Understanding Skin Bruising in Seniors

Did you ever have a bruise that seems to pop up out of nowhere, for no known reason? If so, you are not alone.

At one time or another, we’ve all had bruises that appear without any recollection of an injury. As we age, these seemingly unexplained bruises can become more frequent and easier to acquire, making us ask ourselves, “why am I bruising so easily?” This phenomenon is not imagined; aging skin really does bruise more easily.

As bodies age, physical changes can affect skin. First and foremost, skin becomes more delicate, making it more prone to bruising. In seniors, bruising often results from everyday incidents like falls or bumps. But there are many other reasons why seniors bruise more easily than younger adults.  While some bruises are harmless, others may signal more serious health issues.

Here, we’ll explore bruising in seniors. We’ll examine the differences between the “harmless” and dangerous types of bruises, what causes easy bruising, how to distinguish between normal skin changes and situations where medical attention may be necessary, and strategies to help prevent bruising.

What is a Bruise?

A bruise, also known as a contusion, is a mark on the skin that occurs when small blood vessels (capillaries) beneath the surface are damaged or ruptured due to trauma. This damage causes blood to leak into the surrounding tissues, resulting in discoloration that can range from red or purple to blue, green, or yellow as the bruise heals. Bruises are typically tender to the touch and may cause swelling in the affected area.

Types of Elderly Skin Bruising

Understanding the most common types of bruises in seniors can help in identifying whether they are harmless or if they may indicate a need for medical attention.

• Petechiae: Tiny, pinpoint red or purple spots that occur when small capillaries break and bleed into the skin. They often appear in clusters and can be a sign of a more serious condition if they appear suddenly and in large numbers.
• Hematoma: A collection of blood outside of blood vessels that forms a raised lump under the skin. Hematomas are usually caused by more significant trauma and can be larger and more painful than other types of bruises.
• Senile Purpura: Dark purple or red bruises that commonly occur on the forearms and backs of the hands. These are caused by normal aging (skin thinning) in combination with sun damage — and they can occur with only minor trauma or even no injury at all. While not harmful or the sign of any serious condition, these bruises often last longer (about three weeks) and can cause skin discoloration even after they’ve gone away.

What Causes Easy Bruising in Seniors?

Seniors bruise more easily than younger adults for these key reasons:

Thinner Skin

As we age, our skin naturally becomes thinner and loses collagen, a protein that provides elasticity and structure. This thin, fragile skin is more susceptible to tearing under impact, leading to the formation of bruises even from minor bumps.

Fragility of Capillaries

Blood flow weakens with age. This means that smaller blood vessels near the skin’s surface, called capillaries, become more fragile and break more easily during a bump or fall. This leakage of blood from the capillaries causes the discoloration we see as a bruise.

Reduced Fat Padding

The cushioning layer of fat under the skin diminishes with age. This fatty layer acts as a protective barrier against impacts, so its reduction leaves blood vessels closer to the skin’s surface and more prone to damage.

Medications

Certain medications, particularly blood thinners like aspirin and warfarin, can increase the risk of bruising by reducing the blood’s ability to clot.

Underlying Health Conditions

Conditions like diabetes, vitamin deficiencies (especially vitamin C and K), and disorders affecting blood clotting can contribute to easier bruising.

Physical Activity and Falls

Reduced mobility and balance issues increase the risk of falls, which can lead to bruising.

Skin Conditions

Certain skin conditions, like eczema or dry skin, can make the skin more fragile and prone to tearing or bruising.

Seniors requiring daily assistance with routine tasks are often more prone to bruising. Despite gentle handling, frequent movement can bruise their delicate skin, particularly under the arms and on the legs. Additionally, medical procedures such as IV insertions or injections, as well as prolonged inactivity, are common causes of bruising in older adults.

When to Worry About Bruises in Older Adults

Seek medical attention for bruising if it is unexplained, frequent, severe, unusually large or painful, accompanied by other symptoms (such as fever or fatigue), doesn’t heal after a few weeks, or occurs around the eyes or head. It’s vital to consult a doctor to rule out any underlying medical conditions – or possible abuse.

Strategies to Prevent Elderly Skin Bruising

Managing bruising in seniors involves protecting skin from injury, ensuring a balanced diet rich in vitamins and discussing any concerns with healthcare providers, especially regarding medications that could affect bruising susceptibility. Here are some effective preventive strategies:

• Reduce fall risk by improving home safety, maintaining strength and balance and addressing any vision problems that could contribute to falls.
• Eat a diet rich in fruits, vegetables and whole grains to provide essential vitamins and minerals that support skin and blood vessel health. Vitamin C promotes collagen production, while Vitamin K plays a role in blood clotting.
• Drink plenty of water throughout the day to help maintain skin elasticity.
• Consider consulting a doctor about vitamin C and K supplements if dietary intake is insufficient.
• Talk to a doctor about medications that might increase the risk of bruising, such as blood thinners. Explore alternative medications if possible.
• Wear protective gear like padded shorts or elbow pads during activities that carry a higher risk of falls, like gardening or biking.
• Wear sunscreen to help prevent further damage to delicate skin.
• Try treatments, such as topical retinoids, which can help build collagen and protect skin.
• Limit alcohol … Excessive alcohol consumption can impair coordination and increase fall risks.
• Regular doctor visits are crucial to monitor overall health and identify any potential concerns related to bruising.

When Bruising May Indicate Abuse

Bruises on seniors can indicate elder abuse. Elder abuse is defined by the National Center for Elder Abuse (NCEA) as an intentional or negligent act by a caregiver or a trusted person that causes or creates a serious risk of harm to an older adult. Signs of elder abuse includes bruises in unusual locations (around the inner thighs, for example), patterned bruises (like finger or hand imprints), multiple bruises at various stages of healing, frequent or unexplained bruises, symmetrical bruises and fearful behavior around certain individuals. These indicators warrant further investigation to ensure safety.

While bruising in seniors may be a cause for concern, it’s important to consider the whole picture before jumping to conclusions. If you suspect elder abuse, report it to the  Adult Protective Services (APS) in your area. You can find contact information online or by calling the National Elder Abuse Hotline at 1-800-677-1116.

Where You Live Matters

Where You Live Matters is powered by the American Seniors Housing Association (ASHA), a respected voice in the senior housing industry. ASHA primarily focuses on legislative and regulatory advocacy, research, and educational opportunities and networking for senior living executives, so they can better understand the needs of older adults across the country.