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What Factors Predispose an Elderly Patient to Develop a Decubitus Ulcer?

If your loved one lives in a nursing home or is treated in a hospital, you probably do not expect to see a sign of neglect, such as a bedsore.

Contrary to popular belief, bedsores are avoidable, even in individuals with factors that predispose them to the condition. Read on for more information about those factors, why bedsores are a sign of neglect, and how your loved one can obtain compensation for the expenses and impacts of the injury.

If you or your loved one suffered neglect, an experienced bedsore attorney can help you understand the legal process of pursuing compensation, negotiate with the at-fault parties, and fight on your behalf for maximum compensation.

What Is a Decubitus Ulcer?

A bedsore, also known as a decubitus ulcer or a pressure ulcer, is an injury to the skin and underlying tissue that is caused by prolonged pressure.

This injury presents with:

  • Unusual changes in skin color or texture in the affected area
  • Swelling
  • Pus-like discharge from the wound
  • An area of the skin that feels warmer or cooler than other areas
  • Areas that are tender to the touch

Pressure ulcers are categorized into four stages of severity:

  • Stage 1: The mildest form of a pressure ulcer affects only the outer layer of skin. This stage of bedsore presents with discoloration and tenderness of the affected area.
  • Stage 2: This level of bedsore affects both the outer layer and the inner layer of skin. Stage 2 pressure ulcers often appear blistered or weepy. The skin tears easily and appears pink and moist.
  • Stage 3: Stage 3 decubitus ulcers involve all layers of the skin and the fat tissue beneath the skin. The wound can look cratered from dead skin that eventually lifts off.
  • Stage 4: This level of injury involves the skin, fat tissue beneath the skin, and even the joints, muscles, and bones. Stage 4 pressure ulcers can take months or even years to heal and leave the patient at extreme risk of infection due to the introduction of bacteria into the open wound.

What Factors Predispose an Elderly Patient to a Decubitus Ulcer?

Decubitus UlcerBelow, we discuss some of the most common factors that make an elderly person more vulnerable to bedsores. What do they all have in common? Neglect by caretakers, from doctors and nurses to attendants and the facilities themselves, whether hospitals or nursing homes. 


Elderly individuals can lose mobility from spinal cord or brain injuries and strokes. An immobile individual cannot change positions independently. The patient must rely on others to perform this important task. A resident’s care plan should note any mobility issues, with detailed instructions for providers about the activities the resident needs assistance with and how to perform it.

Immobility is a major factor in the development of decubitus ulcers. In fact, a study of the factors that affect the development of bedsores found that bedsore patients are usually elderly and hospitalized or immobile for long times.

Bedsores develop in different places on the body depending on whether the patient is confined to a wheelchair or bed and which part of the body is most exposed to the pressure.

In wheelchair-bound patients, decubitus ulcers are most likely to form in:

  • The tailbone or buttocks
  • Shoulder blades and spine
  • The backs of the arms and legs where they rest on the chair

If the patient is confined to bed, pressure ulcers will often appear in:

  • The back or sides of the head
  • The hip, lower back, or tailbone
  • The shoulder blades
  • The heels, ankles, or the skin behind the knees

This points to staff that doesn’t monitor or move a patient enough, or that moves them into inappropriate positions.


Incontinence leads to moist skin, which can also increase the risk of an elderly patient developing pressure ulcers. Incontinent residents must have provisions in their care plans that include regular inspections for bedsores, as well as treatment to keep the resident’s clothing and skin dry, the affected area clean, and a layer of protective cream on the wound to prevent it from worsening or becoming infected.

This again points to staff that doesn’t properly monitor a person, or clean and dry them.

Issues With Sensory Perception

A spinal cord injury can result in the loss of sensation, cognitive impairments that render the individual unable to perceive discomfort or to adequately communicate discomfort, and certain medical conditions.

A bedsore in this case ultimately forms because staff doesn’t sufficiently monitor or move a patient to avoid too much pressure on a specific body part.

Poor Nutrition and Hydration

Nutrition and hydration are important for healthy skin that can heal from injury. Individuals who lack proper nutrition and hydration face an increased risk for developing new pressure ulcers and may require longer to heal from existing ones. This is particularly true in undernourished individuals, individuals with a low body mass index, and individuals who cannot feed themselves.

The body requires sufficient macronutrients—carbohydrates, protein, fat, and water—as well as micronutrients—vitamins and minerals—to preserve the integrity of skin and to prevent its breakdown. Diets too low in protein will affect the body’s ability to produce enzymes, collagen, and connective tissue, and will prevent a wound bed.

Once again, staff that doesn’t provide proper nutrition to a patient can face liability for neglect if bedsores develop.

Medical Conditions Affecting Blood Flow

Decubitus ulcers form when staff allow someone to sit or lie down in one position for too long, limiting blood flow to an area. Certain conditions that reduce circulation, such as diabetes, can increase an individual’s risk of suffering bedsores, as poor circulation causes the skin and underlying tissues to become more easily damaged.

When bedsores develop after doctors fail to note these conditions and/or staff don’t follow appropriate treatment plans, a viable legal claim may result.

Why Decubitus Ulcers Often Point to Neglect

Despite the popular belief that bedsores are just a part of aging, they actually signal neglect, particularly when caregivers ignore certain predisposing factors, such as poor nutrition and hydration, immobility, and incontinence. Federal nursing home laws enshrine the rights of long-term care facility residents, including maintenance and improvement of the individual’s quality of life while in the facility and access to quality care.

One of the main factors that leads to neglect is understaffing. Hospitals, nursing homes, and long-term care facilities must provide enough staff to meet the needs of each patient and provide all patients with an adequate amount of direct care from licensed medical professionals. Facilities should also provide access to wound care specialists and other providers who can uphold the resident’s right to quality care.

When new patients come to a facility, they must undergo a baseline medical evaluation to develop an individualized care plan. This care plan should outline the specific medical issues that staff need to monitor, as well as any necessary assistance, such as repositioning for immobile residents or ensuring that an underweight resident is getting adequate nutrition or hydration. Staff should also receive adequate training to properly treat bedsores to ensure that they do not worsen or become infected.

An understaffed facility cannot keep up with the needs of patients and following individualized care plans. This can lead to lapses in care that can cause patients to acquire conditions such as bedsores.

What You Can Do for Your Loved One

Individuals typically enter a nursing home because they cannot accomplish all of the tasks necessary to live independently, including personal hygiene and self-care tasks, maintenance of a home, remembering to take medications, and mobility both inside the home and in society. Great reliance is placed on care providers in these facilities by the residents and their family members.

Filing a Complaint

If you believe that your loved one is suffering from neglect in a skilled nursing facility, one of the most important things that you can do is share your beliefs with someone with the authority to investigate. All states have a long-term care ombudsman program, which is an office devoted to the quality of care that nursing home residents receive.

You can file a complaint through that program, through your state’s adult protective services division (which is often part of the Department of Children and Families), or if the resident is in immediate danger, you can report your suspicions to the local police. A lawyer can help you with all of these tasks.

Federal and state nursing home laws require investigation of all complaints of elder abuse and prohibit retaliation against a resident for any complaint.

Pursuing Compensation

If your loved one endured a bedsore because of neglect or if you lost a family member due to medical complications caused by the wound, a bedsore lawyer can help you pursue compensation for the expenses and emotional impacts of the injury or loss through a civil lawsuit.

Damages in civil lawsuits refer to payments made to compensate for harm. Economic damages cover your out-of-pocket expenses incurred due to the injury. Non-economic damages compensate individuals for how their injuries affected their quality of life.

Common expenses and impacts included in cases involving decubitus ulcers are:

  • Medical expenses for the treatment of the injury
  • Relocation to another facility
  • Physical pain and suffering
  • Emotional distress

Common expenses included in nursing home wrongful death cases include:

  • Funeral and burial costs
  • Medical expenses for the treatment of the resident’s final injury
  • Loss of companionship that was provided by the deceased to his or her loved ones

Liability in Bedsore Cases

If you can prove that negligent staff failed to provide your loved one with the standard of care needed to prevent bedsores, then both the individual staff members who failed to provide care as well as the facility itself may face liability.

To establish liability, you must prove:

  • The at-fault party owed you a duty of care. The duty of care is the way that a reasonable person would react in similar circumstances. Staff members, for example, must maintain a patient’s rights to quality care and a positive quality of life. Facilities, whether nursing homes or hospitals, need procedures to uphold the patient’s right to care and properly train and staff employees to follow those procedures.
  • The at-fault party breached the duty of care. Any action that violates the required standard of care constitutes a breach. A staff member failing to follow a patient’s care plan, resulting in the development of a decubitus ulcer, would constitute the breach.
  • Fernandez Firm Accident Injury Attorneys Tampa Lawyer
    Nursing Home Abuse Lawyer, Frank Fernandez

    The breach resulted in the injury, which caused your loved one to experience expenses and psychological impacts.

If your loved one suffered a decubitus ulcer while living in a nursing home, and you suspect negligence, contact an experienced nursing home negligence attorney today. You can discuss the details of your loved one’s injuries, discuss your legal options, and determine your eligibility to pursue compensation.