Understanding the Stages of Pressure Sores

Pressure sores—also known as pressure ulcers or bedsores—are a significant healthcare concern that affects thousands of individuals each year, particularly those with limited mobility. These wounds result from prolonged pressure on the skin and underlying tissues, often occurring in people who are bedridden or use wheelchairs. Left untreated, pressure sores can progress rapidly, leading to serious complications, including infections and even death.

In this blog, we’ll explore the four stages of pressure sores, the risk factors, prevalence, and the critical importance of early intervention and care. Understanding the progression of pressure sores can help caregivers, families, and nursing home providers recognize the warning signs and take swift action.

What Are Pressure Sores?

Pressure sores are injuries to the skin and underlying tissue caused by unrelieved pressure, friction, or shear—especially over bony areas such as the heels, ankles, hips, and tailbone. The condition most commonly affects people with limited mobility, such as the elderly, those with spinal cord injuries, or patients recovering from surgery or illness in hospitals or nursing homes.

Prevalence and Impact

Pressure sores are alarmingly common and costly. According to the Agency for Healthcare Research and Quality, more than 2.5 million people in the United States develop pressure ulcers each year, and about 60,000 people die annually from related complications related to bedsores.

According to the Centers for Disease Control (CDC), in long-term care settings, up to 28% of nursing home residents experience pressure sores at some point during their stay. Additionally, treatment costs for pressure ulcers in the U.S. are estimated to range between $9.1 and $11.6 billion annually.

The Four Stages of Pressure Sores

Pressure sores are classified into four main stages based on their severity, with additional categories for unstageable wounds and deep tissue injuries. Accurate staging is crucial for determining the proper treatment plan and gauging the level of tissue damage.

Stage 1: Non-Blanchable Erythema of Intact Skin

Description:

Stage 1 pressure sores are the mildest form, involving only the outermost layer of skin. The skin remains intact but shows persistent redness (or discoloration in darker skin tones), which does not blanch (turn white) when pressed.

Symptoms:

• Red, blue, or purple discoloration
• Warmth, swelling, or hardness at the site
• Pain or discomfort
• Skin may feel firmer or softer than surrounding tissue

Common Sites:

• Tailbone or sacrum
• Heels
• Elbows
• Hips

Treatment:

• Relieve pressure by repositioning every 1–2 hours
• Use pressure-relieving mattresses or cushions
• Keep the skin clean and dry
• Improve nutrition and hydration

Prognosis:

With prompt intervention, stage 1 sores can heal within a few days. However, if pressure continues, they can progress quickly.

Stage 2: Partial-Thickness Skin Loss with Exposed Dermis

Description:

Stage 2 ulcers involve partial-thickness skin loss, affecting the epidermis and part of the dermis. The sore may appear as a shallow, open wound with a red or pink wound bed. In some cases, it may present as an intact or ruptured blister.

Symptoms:

• Visible skin loss
• Blistering or open sore
• Possible clear fluid drainage
• Mild to moderate pain

Common Sites:

• Same as stage 1, though more likely in high-friction areas

Treatment:

• Continue pressure relief techniques
• Apply moist wound dressings
• Avoid antiseptics that delay healing
• Monitor for signs of infection

Prognosis:

With appropriate care, healing time ranges from days to a few weeks, depending on the patient’s overall health and comorbid conditions.

Stage 3: Full-Thickness Skin Loss

Description:

At this stage, the sore extends through the entire dermis into the subcutaneous tissue. The wound may present as a deep crater, sometimes with slough (yellowish dead tissue), and may expose underlying fat, though not bone, tendon, or muscle.

Symptoms:

• Large, open wound
• Possible drainage or foul odor
• Signs of infection: redness, swelling, fever
• Necrotic tissue may be visible

Common Sites:

• Sacrum
• Hips
• Back of the head in bedridden patients

Treatment:

• Wound debridement (removal of dead tissue)
• Antibiotics if infection is present
• Advanced dressings and wound care products
• Nutritional support and hydration
• May require surgical consultation

Prognosis:

Stage 3 ulcers can take several weeks to months to heal and often result in scarring. Recovery depends heavily on proper wound care and underlying medical conditions.

Stage 4: Full-Thickness Skin and Tissue Loss

Description:

This is the most severe stage, involving extensive tissue damage down to the muscle, tendon, or even bone. Eschar (black, dead tissue) and slough are common. The risk of serious infection, such as osteomyelitis or sepsis, is high.

Symptoms:

• Deep, large wound
• Visible muscle, tendon, or bone
• Heavy drainage, foul odor
• High risk of systemic infection

Common Sites:

• Same as earlier stages, especially sacrum and heels

Treatment:

• Surgical intervention often necessary
• Regular wound cleaning and debridement
• Negative pressure wound therapy (vacuum-assisted closure)
• Intravenous antibiotics
• Pain management
• Long-term rehabilitation

Prognosis:

Healing may take months or even years. In some cases, the damage is irreversible, and the patient may suffer permanent disability or even death if sepsis occurs.

Risk Factors for Pressure Sores

Several factors increase a person’s risk of developing pressure ulcers:

• Immobility: Common after surgery, injury, or illness
• Incontinence: Moisture from urine or stool increases skin breakdown
• Poor nutrition or hydration
• Neurological disorders: Such as spinal cord injuries or dementia
• Age: Elderly individuals have thinner skin and reduced blood flow
• Medical conditions: Diabetes, vascular disease, and infections

Prevention is the Best Treatment for Bedsores

Because pressure sores can be difficult and expensive to treat, prevention is crucial. Strategies include:

• Repositioning patients frequently (every couple of hours)
• Using support surfaces like specialized mattresses and cushions
• Monitoring skin daily, especially over bony prominences
• Keeping skin clean and dry
• Maintaining good nutrition and hydration
• Training caregivers and staff on pressure ulcer prevention

A study in Advances in Skin & Wound Care found that multidisciplinary prevention programs can reduce the incidence of pressure ulcers by more than 50% in long-term care settings.

Legal Implications of Bedsores and Nursing Home Neglect

In many cases, pressure sores—especially those in later stages—are preventable with appropriate care. Their presence, particularly in nursing homes or hospitals, can indicate negligence. Understaffing, lack of repositioning, and inadequate hygiene are all potential signs of substandard care.

Families with loved ones suffering from advanced pressure sores should consider consulting with an experienced Illinois nursing home abuse attorney, as facilities can be held liable under both civil and regulatory standards.

Contact the Top-Rated Illinois Nursing Home Abuse and Neglect Lawyers at John J. Malm & Associates

Pressure sores are not just a healthcare inconvenience—they are a serious medical condition that can significantly impact quality of life, prolong hospital stays, and even lead to death. Fortunately, early detection, prevention, and proper wound care can dramatically reduce their severity and prevalence.

Healthcare providers, caregivers, and family members all play a role in prevention. Recognizing the stages of pressure sores is the first step toward better outcomes and avoiding unnecessary suffering.

If you or a loved one developed a pressure sore in a nursing home, contact John J. Malm & Associates for a free consultation. Don’t wait to take action. Let our award-winning Illinois elder abuse attorneys help you get the compensation you deserve.