Why are the elderly more at risk of pressure ulcers?

 

ARTICLE WRITTEN BY SYLVIE HAMPTON


Figure 10.  The outer skin (epidermis) is firmly held in place by finger like projections.

Figure 10. The outer skin (epidermis) is firmly held in place by finger like projections.

When we are young we have collagen and elastin in the skin. This holds water and ‘plumps’ the skin so we have smooth and unlined skin. The surface of the dermis connects to the epidermis and is held in place by ‘finger like’ projections (Fig 10 and 11).

As we age there is a loss of collagen and elastic fibres and this creates thin and inelastic skin, and weakening of the finger like attachment between the dermis and epidermis (dermal-epidermal junction). Because the skin is thinner and the dermis and epidermis are easily pulled apart, the elderly will be at higher risk of pressure injury, skin tears and friction tears. Once the two surfaces are pulled apart, fluid will fill the gap and this is a blister. In pressure ulcer terms it is a Category 2.

Figure 11.  Due to friction or trauma, these two parts can be pulled apart – causing blisters or exposure of the dermis.

Figure 11. Due to friction or trauma, these two parts can be pulled apart – causing blisters or exposure of the dermis.

Blisters are commonly seen over heels and sacrum caused by pressure and movement over sheets. They are usually only the junction between epidermis and dermis filled with fluid and the cause is the same as wearing a tight pair of shoes.

The collagen in young skin holds water and the elastin gives the skin form and support. As we age, the collagen thins and we lose elastin as well. This means that the skin will wrinkle and sag and the loss of collagen means the skin is much thinner as there is not the water content to provide the plumpness.

The loss of collagen in the older skin means that any wound (such as a pressure ulcer) will be slower to heal.

 
 
 

 
 

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Clinical blogSylvie Hampton