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Pressure Ulcers vs Kennedy Terminal Ulcers: What’s the Difference?

— May 20, 2021

Understanding the difference between a pressure sore or bedsore and a Kennedy terminal ulcer is vital so that you can identify whether your loved one is being treated properly during their older years.

As bodies age, they become more susceptible to a number of medical conditions—especially on the skin, which becomes thinner and more fragile over time. While it is not uncommon for an older person’s skin to become irritated more easily or to require lotion and increased care to avoid cracking and dry skin, the development of sores and ulcers are of significant concern. Nursing homes and hospitals must follow federal regulations to prevent wounds from developing on patients. Preventable wounds occur due to nursing negligence.

Not all ulcers are the same, and understanding the difference between two of the most common—pressure ulcers and Kennedy terminal ulcers—is an important part of ensuring that your loved one is being treated with care and attention at a long-term care facility, hospital or nursing home.

The Presence of Ulcers in Long-Term Care

Ulcers and sores are not rare occurrences in long-term care. However, this does not mean wounds are an acceptable outcome of a long term care residency.

One of the most common varieties is the pressure ulcer, which is also sometimes referred to as a pressure sore, pressure injury or a bedsore. Any resident of a nursing home who develops a bed sore should be attended to immediately, and the family should investigate legal action against the nursing home for negligence. Bedsores are not an acceptable part of an aging loved one’s health situation.

Conversely, a sore that at first glance appears to be a bedsore could turn out to be a Kennedy terminal ulcer. Kennedy ulcers are treated differently and do not arise from the same causes that create bed sores. Still, Kennedy ulcers are oftentimes misdiagnosed as pressure ulcers. Similarly, pressure ulcers are commonly misdiagnosed as Kennedy terminal ulcers if the patient is dying.

It is vital that you understand the difference between the two so that you can advocate for proper care for your loved one or family member.

The Difference Between Pressure Ulcers and Kennedy Ulcers

Pressure ulcers and Kennedy terminal ulcers are not the same medical phenomenon. In fact, not only can they appear different visually, but they also progress at different rates and are caused by different factors. While a pressure ulcer is an indication of negligence and abuse in nursing home care, Kennedy terminal ulcers arise on their own and offer a critical indication of a person’s health decline, oftentimes signaling the dying process.

Pressure Ulcers

Pressure ulcers are often referred to simply as pressure sores or bed sores. They arise—as may be expected from their name—due to pressure placed on the skin for an extended period of time. Most often, this occurs when an elderly person is lying down and struggles to move on their own without assistance.

Over time, pressure builds up in the skin areas that are in contact with the bed or chair. This pressure placed on the skin, most commonly in the areas surrounding the tailbone, buttocks, elbows, and shoulder blades, reduces proper circulation and puts strain on the flesh. Left like this for hours, the skin can begin to degrade, forming an ulcer.

Once an ulcer has begun to form on the skin, it must be treated immediately to prevent the injury from becoming worse. Continued pressure on the area will cause further skin degradation, which causes the sore to become deeper. The most severe bed sores can go untreated for so long that the skin fully degrades all the way down to the bone.

These pressure ulcers can develop over the course of weeks and remain with a patient for months, even years.

Unsurprisingly, pressure ulcers are extremely dangerous and painful. As open wounds, they leave their victims susceptible to sepsis and other infections that could prove fatal. This is why prevention of bedsores is a critical aspect of the staff’s job at a nursing home.

Are Pressure Ulcers Preventable?

Pressure ulcers are simple to prevent — just move the at-risk patient.

Image by Kari Shea, via
Image by Kari Shea, via

Pressure injuries do not arise due to any medical condition, but rather are caused by the extended pressure placed on small areas when a resident lies down without moving. Staff are supposed to help elderly residents to shift their body weight every few hours to prevent pressure sores.

Bed sores and pressure ulcers are highly indicative of nursing home neglect.

Kennedy Terminal Ulcers

In contrast with pressure ulcers or bedsores, Kennedy terminal ulcers are not caused by neglect. Instead, Kennedy terminal ulcers come about as part of the dying process. Your skin is an organ, just like your heart, lungs, spleen and liver. When a patient begins the dying process, organs fail. Sometimes, the skin fails and deteriorates into a Kennedy terminal ulcer.

The skin as an organ is directly influenced by the health of the entire body—from the heart pumping sufficient blood to oxygenate the skin to the kidneys processing water and waste. As an individual’s life nears its end, the many systems of the body cease to function at peak performance, and the skin is one area that suffers as a result.

As the heart weakens and blood pressure is decreased throughout the body, certain areas will begin to experience ischemia, or reduced blood flow. This process is called hypoperfusion. When a patch of skin is no longer receiving adequate blood (and therefore oxygen), it begins to die, creating an ulcer.

Unlike pressure ulcers, which progress slowly over time due to extended stints of pressure placed on the skin, Kennedy terminal ulcers arise suddenly—so quickly, in fact, that they may appear as a bruise in the morning and a fully formed ulcer just a few hours later. They are associated with end of life care because they result from the body’s functions beginning to slow. It is not uncommon for Kennedy terminal ulcers to appear within the final two weeks of an individual’s life—which is why the word “terminal” is used to describe them.

Kennedy ulcers often appear in the shape of a pear, butterfly, horseshoe, or some irregular-shape. Conversely, a pressure ulcer is usually a circle.

Are Kennedy Ulcers Preventable?

While bedsores are entirely preventable with regular shifting of an individual’s body weight, Kennedy terminal ulcers are a natural part of the process of passing away. Regular, vigilant care must still be taken, since Kennedy ulcers can be hastened by extended pressure on the skin. However, even the best care cannot completely stop the effects of the body’s internal systems shutting down.

Use of a Kennedy Ulcer Diagnosis to Conceal a Bedsore

Occasionally, our lawyers will investigate a case where a facility diagnoses a patient’s wound as a “Kennedy terminal ulcer”, but the wound has all the signs of being a garden variety bed sore. This may be done as a way to cover up neglect of the patient, since Kennedy ulcers just happen while bed sores really should not occur.

If you think your family member received a misdiagnosis of a Kennedy ulcer, compare the above factors and see which kind of wound closer fits the description of your family member’s ulcer.

What to Do If Your Loved One Has Ulcers or Sores

Understanding the difference between a pressure sore or bedsore and a Kennedy terminal ulcer is vital so that you can identify whether your loved one is being treated properly during their older years. If you suspect that the ulcers your loved one has developed are the result of negligence or abuse, be sure to reach out to legal team with years of experience in nursing home abuse cases.

At Senior Justice Law Firm, our attorneys have handled thousands of wound lawsuits arising out of nurse neglect.

LegalReader thanks our friends at Senior Justice Law Firm for permission to republish this piece. The original is found here.

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