Hematoma in the elderly

Trainee: I noticed that elderly patients get frequently bruised. I was just wondering why?

Nurse: This is common with age. As one gets older, the skin becomes thinner and loses some of the protective fatty layer that helps cushion the blood vessels from injury. However, bruises are harmless and go away without treatment, but they can sometimes be a sign of a more serious problem.

Trainee: So what exactly is hematoma?

Nurse: Most bruises form when small blood vessels near the skin’s surface are broken by the impact of a blow or an injury. When this happens, blood leaks out of the vessels and initially appears as a black-and-blue mark. Eventually, the body reabsorbs the blood, and the mark disappears. However, the elderly may easily bruise themselves and not even notice this, which might result in a substantial bruise.

Trainee: Is there any example of a serious hematoma that an old person may suffer from?

Nurse: Yes. This is often related to falls. We call that subdural hematoma. The risks for this are recurrent falls, repeated head injuries, anticoagulant medication, and of course old age. And if the person begins to experience headaches, vomiting, dizziness, confusion, sometimes even lethargy, unconsciousness and seizures, we either give medications or proceed to surgical drainage, after having done a CT or an MRI.

Trainee: Can medication influence easy bruising?

Nurse: Yes. Anticoagulant medications and anti-platelet agents reduce the blood’s ability to clot. As a result, bleeding from capillary damage might take longer than usual to stop, which allows enough blood to leak out and cause a bigger bruise.

Trainee: When does easy bruising indicate a more serious problem?

Nurse: In case of a blood-clotting problem or a blood disease when a person has frequent, large bruises; when they easy bruise and have history of significant bleeding, such as during a surgical procedure; when suddenly they begin bruising, especially if they recently started a new medication; or when they have a family history of easy bruising or bleeding.

Trainee: How can we prevent minor bruises at home?

Nurse: For example, in order to avoid falls, we should use good lighting; avoid loose rugs; arrange furniture and electrical cords so that they’re not in their way; find out about the side effects of medications they take; and have their vision and hearing tested.

Trainee: And once a serious hematoma has formed?

Nurse: Unfortunately, not much can be done then. Minor bruises eventually disappear as the body reabsorbs the blood, although healing might take longer with age. But if the bruise is very serious, surgical debridement is used to remove the hematoma and prepare the wound site together with split skin graft procedure. Not all patients are suitable for surgery as this underlies anesthetic risk comorbidities, the age and general skin condition, and the donor site for the graft procedure that creates additional open wound which requires further management.