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Pressure Injury in Older Adults

Pressure Injury in the Elderly: Pathogenesis and clinical findings Pressure injury is a localized injury to skin and soft tissues caused by prolonged pressure, shearing forces (underlying tissues &/or bone move while skin remains stationary), moisture, &/or friction between skin Authors: Shiva Ivaturi, Jake Thorsteinson Reviewers: Anika Zaman, Luiza Radu, Catherine R Jarvis, Carolyn Wong* *MD at time of publication Reduced mobility +/- prolonged immobilization (e.g., surgery, hospitalization, spinal cord injury) Uncontrolled diabetes mellitus Chronic venous insufficiency Age-related ↓ metabolism & ↓ nutrient & fluid intake Glucose regulation is impaired & causes hyperglycemia (↑ intracellular glucose) ↑ Venous pressures in extremities Tissues undergo sustained external pressure ↑ Tissue temperature ↑ Oxidative stress (imbalance in reactive oxygen species) ↓ Venous valve function causes venous stasis (impaired blood flow through veins) Body becomes dehydrated Arterial & venous blood flow to affected area are impeded ↓ Oxygen efficiency in tissue circulation Sensory nerves become dysfunctional (especially distally in the feet) Fluid leaks into surrounding tissues ↓ Skin turgor (elasticity) Insufficient nutrients for tissue repair ↑ the body’s susceptibility to tissue damage ↓ Perfusion & tissue oxygenation ↓ Sensation of pain, touch, & proprioception ↑ Skin breakdown Worsens existing wounds or tissues prone to wound injury ↑ Cell death causes chronic & large wounds Epidermal (topmost skin layer) breakdown exposes deeper necrotic (dying) skin layers Lactate (marker of local acidosis from ischemia) is released Involves & damages additional nerves Microbial flora from skin, gastrointestinal tract, &/or urogenital mucosa colonize the wound Stimulates nociceptors (detectors of harmful stimuli) Deep tissue &/or bone infection Skin &/or superficial infection Pain ↓ Mobility/ prolonged immobility ↑ Risk of chronic pain disorder ↑ Risk of mood disorders (depression) ↑ Risk of delirium Periostitis (inflammation of bone’s outer layer) Septic arthritis (bacterial joint infection) Osteomyelitis (infection of bone) Cellulitis (bacterial skin infection) Bursitis (inflammation of joint bursa) Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Jul 7, 2026 on www.thecalgaryguide.com Creative Commons