A pressure ulcer, also known as a bedsore or pressure injury, is an injury to the skin and underlying tissue caused by prolonged pressure. This constant force disrupts blood flow, leading to tissue damage and eventually cell death. They form over bony areas of the body, such as the hips, tailbone, ankles, and heels. The severity can range from a patch of discolored, painful skin to a deep, open wound that exposes muscle or bone.
Prevalence in Healthcare Environments
Prevalence rates for pressure ulcers fluctuate by healthcare setting. In acute care hospitals, between 6% and 18.5% of patients may develop one. Rates are higher in intensive care units (ICUs), ranging from 16.6% to 29% due to the critical condition and immobility of patients.
Long-term care facilities, such as nursing homes, also report high numbers of these injuries. Global reviews show prevalence in these environments can range from 3% to over 32%. Data from 2004 indicated that 11% of U.S. nursing home residents had a pressure ulcer, and these facilities continue to manage a high burden of these wounds.
In home healthcare, prevalence rates have been documented from 0% to 29%. One survey of patients admitted to home care found that over 9% had a pressure ulcer. This shows that individuals receiving care at home remain susceptible, often due to chronic conditions and limited mobility.
Identifying At-Risk Demographics
Advanced age is a prominent risk factor. Research indicates that 73% of hospital-acquired pressure ulcers occur in patients older than 65. This is often due to the increased likelihood of having associated problems like chronic illness, dry skin, and reduced mobility.
Immobility is a major predictor for developing pressure ulcers. Individuals with conditions that limit movement are at high risk, such as patients with spinal cord injuries, who show a prevalence of 20% to 30% within five years of injury. Patients who are bedridden, wheelchair-bound, or have neurological disorders are also more likely to experience the unrelieved pressure that causes tissue damage.
Specific health conditions also increase a person’s risk. Chronic diseases like diabetes and vascular disease compromise circulation, making tissues more susceptible to injury from pressure. Malnutrition and incontinence are other contributing factors, as poor nutrition weakens the skin and excess moisture can lead to skin breakdown.
Financial and Mortality Costs
The annual cost of treating pressure ulcers in the United States is between $9.1 billion and $11.6 billion. One analysis from 2016 estimated that government spending on hospital-acquired pressure injuries surpassed $26.8 billion. These expenses are driven by intensive resources and an increase in the length of hospital stays, which is extended by an average of over four days for these patients.
The cost to treat an individual pressure ulcer varies with its severity, with estimates for care ranging from $20,900 to $151,700. These figures account for specialized dressings, potential surgical interventions, and the extended nursing care required to manage the wound and prevent complications.
Pressure ulcers are also associated with a significant increase in mortality. Approximately 60,000 patients in the U.S. die each year from complications such as sepsis. For older patients, developing a pressure ulcer is linked to a fivefold increase in mortality risk, as the wound itself can introduce life-threatening infections.