A pressure sore or bed sore is any lesion caused by unrelieved pressure that results in damage to underlying tissue. The severity of these injuries varies. In general, the elderly are at higher risk of developing pressure sores because of aging changes to the skin. Long term care facilities must recognize the resident's risk and take active preventive measures. Pressure sores are caused by unrelieved pressure to bony parts of the body. They are easier to prevent than they are to treat. The first sign of a pressure sore is a reddened area that does not go away within 30 minutes of pressure relief. Avoid rubbing or massaging red areas, which damages underlying tissues.

Pressure sores are classified according to stages. Each stage represents a greater degree of tissue damage than the previous stage. Pressure sores can develop quickly and progress to Stage IV within a very short time. They do not necessarily progress from Stage I to Stage IV or heal from Stage IV to Stage I.

In the long term care facility, pressure sores should be measured weekly, or more often. This includes a metric measurement of length, width, and depth. Other observations, such as odor, drainage, presence of nonviable tissue, and the appearance of surrounding tissue are recorded on the medical record.

Stage I: A reddened skin area that does not fade within 30 minutes after pressure is removed. The area can be large or small, and may be irregular in shape.

Stage II: A superficial open area to the upper layer of skin. It may look like a blister, abrasion (scrape), or shallow crater.

Stage III: A full layer of skin is destroyed. The sore extends into the underlying subcutaneous fat or tissue layer. The sore reaches, but does not go through, the muscle. Nonviable (dead) tissue may be present. This is commonly black in color, but occasionally appears to be hard red or white tissue. The nonviable tissue, called eschar, must be removed before healing can occur.

Stage IV: A full thickness skin loss with extensive destruction. Tissue necrosis occurs, and damage often extends to the muscle, bone, and supporting structures (such as tendon or joint capsule). Note: Undermining and sinus tracts may also be associated with Stage IV pressure sores. These areas are not visible from the surface of the wound. They are deep tunnels that may extend far back under the resident's skin. Like a Stage III sore, if eschar is present, it must be removed before healing can occur.

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Signs that a Loved One In A Nursing Home could be in trouble include Behavioral Problems, Changes In Physical Conditions, Dehydration, and Immobility to name a few.