Understanding older adults skin bruising

You may have noticed older people tend to show more bruises than younger age groups. This is normal, as older adults are more susceptible to skin bruising for a number of reasons:

Thinning Skin

As people age, their skin becomes thinner due to a natural reduction in collagen and fat, which usually helps provide cushioning and protection for skin. Research suggests ageing adults experience what is known as ‘senile purpura’, which is when skin becomes thinner, loses its elasticity, and the barrier function is compromised. 

For older adults, simply brushing against objects at home, or being lifted or moved during personal care activities, can lead to bruising that sometimes looks a lot worse than it actually is.  

Ageing Blood Vessels

Another age-related change is that blood vessels become less durable, which makes them prone to rupture with even minor traumas. A lot of bruising will form due to small blood vessels (called capillaries) at the surface of the skin breaking after coming into contact with something; a piece of furniture, or someone’s hand, for example. 

This usually happens on the arms and legs as these are the most likely areas to come into contact with external objects, and this is particularly common for older people with mobility issues who are being cared for in a care home or at home by a caregiver. If this occurs, blood will leak from the vessel and form a bruise on the skin.

Skin Disorders

Skin can become less healthy overall as we age, as people over the age of 65 tend to have a higher likelihood of skin disorders such as seborrheic keratoses (skin growths), varicose veins, and more. As a result, skin that is less resilient and healthy overall can be more susceptible to bruising and injury. 

Reduced Ability To Heal

As we age, the body’s natural healing processes slow down. As well as diminished organ function and a slower ability to heal from various illnesses, theskin is also thought to heal more slowlyin older age groups, which means bruises can take longer to fade.

Contributing Medications

It is known that certain medications can contribute to the excessive bruising older people experience, as these medications can decrease blood clotting ability. This might include medications such as aspirin, ibuprofen, naproxen, anticoagulant medications, and antiplatelet agents. Some of these medications are available over-the-counter, so a pharmacist may be able to address any concerns over skin bruising via a Medicines Use Review (MUR), which is a consultation with a pharmacist to foster the patient’s knowledge and improve their medicine use. 

In addition, some antibiotics and antidepressants are also associated with clotting issues, so these medications could contribute to the bruising older people notice. If you experience this, do not simply stop taking these medications; speak to your GP about the symptoms you have noticed, so they can adjust your dosage or switch you to an alternative medication.

Dry Skin

Older people tend to experience dry skin more often than younger age groups, and can struggle to stay moisturised, with the total amount of water in the body reduced by up to 15% as we age, leading to further loss of elasticity. As described above, this loss of elasticity can contribute to excessive bruising on skin due to how this affects the skin’s natural healing ability. Using emollients can help to support fragile skin in older adults, and you can learn more about this below. 

Certain Medical Conditions

Conditions such as diabetes can contribute to skin bruising, as they affect the body’s composition, clotting and healing ability. Liver disease can also impact the blood’s ability to clot, as well as blood clotting conditions like haemophilia. 

Risk of Falls and Accidents

Older people tend to be more affected by falls and other types of accidents that cause injuries, as many have reduced balance and mobility issues. When these accidents occur, they can lead to skin bruising. This can happen due to trip hazards like clutter on the floor, poor lighting, and slippery flooring while carrying out personal care tasks in the bathroom. You can read more about this in our guide on what to do if an elderly person falls.

Nutrient and Vitamin Deficiencies

Many older adults lack certain vitamins and nutrients from their diet, and a lack of things like vitamin C, vitamin B12 and iron has been known to affect blood vessels and make skin bruising more likely. You can read more about this in our guide to the best supplements and vitamins for the elderly.

Skin bruising tends to affect around 10% of those over the age of 50, and continues to increase with age. The bruises experienced by older adults can last up to 3 weeks before fading, and there may be skin discoloration remaining at the site of the bruise for a time after.

Understandably, the most common areas older adults tend to notice skin bruising are the areas that receive the most contact with external objects, such as the arms, legs and hands. These areas are particularly prone to bruising as they are more exposed to minor bumps during everyday activities, and these areas also tend to have the thinnest skin with the least amount of protective fat and elasticity, making them more vulnerable to injury.

On many occasions the person may not even realise they have bumped this area, as it is painless at the time, however bruises can slowly begin to show up over the next few hours. Sometimes these bruises can be pain-free, while other times they may be tender or sore to the touch. On the legs, bruises can regularly show up on the shins, which are a common area to bump or scrape when moving around the home, even if this is not felt at the time. 

If an older person has an accident, such as a fall or another significant impact, bruises may appear on other areas such as the back, torso or head, which are usually less exposed. If a severe bruise appears on an older person’s face or another area of the skin that is exposed during contact with others, this can affect the person’s mental health and confidence. You can read more about supporting them with this in our guide to supporting mental health in the elderly.