Expert: Mary Gordon - 12/28/2006

Question
what will happen when the body no longer has the capacity to heal the bedsores and they become infected and do not respond to antibiotics.the skin and sinuses seem to be breaking down is this a sign of end stage of the disease? I would be really grateful for any information

Answer
Pressure sores are a problem with anyone who is bedridden or in a wheelchair, particularly those with dementia. They tend to be thin, so they have even less padding over their bones than a healthier person, they may not feel pain , and their muscular coordination  is compromised, meaning they can't move around to change positions frequently. In many frail elderly, there are other health problems affecting circulation, immune system function - and so often they are very, very slow to heal. Certainly poor nutrition (common in dementia patients with eating problems) makes everything worse. On top of that is incontinent, since moist or soiled skin (i.e. over the buttocks in a diaper) breaks down easier and is more readily infected.

So pressure sores aren't inevitable, but they are certainly a sign that the person is teetering on the edge. People quite often die from complications related to the pressure sores (that is what killed quadiplegic actor Christopher Reeve, and he certainly got exceptional care - but developed bedsores and infections none the less.)

What you are seeing is not from the dementia itself - although they are much more prone to them, and the dementia adds a degree of difficulty to prevention AND to treatment, and also leads to complications - they are not inevitable. What you describe is a function of the stage of the bedsores. Hee is a description of wound severity stages from bedsores.
http://www.expertlaw.com/library/malpractice/decubitus_ulcers.html

First thing to do is to try and get the current sores dealt with, and surgery may be required. But more important is to prevent new ones - if your loved one is in a nursing home, you need to ensure that more active efforts are made to prevent them. Here are very general helpful tips
http://www.carepathways.com/cto14.cfm

You might want to look into what medicare will pay for, as they will pick up the tab for devices like air fluidized mattresses in patients with besores that won't heal. These devices are worthwhile, since they not only promote better and faster healing of existing sores, but prevent recurrence and formation of new sores. Lots of good info here
http://www.decubitus.org/index.html

Hope this helps.

Mary G.