Burd et al 10 reported a risk of death among geriatric patients who developed a pressure ulcer to be 4 times greater than the norm and 6 times greater in patients whose pressure ulcers did not heal. Leshem and Skelskey 11 reported that patients in long-term care have more Stage I and Stage II ulcers, while patients in acute care have more Stage III and Stage IV ulcers. A number of age-related changes in the body have been documented. With age, there is a thinning of the dermis and flattening of the dermal-epidermal junction. This can lead to wrinkling and to tearing of the skin, loss of elasticity, increased skin permeability, and alterations in the barrier function of the skin, creating potential for irritant reaction to some products.
Pressure also has greater impact.
The elderly have an altered immune response and decreased dermal vascularity, both leading to an increased potential for infection. The elderly population has an increased incidence of diminished level of consciousness, more diagnoses, and more incontinence or increased exposure to moisture. Basic good care is the critical component of prevention. Patients should be frequently repositioned or have position changes at least every 2 hours, if consistent with overall patient goals. Using a written schedule is most helpful.