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Bedridden Elderly: Factors and Risks

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International Journal of Research and Scientific Innovation (IJRSI) | Volume VII, Issue VIII, August 2020 | ISSN 2321–2705

Bedridden Elderly: Factors and Risks

Normala R., & Lukman Z.M.
Faculty of Applied Social Sciences, Universiti Sultan Zainal Abidin, Kuala Nerus, 21300 Terengganu, Malaysia

Abstract: Health problems among the elderly will occur if their pressure, diabetes, asthma, cancer, renal (kidneys), urinary
healthy-living needs are not met or achievable. The implications, (bladder), and rheumatism (joints) (Liu & Wong, 1997; Sidik,
if left unchecked, can affect the patients’ quality of life and lead Rampal & Afifi, 2004; Wressle, Engstrand & Granérus, 2007;
to them suffering from social dysfunction. Therefore, the purpose Gambhir et al., 2014; Alzahrani & Alamri, 2017; Jaul et al.,
of this article is to discuss the factors that cause the elderly to be
2018; Liang et al., 2018; Younis & Ibrahim, 2018; Alzheimer’s
bedridden and the possible risks arising from this problem.
Association, 2018). Most of the elderly have only one chronic
Keywords: elderly, bedridden, factors, risks, care, gerontology . illness, though some may have two or more conditions (Liu &
Wong, 1997; Sidik, Rampal & Afifi, 2004). Thus, the loss of
I. INTRODUCTION ability due to these illnesses, can lead to the elderly being
bedridden.
A mong the various age groups, the elderly is most at risk
from being bedridden (Cao et al., 2020). Each bedridden
patient will differ in their recovery times. Some may be
Generally, the elderly will experience problems with their
physical health as their age advances (Sagner, Kowal, & Dowd,
bedridden for a week, a month, a year or even longer, 2002; Milanovic et al., 2013), hence advancing age is one of the
depending on the health issues that they are experiencing factors of being bedridden. A severely weakened physical
(Handicap International, 1996; Bekdemir & Ilhan, 2019). condition will prevent the elderly from moving about on their
A patient is defined as being bedridden if he or she is confined own. Brittle bones can prevent the elderly from walking and
to a bed for 15 days or more, with 90% of their time spent in causes reduced mobility that leads to being bedridden while
bed and requiring the assistance of another person to do their cognitive problems can also lead to the same condition (Orun,
daily activities (Bains, Singh & Singh, 2010; Wani & Malik, Roesler & Martin, 2015).
2013). Bedridden patients require full-time treatment (Hatano, Another factor to being bedridden is the injuries caused by falls
et al., 2017). As part of the recovery process, bedridden among the elderly (Handicap International, 1996; Fumio, 2001;
patients need medical equipment such as special mattresses, Fujiwara, 2010; Orun, Roesler & Martin, 2015). Accidents and
tubes, special milk, oxygen and others (Ministry of Health falls can cause spinal injuries and disabilities. A previous study
Malaysia, 2016). had noted that falls are the main factor to the degradation of
Bedridden differs from bedrest in that the latter only involves daily activities among the elderly (Yoshino et al., 2011). Elderly
the patient resting in bed for a determined period of time, as people are at high risk of falling due to their poor physical
part of the recuperation process directed by a medical endurance. It is said that spinal fractures are one of the main
practitioner. Meanwhile, bedridden refers more to the factors in the death of the elderly (Berral et al., 2008). They may
perception of the deteriorating patient's state of health and also lose limbs as a result of accidents such as road accidents,
reaching the final stage of life which will end in death (Orun, workplace accidents, sports accidents and others.
Roesler & Martin, 2015). The elderly who are afflicted with these conditions are unable to
II. FACTORS THAT LEAD TO THE ELDERLY BEING take care of themselves, including activities such as going to the
BEDRIDDEN toilet, bathing, combing their hair, brushing their teeth, eating
and carrying out interpersonal relationships (Hacer et al., 2015).
Elderly bedridden patients are usually preceded by disabilities Being bedridden for long periods of time can cause further
due to chronic diseases (stroke, diabetes, cancer or heart disease) complications to appear such as ulcers on the affected body parts
(Handicap International, 1996; Ishikawa, et al., 2006; Yoshino et and also urinary tract infections (Bains, Singh & Singh, 2010;
al., 2011; Wani & Malik, 2013; Orun, Roesler & Martin, 2015). Jaul et al., 2018).
In fact, the two main causes of the elderly being bedridden are
stroke and broken bones (Ishikawa, et al., 2006). As such, early III. HEALTH RISKS FOR BEDRIDDEN ELDERLY
efforts to reduce bedridden among the elderly should focus on To ease the provision of care for the bedridden elderly,
the prevention of these two medical conditions. caregivers need to be aware of the risks to the mental and
Chronic illness is associated with the risk of physical and mental physical health of the elderly. The following are some of the
disability as well as decreased individual quality of life (Liang et health risks among the elderly:
al., 2018). Among the chronic illnesses commonly experienced Pressure Ulcers: Pressure ulcers are also known as decubitus
by the elderly are dementia (senility), Parkinson's, Alzheimer's, ulcers, pressure sores or bed sores are common health
insomnia (sleep disorders), eye diseases (glaucoma, cataracts), problems that occur among immobilised patients and require
cardiovascular (heart), digestive system disorders, high blood

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International Journal of Research and Scientific Innovation (IJRSI) | Volume VII, Issue VIII, August 2020 | ISSN 2321–2705

care by another person (Ladan et al., 2014; Shuk-Fan, 2016). Staying in one position for long periods of time also puts
Pressure ulcers are a serious condition because they are pressure on the spine and causes back pain (Wright et al.,
localised injuries to skin and tissues that are caused by 1995). Bedridden elderly should be frequently repositioned to
protruding bones, pressure and/or abrasions (National avoid stress on the spine (Berral et al., 2008; Bains, Singh &
Pressure Injury Advisory Panel, 2016; Ladan et al., 2014; Singh, 2010).
Edsberg et al., 2016).
Depression: Bedridden patients can become depressed
The National Pressure Injury Advisory Panel (2016) because they may feel that they are burdening others, are
categorised pressure ulcers into six stages, namely: Stage 1 losing their autonomy, or because their social interactions are
with reddish skin; Stage 2 with reddish skin and wounds or limited. Bedridden patients will experience depression due to
abrasions; Stage 3 with visible deterioration of the skin layer failure to adapt to lifestyle changes, inability to manage
on the wound; Stage 4 with deterioration of the skin and themselves and inability to continue social life as usual
thickening of the tissue layers and the affected muscles, (Normala et al., 2014). They will feel lonely, useless and
tendons, ligaments, cartilage or bones are clearly visible; quick to give up (Alan & Mel, 2003). It is important to meet
Stage 5 which is unstageable, i.e. loss of skin and tissue due to their emotional and mental health needs and to help the
thickening wounds so that tissue damage is not visible; and patients know that they are still part of their community
finally Stage 6 with deep tissue injury, i.e. a purple or maroon (Normala et al., 2014).
localised area that indicates it is covered in blood on suspicion
Sleep Disorders: Sleep disorders are common because
of soft tissue being damaged. According to Ladan et al.
bedridden patients may have irregular sleep schedules, do not
(2014), if not treated promptly, the patient will experience
physically exercise, or feel too much pain from lying in an
skin damage in the affected area that will spread to deeper
uncomfortable position for too long (Matsumoto et al., 2015).
layers of tissue and will affect muscles, tendons and bones.
Caregivers need to ensure that patients' sleep schedules are in
Pressure ulcers often occur among the bedridden elderly,
order, use active and passive exercises on a daily basis and
wheelchair-bound persons and individuals in long-term care
ensure that patients sleep in a comfortable and varied position
(Shuk-Fan, 2016).
(Daglar et al., 2014).
Urinary Tract Infections: This infection is among the leading
Muscle Cramps: Being bedridden for a long time can lead to
causes of death in older adults (Cortes-Penfield, Trautner, &
complications to the patient's muscles. Muscle complications
Jump, 2017). Women are 30 times more at risk for urinary
include muscle spasms and loss of muscular endurance
tract infections than men, where half of the women have
(Mersal, 2014). Providing support to limbs and having active
experienced it at least once in a lifetime (Rowe & Juthani-
and passive exercise programs will help maintain muscle tone
Mehta, 2013; Tan & Chlebicki, 2016). Urinary tract infection
and movement (Dittmer & Teasell, 1993).
is a condition in which one or more parts of the urinary
system such as the kidneys, ureters (channels from the Loss of Appetite: Bedridden patients may feel lethargic and
kidneys to the bladder), bladder and urethra (urinary tract) lose their appetite (Harith et al., 2010). Loss of appetite and
have been infected with bacteria (Puca, 2014; Tan & related nutritional status are clinical signs that need to be
Chlebicki, 2016). Major risk factors for urinary bladder evaluated routinely in all at-risk elderly (Volkert et al., 2006).
infections other than age factors include catheter use, mental Effective prevention and treatment measures need to be
problems, diabetes, gynaecological problems (women), implemented at an early stage and the involvement of
prostate hypertrophy (men), dehydration, poor hygiene and multidisciplinary teams is necessary to slow the progression
other infections (Cohn & Schaeffer, 2004; Puca, 2014; Mody of the disease and to improve the patient’s function and
& Juthani-Mehta, 2014). Common symptoms of urinary tract quality of life as a whole.
infections include cloudy or dark urine, bloody urine, foul-
IV. CONCLUSION
smelling urine, frequent urination, pain or burning sensation
during urination, feeling of pressure in the lower pelvis, fever Caregivers play an important role in ensuring that the
and night sweats or chills (Sollitto, 2019). bedridden elderly have a good quality of life. Nevertheless, it
is not an easy task and caregivers need to be strong physically
Lung Congestion and Lung Inflammation: Being immobilised
can cause mucus and fluids to accumulate in the chest, leading and mentally to avoid being negatively affected themselves.
to pneumonia and other complications (Wani & Malik, 2013). Caregivers can help their bedridden loved ones by providing
frequent social activities and arranging time for friends and
Preventive measures include lifting the head during waking
other family members to visit so that they will not feel lonely
hours, ensuring that patients do not overeat or have bloating
and forgotten. Caregivers should also encourage the bedridden
that can block deep breathing and encourage deep breathing
elderly to not lose hope and surrender to their illness.
exercises and coughing (Thiem, Heppner & Pientka (2011).
Back Pains: Patients who have been bedridden for a long time ACKNOWLEDGEMENT
should be encouraged to move as often as possible to avoid This research was conducted to meet the requirement for the
pain in certain areas (Ministry of Health Malaysia, 2007). completion of a Doctor of Philosophy.

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International Journal of Research and Scientific Innovation (IJRSI) | Volume VII, Issue VIII, August 2020 | ISSN 2321–2705

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