What Causes Bruising in Elderly
Have you noticed that an older member of your family is bruising more than usual? Elderly bruising is quite common, and a number of risk factors make it more likely to happen. If you're here, you may be worried about the number of bruises you're seeing on someone you care about. By learning more about how elderly bruising happens and the factors that make bruises common, you may be able to put your mind at ease.
What Is a Bruise?
Everybody's skin has several layers. Beneath those layers, there's a network of small blood vessels called capillaries. When someone falls over or they're hit sharply by something or someone, their capillaries may burst. The blood that then leaks from them will cause a temporary and visible mark that is a bruise.
As bruises usually arise from injuries, the body's inflammatory response kicks into action too. By sending inflammatory markers to the injured area, the bruised person's body is helping it to heal. Those markers also cause swelling and tenderness, which means bruises are often uncomfortable.
Does Age Affect How You Bruise?
Certain factors make bruising more likely, and age is one of them. As people get older, the amount of collagen and elastin they produce declines. Together, those proteins provide skin that's firm, taut, and sturdy. A loss of collagen and elastin results in skin that's looser and more fragile.
Elderly bruising is more common than bruising in younger people because an older person's skin is thinner. As the skin is thinner, it doesn't provide as much protection to the network of capillaries beneath. Additionally, thinner skin is easier for others to see through. This means that elderly bruising is more common and it's more noticeable.
What Are Some Common Hazards that Increase Falls?
A lot of older people have a higher fall risk than their younger counterparts. This means that elderly bruising is quite common partially because falls are more common. As people age, their muscles begin to lose their tone and their bones lose some of their density. Together, these factors can result in less stability, making it easier for a senior person to fall over.
Chronic Health Conditions
Many older people suffer from chronic health conditions that increase their risk of elderly bruising. One example of this is postural hypotension. If someone suffers from postural hypotension, their blood pressure will drop suddenly when they go from sitting to standing. When their blood pressure drops to the extent that they can't maintain their balance, they may fall over and injure themselves.
Dementia may also increase the risk of elderly bruising, as individuals with dementia experience a decline in their activity levels. If you have a relative who suffers from dementia, you can decrease this risk by helping them to stay active and use their muscles.
Other rarer conditions such as Meniere's disease also make it easier for a person to fall. A disorder of the inner ear, Meniere's disease can cause someone to suddenly lose their balance. If this happens, they may struggle to remain upright, resulting in a fall.
Poor vision is a common complaint that affects a lot of older people. If someone is partially sighted, they may miss some of the hazards that are obvious to others. Additionally, if they have poor peripheral vision, they may not notice the hazards that are coming toward them. Falls as a result of reduced vision are a common cause of elderly bruising.
Sometimes short-term illnesses make it easier for people to fall over. A condition called labyrinthitis sometimes occurs following a viral illness. Like Meniere's disease, it affects the inner ears, resulting in poor balance. If a relative is suffering from labyrinthitis, you should advise them to reduce their usual activities until it ends.
Everyone is at risk of falling when they regularly walk over uneven surfaces. Being older and having poor balance can increase a person's chances of having an accident. If that person is living in a property surrounded by uneven surfaces, they need to address the issue to decrease their fall risk
The Wrong Footwear
Wearing footwear that has a poor grip or that doesn't fit correctly makes it easier for people to fall. Because of this, it's important for all older people to check their footwear every three months to make sure the sole is still adequate.
Icy or Wet Weather
When it's cold outside or it's raining a lot, falls are more likely to happen. Rain is particularly problematic as it may result in wet leaves that are difficult to spot. It's important for older people to always take extra care when walking in wet or icy environments.
A Lack of Property Adaptations
As people get older, their ability to navigate their way around their homes may decrease. Fitting handrails and using anti-slip surfaces in showers are two of the ways older people can adapt their property to make it safer. Additionally, they should look out for loose floorboards and frayed pieces of carpet, especially at the top of stairs.
As you can see, there are lots of reasons for elderly bruising to be more common than bruising in younger people. If you're reading this for a relative and you notice any of the risk factors above, it's worth addressing them promptly. Although not all falls will result in a serious outcome, reduced bone density in senior people does result in an increased risk of breaking a bone.
Which Medical Conditions and Medications Can Increase Bruising?
Certain medical conditions and medications make elderly bruising more likely to happen. Additionally, some can make bruising look alarming and others make bruises more dangerous.
Low Platelet Count
Individuals who have a low platelet count don't produce as many clotting factors as other people. As a result, any bruising they encounter may look larger than the bruises other people experience. A common cause of low platelets is rheumatoid arthritis. If you know someone who is regularly experiencing large bruises, their doctor may wish to perform some blood tests.
Chronic Kidney Disease
Chronic kidney disease is more common in the elderly population. It has a direct effect on the patient's clotting factors, which makes bruising more likely. The extent of their bruising may vary according to the stage of their disease. If someone you know has CKD, it's likely that their doctor is monitoring the condition.
Low Vitamin K
A number of medical conditions result in low vitamin K and some of them are quite rare. As vitamin K is essential for clotting, having less of it makes bruising more likely. In a lot of cases, patients are already aware of their low vitamin K disorder and receive appropriate therapies to manage it.
Long-Term NSAID Use
Non-steroidal anti-inflammatory drugs (NSAIDs) include medications such as Naproxen and Ibuprofen. They work by disrupting an enzyme that leads to swelling and pain. Unfortunately, this enzyme disruption can also lead to side effects such as increased bruising. If you have a relative who is using NSAIDs for pain relief, ask them to discuss alternative analgesics with their doctor.
Using steroids such as prednisolone can result in the patient's skin becoming thinner. Such steroids are often used in difficult-to-control asthma and for chronic obstructive pulmonary disease.
Many senior individuals take anticoagulants to reduce their stroke risk. Drugs such as Warfarin make the blood thinner, which then makes it easier to bruise.
Naturally, the list of medications above isn't exhaustive. As a result, if someone you know is experiencing bruising more often than normal, it's worth asking them to seek medical advice so they can identify the cause.
When to Worry About a Bruise
In many cases, elderly bruising isn't anything to worry about. Although they can be distressing to look at, the majority of bruises will turn yellow and eventually fade away. There are some times, though, when you need to pay close attention to bruising.
Sometimes bruises can turn into hematomas. Hematomas are big collections of blood that gather beneath the surface of the skin and trap themselves within a tissue. They're more likely to occur when elderly bruising arises as a result of significant trauma. However, they can also arise following common medical procedures, such as taking blood and inserting a cannula.
In a lot of cases, hematomas aren't a cause for concern. However, you should watch out for the following accompanying symptoms and raise them with a medical professional quickly if they occur in someone you know:
- Numbness or tingling around the site of the bruise
- Sudden loss of function in a limb
- A bruise that keeps appearing in the same spot
- A bruise that lasts longer than two weeks
- A bruise that is getting larger and won't go away
- Loss of sight
- Bruises appearing on the trunk of the body without an identifiable cause
Any bruises that appear behind someone's ear immediately following head trauma should receive emergency medical attention. Such bruises are a potential sign of significant brain bleeding following trauma.
How Can You Detect Potential Elderly Abuse?
One of the biggest concerns people have about elderly bruising is that it's a sign of elderly abuse. Such concerns become even more worrying when the person in question struggles with communication. Or, when they have a poor memory.
Fortunately, the majority of bruises aren't there because abuse has occurred. With that said, it's worth understanding what the signs of elderly abuse are so you can keep your loved one safe.
The Bruise Has No Explanation
Any bruises that appear on your relative should come with an explanation. For example, your relative may willingly tell you about a fall they had. Or, the residential facility they're living in may provide a record of a witnessed fall. Although not all unexplained bruises are a sign of elderly abuse, it's worth being cautious when one appears.
The Bruise Can't Be Explained by a Fall
Some bruises can't be explained by a fall. For example, a series of small bruises at the top of someone's arm is more indicative of fingers being pressed into the skin than a person falling over. Similarly, bruises that appear in very fatty areas or around the jaw are less likely to occur following a fall. Be particularly wary of elderly bruising that bears a resemblance to an inanimate object.
It Keeps Happening
There's always a chance that repeated incidents of bruising are due to medical causes. However, it's also a sign that someone is suffering from abuse. If there's no clear medical cause, question where the bruise is coming from.
Reluctance to Discuss the Bruise
Sometimes people who are being abused are too scared to discuss their abuser. They may feel ashamed of what's happened or they may fear the repercussions of speaking up. When someone wants to avoid talking about where their bruise has come from, investigate whether it's because they feel scared to speak up.
Other Signs of Neglect
It's often the case that elderly abuse occurs in an environment where someone is unable to care for the older person. Other signs of neglect can include losing weight, wearing dirty or ill-fitting clothes, poor hygiene, and repeated infections.
Individuals who are being abused often become withdrawn. If you've noticed a change in someone's personality, question what the cause is.
How Can You Help Reduce the Risk of Elderly Bruising?
In many cases, elderly bruising will disappear by itself. Although it may not look very nice, it isn't a significant source of discomfort.
However, it's normal to want to reduce the likelihood of bruising. If you're worried about a relative, you'll naturally dislike the idea that something is causing them to bruise.
Reducing the risk of elderly bruising usually involves eliminating risk factors. For example, if someone is repeatedly falling over, try to find out why this is happening. If the falls regularly occur in one area of their house, it may be because that environment needs modifications. Or if they routinely bruise when nobody else is at home, they may need to go into an assisted living facility.
In the event that a medication is causing bruising, it's always worth asking a doctor about using alternatives. However, you should also remember that your doctor will be keen to continue using a medication if it's the best available one. Using blood thinners to reduce someone's stroke risk is more important than avoiding the occasional bruise.
At Bethany Home Care, we offer assisted living facilities to older people in Alameda and Contra Costa Counties. Our home-like environment helps our residents maintain their independence while staying safe. If you'd like to discuss using our assisted living facilities, contact us.