What Are Bedsores?

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Bedsores, also known as pressure ulcers or decubitus ulcers, are lesions caused by pressure, friction, or other kinds of prolonged contact with a hard surface. They are most commonly found in those who spend the majority of their time in wheelchairs or in beds. While bedsores range in severity, they can be extremely dangerous, especially for those whose immune systems are already weakened by old age or a chronic health condition. Open sores not only cause acute pain to the victim, they also leave the body open to infection, especially if they are not noted, cleaned, and dressed properly.

In 2009, the Centers for Disease Control and Prevention performed a statistical analysis of information gathered by the 2004 National Nursing Home Survey and found several shocking statistics. Through their assessment, they found that around 159,000 nursing home residents in the United States suffered from some level of bedsores, representing 11% of all nursing home residents in the country. The most common ailment of this group (around 50%) was stage 2 bedsores. They also found that residents below the age of 64 were more likely to have pressure ulcers and that only 35% of patients with more severe bedsores (stage 2, 3, or 4) were given special wound care treatment.

Causes of Bedsores

Bedsores develop when an area of tissue is damaged and begins to die in a process called necrosis. Bedsores usually occur on bony protrusions of the body that come into prolonged contact with a surface such as a bed or a chair. Depending on the patient’s position, wounds most commonly appear on the hips, ankles, heels, tailbone or spine, shoulder blades, back or sides of the head, and the backs of the arms or legs. Bedsores are more common in immobile patients who cannot readjust themselves or give their bodies a break from contact with a particular surface, but they can occur in ambulatory patients as well. In fact, some studies have suggested that low-level bedsores can occur after 2-3 hours of pressurized contact. There are three common contributing factors for the development of bedsores.


Prolonged pressure on one part of the body can decrease the amount of blood that is able to reach a particular area. If an area is deprived of blood, and therefore oxygen and nutrients, for an extended period of time, or periodically, it will begin to die. The longer the area goes without essential life-sustaining elements, the deeper the wound will become.


When the skin rubs repeatedly against a material, such as clothing or bedding, the friction can begin to wear down the area, making it weaker and more vulnerable to lesions. The agitated area of the skin can become further weakened if it is kept damp or moist, through humidity in the air or sweat from the patient’s body which is not given the opportunity to dry out. Incontinence can also cause a build up of moisture.


Shear is similar to friction and occurs when two surfaces are pulled in opposite directions, creating tension which weakens tissue over time, making it vulnerable to tears and wounds. For example, when a chair is reclined, the top layer of skin on the lower back might be pulled with the chair, while the weight of the body pulls underlying tissue in the opposite direction.

Stages of Bedsores

Bedsores or pressure ulcers are classified into four different stages, depending on their depth, severity, and the layers of skin involved. The amount of surface area of the body that the ulcer covers does not determine its stage; stage 1 bedsores may cover a large portion of the body while stage 4 may only cover a small area and still be considered more severe. The condition usually progresses from the first stage through to the fourth if left untreated or not discovered early enough.

Stage 1

Stage 1 bedsores are usually more superficial. The skin remains intact and may, in some cases, appear normal, although when palpated the skin will feel warmer than the surrounding areas. The patient may experience burning or itching sensations. In other cases, the skin will be blue, purple, or red, indicating degradation of the tissue. Intervention during stage 1 is most effective and can prevent serious health concerns.

Stage 2

During stage 2, the top layer of skin or “epidermal layer” is affected and, occasionally, the second layer or “dermis” may be involved. The skin, in this stage, is broken, creating a painful open sore than may resemble a cut or a blister which may weep yellowish fluid. The area surrounding the wound may be particularly sensitive to the touch or discolored.

Stage 3

In stage 3, the epidermal layer, the dermis, and the subcutaneous tissue are all affected, and the wound extends through all three. The lesion in stage 3 often looks like a crater, with a hollow area. In some patients, the bone and muscle may be visible, but the sore has not extended into these tissues. Sometimes dead tissue or “necrotic slough” can be seen in the wound, which must be immediately removed in order to avoid severe infection.

Stage 4

Stage 4 is the most severe form of bedsores and involves all three layers of skin along with muscle joints, tendons, and/or bone. They are usually characterized by large wounds and are particularly vulnerable to infection.

Baltimore Nursing Home Abuse Attorneys

If you have a loved one staying in a short term or residential nursing home, it is important to recognize the possibility of the development of bedsores, even if they are able to walk around on their own. The earlier that bedsores are found by caretakers, the sooner they can be cleaned and treated. Though easily treatable, if neglected, bedsores will almost certainly progress to more serious wounds which come with the risk of infection and even death. In 2005, one study found that, over a ten-year period, doctors proclaimed pressure ulcers as the cause of death in 114,380 people in the United States. For more information, and a free consultation on your case, call trial attorneys Charles Gilman and Briggs Bedigian today at (800) 529-6162 or contact them online.

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