Patients at risk are those who have limited mobility and spend a great deal of time in bed or sitting. This can be at home, in a nursing home, a hospital, or in a retirement home. The causes for being bedridden include spinal cord injuries, strokes, progressive neurological disease, fractures, comas, and those in intensive care units (ICU). Around 70% of bed sores occur in patients over the age of 65. The remainder occur in younger patients who suffer from issues that leave them in the bed. Bed sores develop from the abuse of the skin due to immobility, as well as prolonged exposure to moisture. Bed sores lead to a decreased quality of life as well as increased mortality and morbidity. They are localized injuries to the skin or underlying soft tissue, usually overlying a bony prominence. This includes the bottom, the ankles, the heels, or the hip bones. However, they can occur at the site where a patient is hooked to a ventilator and are constantly rubbed against by the equipment or tubing.  They develop due to unrelenting pressure to the area, which blocks the flow of oxygen and nutrients to the affected area, causing cell death.  This can happen despite a caregiver's best attempt at preventing them. However, some cases develop due to inattention and elder abuse.  Elder abuse is a public health concern despite being grossly under-reported and under-detected. The severity of bed sores ranges from stage I to stage IV. The state of the bed sore affects the health of the patient and changes the kind of treatment necessary.  Stage I is when the sore is an area of redness over a bony prominence, that will not turn pale when pressed with your finger. The redness will not go away or get better.  Stage II entails the loss of partial skin thickness to the outermost layer of skin. Often a shallow wound with a pink-red base will occur at the site with a clear fluid filled blister overlying this shallow wound.  Stage III consists of a wound with total loss of the thickness to the outer layer of skin, which cuts into the underlying layer of skin. The wound is not too severe, does not continue into the muscle layers and bone, and the tendons and muscles are not exposed. Stage IV is when all the outer and inner layers of skin are gone, exposing the underlying muscle layers. The bones, tendons, and muscles may be exposed. If there is no underlying fat in the area, the sores, such as those on the ears or nose that occur from respiratory devices, are classified stage IV as well.
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