Bruising in the Elderly: Causes and Prevention

If you suddenly see bruises on your elderly mom’s skin and she can’t tell you where they came from, don’t assume the worst. It’s actually quite normal for elderly people—especially women—to have unexplained bruises. The goal is to minimize their occurrence and treat them if they are especially severe.

How Bruises Form

When you sustain an injury, it may damage your small blood vessels beneath the skin without actually breaking the skin. The blood vessel can burst, leaking blood into the surrounding tissue. But the blood has nowhere to go, since your skin is still whole. It pools under the skin, causing discoloration and sometimes swelling.

Then the blood clotting action kicks in, and the bruise gradually heals itself. In the meantime, its colors wane from red to purplish-black, to green or yellow-brown, until the bruise disappears completely after about two weeks. The area feels tender at the beginning, but the pain fades together with the bruise.

Seniors bruise more easily because their skin is much thinner and less flexible. The blood vessels also become more fragile with age, making them more likely to burst from an injury. In addition, wounds heal more slowly as we age, so bad bruises will hang around longer.

Causes of Elderly Bruising

1. Mild Trauma

Bruises can come from some kind of blow to the body. Falling is one common way to sustain bruises. But if your parent is sure they didn’t fall, it’s equally likely the bruise came from bumping into something or knocking against a piece of furniture. Since seniors bruise much more easily, it was likely just a minor bang and they already forgot about it.

If they recently had a blood test or IV, the needle could have caused bruising as well. Whenever trauma is the cause of the bruise, or if you’re not sure where the bruise came from, apply ice and raise the area above the heart if possible.

2. Medications

Seniors who take medications such as blood thinners, aspirin, corticosteroids, or chemotherapy can develop bruising as a side effect. If your parent or loved one is taking one of these treatments and suddenly develops bruises, speak to their doctor about adjusting the dose. Changing the medication may also help reduce or eliminate bruising.

3. Actinic Purpura

This kind of bruising doesn’t come from impact. Actinic purpura comes from years of sun exposure. Too much sun weakens the blood vessel walls and eventually causes them to burst. The bruises this condition causes often look like large, purplish freckles. They show up clearly on aging skin, and may alarm you at first. In most cases, actinic purpura is harmless and does not need treatment. However, you should mention them at your parent’s next medical appointment so the doctor can check them out just in case.

4. Vitamin Deficiency

Deficiencies of certain vitamins and minerals can cause bruising. Among these are vitamin C, vitamin D, and folate. Speak with your loved one’s doctor about adding vitamin supplements to their diet.

5. Serious illness

Significant bruising may point to health issues such as leukemia or other blood diseases. Liver disease can also cause bruising, since it’s the liver that’s responsible for producing blood-clotting factors.

How to Prevent Elderly Bruising

You can’t prevent all bruises, but you can take some steps to lower your parent’s chances of injuring themselves.

First, make sure their surroundings are safe. If your mom is a resident in a skilled nursing facility, she’s in a safe environment with care professionals always nearby to keep a close eye on her. But if she’s at home alone, she’s at higher risk of sustaining injuries, including bruises.

Make sure your parent’s room is lit with a nightlight, so if they get out of bed at night they can avoid bumping into things. Follow fall prevention guidelines, as outlined in our blog post How To Prevent Senior Falls . 


Selecting Long Term Senior Care

Selecting Long -Term Senior Care
A Guide to Making Informed Choices

Mom hardly cooks anymore, and often skips her medication. She’s definitely not taking care of herself or the house as she used to. You’re afraid that she might forget to turn off the gas, or stop cooking for herself altogether. The next fall could land her in the hospital. Is it time to sit down as a family and decide what is best to safeguard the years you have left with her?IMG_1233

Dad has piles of newspapers in the living room and dirty dishes all over the kitchen. He’s often forgetful and confused when you ask him about important matters concerning his finances and upkeep of the house. Worse, you know he’s not taking his blood pressure medicine on a regular basis. What if he has a stroke, even a minor one, and no one finds him for hours afterward?

The scenes described above are played out in thousands of homes each and every day. If you can relate to one of them, it is comforting to know that there have never been more or better options when it comes to long-term senior care. This article is designed to educate family members about those choices and help them select the one that offers the most appropriate services, in the most comfortable setting, and that will allow their loved ones to live the fullest possible lives.

How Do You Know When the Time is Right?
The reality is that at some point, even the healthiest and most robust senior will likely require some level of assistance outside the home. If your loved one is experiencing ongoing health difficulties or needs assistance with activities of daily living, take a few moments to answer the questions below. If you can answer yes to any of them, the time has probably come to make a decision concerning long-term care.

• Has your loved one’s advancing age or a chronic health condition resulted in seriously
diminished strength and inability to function independently?

• Has it become increasingly difficult for family members and friends to provide adequate care
without regular professional support?

• Have escalating clinical needs or changes in behavior rendered the current setting for care
inadequate or unsafe?

When Everyone Suffers
All too often, a sense of guilt keeps people from seeking the help they need to care for aging parents or a family member who can no longer function independently. Despite ever-increasing physical and emotional demands, they nevertheless attempt to care for their loved ones themselves and frequently jeopardize their own physical and mental health in the process. At-home caregivers frequently push themselves to the limit and put a greater burden on themselves and their families than anyone can be expected to handle. In these situations it is important to make a prompt but well-considered decision that is in the best interest of everyone involved.

Responding to Changing Times and Changing Needs
Over the years, long-term care has developed and evolved, adjusting to meet changing times and responding to many different needs – the health of the older adult, his or her mental capabilities, the desire for social interaction, and the family’s ability to participate in the care.

Long-Term Care Options
In choosing long-term care you will be addressing the health, personal care, lifestyle and social needs
of your loved one. There are several options to consider. Some of these are transitional, some
are permanent, and most offer social and recreational services along with professional healthcare support. The following brief descriptions will give you a basic understanding of the most readily available alternatives.

Assisted Living Residences – Assisted living provides relatively independent seniors with health care support and personal assistance in a home-like environment. Typical services may include:
• Private or semi-private rooms

• Three meals a day served in a common dining area

• Housekeeping

• Transportation

• Assistance with activities of daily living such as eating, bathing, dressing, toileting and mobility

• 24-hour security

• Laundry services

• Social and recreational activities

Limited health care services are provided by the facility. When required, clinical care is generally provided by outside professionals and home healthcare agencies at an additional cost.

Sub-Acute Care and Rehabilitation – Sub-acute care is the answer for those recovering from
a serious injury or illness who no longer need the acute care provided in a hospital but still require some help with their recovery. Skilled nursing homes frequently provide sub-acute care both to residents and short-term non-residential patients. In many communities sub-acute care is also provided by freestanding facilities. Sub-acute patients receive skilled nursing care, rehabilitation therapies, wound
care and other specialized services until they are able to return home or move to an alternate level of care.

Skilled Nursing Facilities – For most people, long-term care is synonymous with “nursing
home care.” When patients are no longer able to care for themselves, a skilled nursing facility provides round-the-clock care and assistance with activities of daily living. Most facilities today offer far more than just quality nursing care. Additional services may include sub-acute rehabilitation, dementia care, respiratory therapy and psychiatric support. They also offer a full range of social and recreational activities to enrich and enhance the lives of the residents.

Specialty Care – Programs designed specifically for people with Alzheimer’s disease and other forms of dementia are available through certain residential skilled nursing facilities. Dedicated units, wings or free-standing facilities offer a safe and secure setting for care. A specially trained staff provide health care support and supervision. Structured activities are designed to stimulate and encourage residents to function at their highest possible level.

Paying for Long-Term Care
There are four basic ways to pay for long-term care:

1. Medicare. Medicare is a federal health insurance program divided into two parts. Part A pays for inpatient hospital services, care in a sub-acute rehabilitation facility, skilled nursing services in a nursing home for a limited period of time, home health services*, and hospice care. Medicare Part B pays for physician services, outpatient hospital care, medical equipment and other health services. Eligibility for Medicare is not based on financial need and is open to nearly all seniors. (*There are various levels of Home Health Care, some are covered by Medicare and some by Medicaid.)

2. Medicaid. Medicaid is a combined state and federal program that pays most nursing home costs for people with limited incomes. The program has limitations as to the amount of assets the patient may own and the income he or she may receive each month and still be eligible.

3. Private Pay. Insurance experts estimate that about one-third of all long-term care is paid for by individuals from their own funds. These “private pay” sources include savings, investments, pension plans, employee stock ownership plans, single premium annuities and cash value of life insurance polices.

4. Long-Term Care Insurance. Given the increasingly high cost of health care, long-term care insurance is becoming more popular as a way to help defray future costs and alleviate anxiety. Policies must be purchased prior to needing long-term care, as eligibility is based on current health. If you are already a candidate for long-term care, you may not qualify for coverage. Premiums are based on age, health and the type of plan purchased. Most financial planners recommend that long-term care insurance be purchased when people are in their late 50s to early 60s, when premiums are more affordable.

How to Be A Parent to Your Parent

The family is meeting to discuss Mom. She’s fallen twice in the last two months and seems a little disoriented and mildly confused lately. She seems to be losing weight too. She’s definitely not taking care of herself – or her home – as she used to. The discussion becomes heated. Snippets of conversation can be heard: “nursing home, retirement residence, respite, hospice…” You think to yourself, I’ve heard many of these terms but I don’t know what they all mean. I don’t know what care is right for mom. I certainly don’t know where to begin.”

Now picture this:

The phone rings. It’s 10:30 at night. Immediately you begin to worry. It’s Mom. She’s fallen again for the second time this year. You realize that it’s just not safe for her to live on her own anymore. The next fall may result in serious injury. But what are the options? You ask yourself, “What decisions can I make that will benefit my mother and ensure her happiness?”

The scenarios above are replayed every day in a thousand different forms in homes throughout the country.

Children are never prepared to be parents..

The role of bringing new life into the world and the responsibility that comes along with it, can be overwhelming regardless of the books you have read, or the classes you’ve taken. Yet, most of us become parents and learn as we go, growing right along with our children.

Just as we may feel unprepared to parent our own children, we are even less prepared for a second, important parenting role – that of being a parent to our own parents. These are the people who brought us up, taught us about the world, gave us values and influenced our views. In short, these are the people who are largely responsible for who we are. They have always been Mom and Dad. We have always been the child.

Know however that you are not alone. There are options to choose from that will provide your loved one with an environment that will enrich his or her life while allowing them the opportunity to rehabilitate themselves and/or to live in security and comfort.

The following are some choices available for senior care today, with brief descriptions of what they offer:

Chore services: Volunteers buy groceries, vacuum, run errands, etc.

Home visitors: This includes meals-on-wheels, story reading, companionship.

Adult Day Care: Daytime activities suitable for seniors, lunches, therapy, games.

Home Health Care: Nurses, physical therapists, and dieticians provide in-home services.

Rehabilitation programs: These provide extensive physical, occupational and speech therapy in their offices.

Continuing care retirement communities/continuing care centers: Designed to meet the changing needs of residents, some offer services ranging up to skilled care off-site.

Assisted living centers: These offer some assistance with eating, bathing and other activities of daily living.

Nursing facilities: These offer all encompassing care including around-the-clock nursing, rehabilitation and physical therapy on-site. All in a healthy emotional and social setting with immediate access for health care needs.

This wide variety of care choices can seem confusing at first glance. They should be viewed, however, as a continuum of care, designed for the varying needs of seniors. They begin with a minimum of help, such as assistance with chores, or social activities ofered at adult day care centers, and continue on to more encompassing care, such as that offered at nursing facilities.