, social and financial aspects of life. It is important to recognize these and their impacts on the quality of life and it is therefore crucial to choose treatment and care options that are tailor-made for each patient.