Bedsores that progress to stage 4 in elderly patients become life-threatening and severe. While some patients no longer experience pain with stage 4 bedsores due to advanced tissue and nerve deterioration, other patients experience excruciating pain with stage 4 bedsores. Due to the large differences in health conditions and environment, stage 4 bedsore management varies drastically between elderly patients. For example, stage 4 bedsore treatments for elderly patients with chronic or terminal illnesses may focus entirely on minimizing pain, as opposed to healing the wound.
What is a Stage 4 Bedsore?
A stage 4 bedsore is a pressure ulcer that has been allowed to progress through stage 1, stage 2, and stage 3 of bedsore development. Stage 4 bedsores may occur in conjunction with other medical skin conditions, but in many cases stage 4 bedsores occur due to the result of nursing home negligence or elder caretaker negligence. Nursing home malpractice, or assisted living facility malpractice, may also result in stage 4 bedsores due to the incorrect treatment of earlier stages of the patient’s bedsores.
Stage 4 bedsores typically occur around areas of an elderly patient’s body that are boney, with little to no fat tissue protecting the deeper tissues. Stage 4 bedsores are life-threatening, and elderly patients with stage 4 bedsores are likely suffering from multiple infections. There is a serious loss of skin, fat, and bone, tendon, or muscle tissue during a stage 4 bedsore. The tissue damage of a stage 4 bedsore can extend far beyond view of the open wound, so that there are actually dead and damaged tissues laying beneath seemingly healthy skin surrounding the bedsore wound.
What Does a Stage 4 Bedsore Look Like?
Stage 4 bedsores will appear as a large, gaping area of damaged and dead tissues. The elder patient’s joints, muscle fibers, tendons, ligaments, or bones in the affected area are visible and dying. The damage from the stage 4 bedsore will likely appear black and rotten, with crusty tissues that have died without being removed from the wound.
An elderly patient with stage 4 bedsores is battling infection, and he or she may never fully recover. Common infections affiliated with stage 4 bedsores include cellulitis or sepsis. A stage 4 bedsore is frightening in appearance. For this reason, most persons lacking medical expertise are not even capable of visually examining stage 4 bedsores.
Stage 4 Bedsore Therapy
Stage 4 bedsore treatment is more accurately described as stage 4 bedsore management for most elderly patients. Although stage 4 bedsore treatment can be aimed at actually healing the open wound, many elder patients are not healthy enough to fully recover from a stage 4 bedsore. As a result, there are many medical processes in place that focus entirely on minimizing pain and discomfort for an elderly person with stage 4 bedsores.
Stage 4 bedsore management may involve the following:
- Changing positions. Changing the position that an elderly patient is sitting or laying in is a necessary part of both bedsore prevention and bedsore treatment. The bedsore is caused by remaining in the same position for an extended period of time, placing pressure on specific areas of the elder patient’s body and causing a lack of blood flow to those body parts. By changing positions and alleviating pressure on an elder’s stage 4 bedsore, pain may be decreased and the wound may be given an opportunity to heal.
- Debridement. Debridement of a stage 4 bedsore focuses on removing any dead tissues of the affected area to minimize further risk of infection. Medical professionals may debride stage 4 bedsores with natural or man-made enzymes, ultrasounds, debriding dressings, biological debriding procedures, or surgical removal of dead and damaged tissues. Some doctors may also clean the stage 4 bedsore with a saline rinse.
- Medication. Newer medications have been developed to help elderly patients heal bedsore wounds. While some of these medications are still in experimental phases, elder patients with severe stage 4 bedsores may opt to try the new medications. In addition, antibiotics or pain relievers may be used to treat any infections and alleviate pain.
- Negative pressure therapy. While the effectiveness of negative pressure therapy varies between patients and seems to rely heavily on the combined use of other bedsore treatment procedures, some elder patients experience success using negative pressure therapy after surgical debridement. Negative pressure therapy removes the rest of a patient’s dead tissues and promotes the formation of new, healthy tissues.
- Air fluidized therapy. This type of bedsore therapy is most frequently accomplished by using air fluidized beds. Air fluidized therapy appears to be most effective with suspected deep tissue injury in elderly patients. It may also help as a form of bedsore prevention.
Berman, Kevin. “Pressure Ulcer.” Medline Plus. Atlanta: 2012. <http://www.nlm.nih.gov/medlineplus/ency/article/007071.htm>.
Bluestein, Daniel and Ashkan Javaheri. “Pressure Ulcers: Prevention, Evaluation, and Management.” American Academy of Family Physicians. 2008. <http://www.aafp.org/afp/2008/1115/p1186.html>.