Why do older people bruise easily?
Bruising in older adults
Older people tend to bruise more easily than other age groups, and while this is not always an issue, it helps to understand why this happens and when it may be cause for concern. Here, we are taking a look at why older people bruise easily, what the contributing factors are, when to seek medical advice for excessive bruising, tips to prevent bruising, how to care for bruises on an older adult, and how caregivers can help older people avoid bruises. At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about bruising in older people, we can help.
What are bruises, and why do older people bruise easily?
The medical term for a bruise is ecchymosis, and these form due to blood pooling under the skin from a blood vessel break. They show up as different colours on the skin, such as black, blue, purple and sometimes yellow or red. As they heal, they may change colour and will eventually fade away. Bruises are usually caused by an injury that does not break the skin, but there are other reasons why they might appear. They may feel sore or tender to the touch, but most bruises will heal on their own and do not need medical attention unless they cause severe pain. People tend to bruise more easily with age, because blood vessels weaken, skin becomes thinner over time, and older people often have less fat and muscle to cushion accidental injuries.
What causes bruising in older adults?
Older adults can end up with bruises in the same way other people do, but there are a few more contributing factors or underlying conditions that could mean this happens more often for them. Also, bruises could appear more severe despite a mild or moderate amount of force being applied to skin. Some other reasons behind excessive bruising in older adults might include:
Medications
Some types of medication cause easier bruising in older people. This happens when medications affect blood clotting, weaken blood vessels, or thin the skin, and some of the medications that do this include:
- Blood thinners like warfarin that reduce clot formation, increasing the risk of bleeding under the skin
- Ibuprofen can affect blood clotting time, which can affect bruising (and should not be taken with anticoagulants)
- Corticosteroids that are commonly used for inflammation, and can make the skin more fragile and prone to damage
- Some chemotherapy medications that interfere with platelet function
Liver disease
Liver diseases such as cirrhosis can cause symptoms like tiredness, loss of appetite, unintentional weight loss, nausea, stomach pains, and visible blood vessels on the skin. As symptoms worsen over time, people with cirrhosis may bleed or bruise more easily.
Vitamin deficiencies
Vitamin deficiencies such as a lack of vitamin C can lead to easier bruising on skin. By not eating enough fruits and vegetables for a long period of time, the body may lack vitamin C, and this can be especially true for older people whose appetite has changed, or who can no longer eat the amount of food they once could. Vitamin deficiencies can cause bruising, dental deterioration, impaired wound healing, and other symptoms.
Sun damage
Sun damage over many years can weaken the elasticity of skin and cause long-term changes to skin collagen. As a result, this can increase the likelihood of bruising. Sun damage causes premature ageing of skin, and senile purpura (more on this below). Sun damage can cause bruises to appear more pronounced in older people.
Senile purpura
Senile purpura is a common condition in older people that affects an estimated 12% of those over 50 years old, and 30% of those over 75 years old. Senile purpura causes lesions on the skin that look similar to bruises, and these usually appear on arms and hands. They can appear after an injury has occured, but often last a lot longer than a regular bruise, sometimes up to 3 weeks before fading. They can also be larger than a typical bruise. Senile purpura is not thought to be serious, but it can increase the risk of skin tears so it is important to take steps to avoid these lesions.
Mobility issues
As well as bruises appearing more easily on the skin of older people, they may also appear more frequently as a result of regular bumps and accidents. Those with mobility issues may find it more difficult to navigate their environment or correct any imbalances quickly enough to avoid injuries, and even small knocks can lead to bruising. While a small bump into a table edge could show no bruises on a younger person, the same soft graze for an older person could leave a bruise behind. You can read about some of the most common mobility issues older adults face, here: Common Mobility Problems In Older People
Other health conditions
A number of other health conditions and their treatments can affect blood platelet count, which contributes to bruising on skin. These include autoimmune diseases, leukemia, hemophilia and others. In all of these, easier bruising could be a common side effect.
When does bruising become a concern?
Small bruises are usually nothing to worry about and will fade in their own time. Larger bruises that are also painful may be an indication of an underlying injury such as a sprain, so if you are worried about this you should have a medical professional check this over. If an older person in your care is experiencing regular bruising and you are aware of the cause, then this is probably nothing to worry about. However, if they get regular unexplained bruises, you should take steps to determine the cause by either paying more attention to bumps and knocks throughout the day, checking the site of bruises for anything that could be causing pressure, or speaking to their doctor for more advice. You should seek a medical opinion if bruises are:
- Extremely painful
- Unusually large
- Swollen
- Accompanied by a lump
- Near the eye and accompanied by vision problems
- Present for more than 2 weeks
- Accompanied by other symptoms like fatigue, unexplained weight loss, or bleeding
Keep in mind that the appearance of bruising can be a characteristic of a serious condition called sepsis. Sepsis is life-threatening, so if you notice dark or blotchy skin accompanied by symptoms like confusion, slurred speech, difficulty breathing, or a rash that does not fade when you roll a glass over it (like meningitis), you should seek emergency medical help straight away.
How to care for bruises on older skin
Bruises tend to fade away on their own and often do not require any treatment, however if you have had a noticeable bruise for a long time and would like to diminish its appearance and heal it, there are a few things you can do:
- Attempt to reduce any swelling by applying a cold compress to the affected area for 15 minutes at a time within the first few hours of bruising, and continue to do this frequently for several days afterwards
- After the first couple of days, apply a heating pad to the area several times a day
- Keep the bruised area elevated to minimise any blood pooling
- Monitor the bruise for changes in colour, size or pain level so you can speak to a doctor as soon as possible if anything drastic changes, or if the bruise does not improve within 2 weeks
- If needed, take over-the-counter pain medication to ease any aches and pains
- Somestudies suggest creams containing vitamin K could help to reduce the appearance of bruises or redness, especially after cosmetic treatments, but evidence is limited – these creams may improve how a bruise looks, but they are unlikely to stop bruises happening in the first place, so check with your GP or pharmacist before using one, as results vary and they may not be suitable for everyone
How to prevent bruising in older people
If you experience frequent bruising, there are a few things you can do to lower your risk of injury and prevent these from developing. For example:
- Consider your clothing by wearing long sleeves, trousers, or padded garments that provide additional protection, particularly during activities that lead to bumps or falls
- Wear supportive, non-slip footwear to reduce the likelihood of falls
- Add more vitamin C into your diet to support blood vessel health, by eating more leafy greens and citrus fruits
- Keep skin hydrated to promote its elasticity and resilience
- Improve the lighting in your home to avoid accidental bumps when moving around
- Remove any clutter and trip hazards that could lead to bumps or falls
- Make further home adaptations such as adding grab rails or handles around the house, as well as non-slip mats, to make it easier to move around without accidents
- Speak to your doctor about the medications you take, and discuss alternatives if there is a chance these could be contributing to your bruising issues
- Get an eye test to ensure you can see your surroundings well enough and avoid bumps around the home or when out and about
Bruising is a normal occurrence and a regular part of ageing, but excessive bruising should be addressed by a doctor, and measures should be taken to avoid frequent bruises if possible to keep skin healthy. Our experienced, supportive Care Professionals can help to monitor bruising, address any concerns you have, and help you take steps to prevent bruises from developing in the first place. You can reach out to your local Home Instead office to discuss the many ways we can help you with this at home.We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.
Michelle Tennant, Clinical Governance Lead