Pressure Sores: Risk Factors
Pressure injuries occur when skin and underlying tissue are exposed to prolonged pressure. While they can affect anyone, certain groups face a significantly higher risk. Among those individuals most at risk are nursing home residents, particularly while rehabilitating after orthopedic surgery.
High-risk populations include individuals with limited mobility, such as:
- Bedbound Residents: Those confined to bed for extended recovery after illness, injury, or surgery.
- Paralyzed Individuals: People with spinal cord injuries or similar conditions that impair movement and sensation.
- Wheelchair Users: Residents unable to shift weight regularly, resulting in sustained pressure on specific areas.
People with chronic conditions also face an increased risk of pressure injuries. Chronic conditions commonly associated with pressure injuries include:
- Diabetes: Neuropathy can reduce sensation, delaying awareness of discomfort or early injury.
- Vascular Diseases (e.g. PAD): Impaired circulation slows healing and increases tissue breakdown risk.
- Neurological Disorders (e.g. MS, Parkinson’s): Limited mobility and sensation heighten susceptibility.
Other high risk groups include:
People with Incontinence. Prolonged exposure to urine or feces weakens the skin barrier, causing irritation and increasing risk of breakdown and infection.
Older Adults. Thinner, more fragile skin, reduced muscle mass, slower healing, and decreased mobility make elderly individuals more vulnerable.
Individuals with Poor Nutrition or Hydration. Malnutrition and dehydration reduce skin resilience and tissue repair capacity. Adequate protein, vitamins, minerals, and fluids are essential to prevention and healing.
Cognitively Impaired Individuals. Dementia or Alzheimer’s disease may prevent residents from reporting pain or discomfort, leading to unrelieved pressure.
Individuals with a History of Pressure Injuries. Previously injured skin and tissue remains weaker and more prone to recurrent injuries.
Assessing Risk
Healthcare providers must be familiar with standard risk assessment tools used in long-term care facilities. Common assessment tools include:
- Skin Assessments. Regular inspections for redness, swelling, warmth, tenderness, or discoloration — especially in high-risk areas — are essential to early detection and prevention.
- Norton Scale. Measures physical condition, mental status, activity, mobility, and incontinence. Scores range from 5–20; lower scores reflect higher risk.
- Braden Scale. Evaluates sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Scores range from 6–23, with 18 or below indicating increased risk.
In most elder abuse cases, neglect must be shown to arise from a conscious disregard of a high probability of harm on the part of the defendant. It is therefore important to establish whether proper risk assessment steps were taken. If risk assessments show that the defendant was aware of significant risk, it’s more likely that a subsequent failure to address that risk will be seen as reckless. If assessments were not performed at all — and the plaintiff is considered a high-risk individual — this can also be viewed as reckless.
If your loved one is in a nursing home or skilled nursing facility, and you suspect they have suffered a pressure injury as a result of neglect, an elder abuse attorney can help you determine whether or not you have grounds for an elder abuse lawsuit. Contact Dudensing Law to talk to an elder abuse attorney in Los Angeles, San Francisco, or Sacramento.