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Life Bedsores that torture the immobile are highly preventable

Bedsores sound like a pretty innocuous problem.

But bedsores -- or, to use the correct medical terminology, pressure ulcers -- are not merely a cosmetic problem.

Every year, complications from bedsores kill thousands of Canadians. Treatment costs exceed $1.1-billion.

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Those numbers, as shocking as they are, do not begin to capture the severity of the problem. Nor do they adequately convey our failure to take seriously a scourge that tortures the most vulnerable members of our society, the frail elderly and the severely disabled.

Bedsores are horribly painful and disfiguring. They rob patients of dignity and quality of life. They are prohibitively costly to treat -- as costly as a heart transplant in some cases.

Bedsores are also a key marker of poor overall prognosis: When you begin to develop severe pressure ulcers, your chances of recovery diminish sharply; it is, if you will, the beginning of the end.

Yet, bedsores remain disturbingly common among patients and residents of acute-care hospitals, nursing homes, long-term care facilities and home-care programs, as well as a constant health threat to people with severe mobility problems.

It also needs to be stressed that bedsores are largely preventable. In fact, doing so is essential, because effective treatments are few and far between.

Pressure ulcers are areas of damaged skin and tissue that develop when sustained pressure -- generally from a bed or wheelchair -- cuts off circulation. The most vulnerable areas are those padded with muscle or fat that lie just over a bone -- the buttocks, hips, heels. When tissue is deprived of oxygen, it can die in a matter of hours.

What begins as a patch of red skin can quickly become a crater-like wound that opens the body up to gruesome, excruciating complications such as bone infections, necrotizing fasciitis (flesh-eating disease), myonecrosis (a severe form of gangrene), sepsis (blood poisoning) and even skin cancer.

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In a recent article in the Journal of the American Medical Association, three respected Canadian and U.S.-based researchers provided a sobering look at what we know about bedsores and their prevention.

Paula Rochon, a senior scientist at the Baycrest Research Centre for Aging and the Brain in Toronto, Sudeep Gill of the department of geriatric medicine at Queen's University in Kingston, and Madhuri Reddy, a wound-care specialist at the Hebrew Rehabilitation Center in Boston came to a sobering conclusion: Despite the breadth of the problem of bedsores, there is a sorry lack of investment in prevention, and little decent research to find the most effective methods.

Still, their paper provides a good overview of the current evidence about what works (and, by extension the interventions family members should insist on to protect their loved ones in care facilities):

Good beds: Standard hospital beds are bedsores' best friends, the root of most problems; there are a number of mattresses -- alternating pressure, low-air-loss, air-fluidized -- and overlays that can greatly reduce the likelihood of pressure ulcers. They cost more, but they are cost-effective and humane forms of treatment, particularly for bed-ridden patients;

Repositioning: Every day, while sitting, lying down, driving, we make hundreds of postural adjustments. But people immobilized by paralysis, injury or illness have to be assisted to move. Patients should be turned every two hours to avoid bedsores. But understaffing and shortages of professional caregivers such as nurses means this is not happening routinely;

Treatment of incontinence: Patients who suffer incontinence -- urinary or fecal -- are at greatest risk of bedsores because their skin is moist, and the bacteria in feces prey on pressure ulcers. Regular changes of continence pads and washing are essential to good health;

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Nutrition: Poor diet, notably a lack of protein, vitamin C and zinc, makes the skin more susceptible to wounds;

Skin health: Dry skin cracks and blisters. People who are immobile need a regular application of lotion. When bedsores do occur, they need to be treated promptly and thoroughly with cleaning, debridement (removal of dead tissue) of wounds and regular dressing changes.

The frequency of bedsores varies wildly by institution -- 0.4 to 38 per cent of patients in acute-care hospitals get them, 2.2 to 24 per cent in long-term care facilities, and 0 to 17 per cent in home care, according to the JAMA article. Some facilities are doing prevention the right way, but many are doing it terribly wrong.

Bedsores are not just a medical problem. They are a barometer of the quality of care -- a direct result of second-rate basic equipment like beds, of understaffing and lack of treatment protocols, of poor nutrition and lack of hands-on care.

It takes time and it takes workers to turn patients regularly, to accompany them to the toilet, to do proper skin care and therapy.

Bedsores are a pervasive challenge, and a malady that needs to be tackled aggressively, with all the prevention and treatment tools at our disposal. We cannot sit idly by while this problem festers.

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apicard@globeandmail.com

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