A bruise, also known as a contusion, forms when small blood vessels under the skin break due to injury, allowing blood to leak into surrounding tissues. This trapped blood initially appears as a red or purplish mark, which then changes color as the body reabsorbs it. While bruising can occur at any age, it is a common observation in older adults. This increased susceptibility is often a normal part of the aging process, but it can also sometimes indicate other underlying issues.
Normal Age-Related Skin Changes
As individuals age, the skin undergoes several structural and physiological transformations that make it more vulnerable to bruising. The protective layers of the skin become thinner over time. This thinning means that the delicate blood vessels lying beneath the skin’s surface are less protected and more prone to damage from even minor impacts.
A significant factor contributing to easy bruising is the loss of subcutaneous fat, which normally acts as a cushion, providing support and protection for blood vessels. With its reduction, blood vessels are more exposed and can rupture with less force. Furthermore, the walls of capillaries and surrounding connective tissues weaken with age, increasing their fragility. The skin also experiences reduced production of collagen and elastin, proteins that provide strength and elasticity, compromising its ability to protect underlying blood vessels.
Medications That Increase Bruising
Several classes of medications commonly prescribed to older adults can significantly increase the likelihood or severity of bruising. Anticoagulants, often referred to as blood thinners, are a primary example. These medications, such as warfarin, rivaroxaban, apixaban, and dabigatran, work by reducing the blood’s ability to form clots, which can lead to larger and more extensive bruising even from minor trauma.
Antiplatelet drugs, including aspirin and clopidogrel, also contribute to increased bruising by inhibiting the function of platelets, blood cells vital for clotting. When platelet function is impaired, blood takes longer to clot, allowing more blood to leak out and form a bruise. Long-term use of corticosteroids, like prednisone, can thin the skin and weaken blood vessels, making them more fragile and susceptible to damage. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen and naproxen, while primarily pain relievers, have a mild antiplatelet effect that can also contribute to easier bruising. It is important for individuals not to discontinue any prescribed medication without first consulting their healthcare provider.
Underlying Health Conditions
Beyond normal aging and medication use, certain underlying health conditions can also predispose older adults to increased bruising. Blood disorders, such as thrombocytopenia, characterized by a low platelet count, impair clotting. Other conditions like hemophilia and von Willebrand disease involve deficiencies in specific clotting factors, leading to prolonged bleeding and easy bruising.
Liver disease can significantly impact the body’s ability to clot blood, as the liver produces proteins vital for coagulation. When liver function is compromised, the production of these clotting factors decreases, resulting in a higher propensity for bruising. Severe kidney disease can also affect platelet function, further contributing to easy bruising. Nutritional deficiencies play a role as well; a lack of Vitamin C can weaken capillary walls and impair collagen production, while a deficiency in Vitamin K, vital for clotting, can lead to impaired blood clotting.
When to Consult a Doctor
While many instances of bruising in older adults are benign and related to age-related changes, there are specific situations that warrant medical attention. It is advisable to consult a doctor if bruising appears without a known injury or if the bruises are unusually large or painful. Bruises occurring in unusual locations, such as the torso, back, or face, without a clear explanation, should also prompt a medical evaluation.
Furthermore, seeking medical advice is important if bruising is accompanied by other concerning symptoms, including fever, unexplained weight loss, persistent fatigue, or bleeding from the gums or nose. A sudden increase in the frequency or severity of bruising, or the appearance of new bruising after starting a new medication, also indicates a need for professional assessment.