The line between "normal aging" and "make an appointment with a doctor" can be hard to determine for caregivers, professional and non-professional alike. Such discernment often comes with experience or medical knowledge--two things that most family caregivers do not have when they begin this process.
One concerning side effect of aging is becoming easily bruised, and this can leave caregivers unsure of how to proceed. The concerns are clear: "Is my loved one okay with all this bruising?" "Is he falling or getting injured somehow when I cannot see?" "Is someone harming her without my knowledge?" "Is my loved one in pain from all this bruising?" "Is there anything I can do to prevent these disturbing bruises?"
Here is some guidance about bruising on aging skin and how to navigate these troubled waters.
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Bruising is generally caused when small blood vessels under the skin burst, filling up small pockets of skin with dark blood. They can become tender and sensitive, even very painful, depending on the depth of the bruise and how large it is. Bruising for most people is merely uncomfortable, a reminder to be more careful next time or to avoid cramped spaces; for seniors, whose bodies heal more slowly, they can be extremely painful and last for weeks.
According to the Mayo Clinic, skin becomes thinner with age, resulting in a smaller barrier between skin and the blood vessels that burst to cause bruising. Skin also loses some of its fatty layer as the body ages, and this fatty layer cushions blood vessels, allowing them to absorb impact rather than burst. The loss of this lowers the body's protection against bumps and blows.
Seniors may also experience bruises that do not come from impact. Called actinic purpura, the blood vessels burst after years of sun exposure (which weakens the vessel walls) and create bruises on the backs of hands or arms. They often look like large, purple freckles, and are especially apparent on aging, translucent skin. Though alarming at first, this is usually not a serious condition and does not often get specifically treated. They also tend to worsen if a senior is on steroids. These bruises are not typically a cause for alarm by themselves but should be checked out by a doctor just in case.
Other causes of bruises are vitamin deficiencies. Some experts cite vitamins C and D as necessary for good, strong skin health and staving off bruises. Family members may want to talk to a doctor about placing their senior on vitamin supplements or simply finding ways for the senior to ingest them more naturally by eating more citrus fruit or taking some more time in the sun. Either way, it is best to consult a doctor, as spikes in vitamin intake can cause adverse effects combined with some medications.
Weight may also be a factor in causing bruises or other skin damage. Excess skin, difficulty moving, and overstretched skin are all factors that make aging skin more stressed. Making sure that a senior is at a healthy weight and maintains a safely active lifestyle are good ways to prevent stress on the skin and to help seniors avoid bruising by keeping them active.
Some medications--even very common ones, such as aspirin or blood thinners--can make bruising worse. If a loved one is on a medication like this or uses corticosteroids (which thins the skin), family members may want to consult a doctor about changing this medication or lowering the dosage, especially if the bruises are causing severe discomfort. Seniors should not stop taking these medications suddenly, however, as this can cause many other problems.
Truly massive bruises should be examined by a physician, and the cause should be discovered. Not knowing or remembering how an injury occurred could be a sign that a senior is having memory issues or has blood sugar problems that result in blackouts or falls. Their home should also be evaluated for health and safety hazards, such as lots of wires (which can cause tripping or falling, causing bruising) or sharp, exposed corners on furniture near walkways.
Extremely large bruises or areas of swelling are cause for very serious concern. They can be signs of internal bleeding or damage and should be seen by a doctor immediately--enough that a trip to an emergency room might be necessary. Persistent bruising and tenderness over time should be examined by a doctor as well, even if it is not a serious internal issue.
If family members think the bruises are being caused by abuse or neglect, they should also consult a doctor. It is important to rule out other possibilities first, such as internal damage or medication side effects, and then contact local authorities to report the suspected abuse. Taking this seriously is the first step toward making sure a beloved elderly one is safe.
American Osteopathic College of Dermatology. Bruising Hands and Arms. AOCD.org. Available at http://www.aocd.org/page/BruisingHandsAndArms. Retrieved July 4, 2016.
Elias, Nina. (July 3, 2014). 7 Odd Reasons Your Bruise Easily. Prevention. Available at http://www.prevention.com/health/health-concerns/7-odd-reasons-you-bruise-easily. Retrieved July 4, 2016.
Mayo Clinic. Easy bruising: Common as you age. MayoClinic.org. Available at http://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/easy-bruising/art-20045762. Retrieved July 4, 2016.
MedlinePlus. Aging changes in skin. U.S. National Library of Medicine. Available at https://www.nlm.nih.gov/medlineplus/ency/article/004014.htm. Retrieved July 4, 2016.
MyClevelandClinic.Org. Aging and Skin Care. The Cleveland Clinic. Available at http://my.clevelandclinic.org/health/diseases_conditions/hic_Aging_and_Skin_Care. Retrieved July 4, 2016