Why Do Older Adults Bruise Easily, and When Should You Be Concerned?

Bruising is something many people expect as a normal part of aging. But when an older loved one begins bruising more frequently – or the bruises seem larger, darker, or unexplained – it’s natural to worry. At Legacy Community Health, we want caregivers to understand the types of bruising that are a normal part of aging, what may signal a more serious concern, and how to best support the health and safety of their aging loved ones.

According to resources from Springpoint and A Place for Mom, and insights from Dr. Alexandra Sibley, a board-certified adult psychiatrist at Legacy, bruising in seniors is often linked to thinning skin, weakened blood vessels, medication effects, and underlying health or mental health conditions.

While most bruises are harmless and fade with time, others may point to more serious health concerns, mobility issues, or even elder abuse.

Why Do Seniors Bruise More Easily?

As people age, their skin becomes thinner and loses elasticity. The protective fat layer under the skin also diminishes, which means less cushioning for small blood vessels. Even a minor bump can result in noticeable bruising.

Dr. Sibley explains: “Certain mental health medications can increase the risk of bruising. This includes SSRIs like sertraline, fluoxetine, or escitalopram, and SNRIs such as duloxetine or venlafaxine. Additionally, some medications common in older adults, like benzodiazepines and sedative-hypnotic sleep aids, can increase fall risk, which often leads to bruising.”

Other factors that make bruising more likely include:

• Blood thinners (e.g., aspirin, warfarin, Plavix)
• Corticosteroids (topical or oral)
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
• Vitamin deficiencies, especially vitamins C and K, and iron
• Chronic illnesses such as liver disease, kidney disease, or diabetes

Springpoint also notes that sun damage over time contributes to fragile skin and may lead to a condition called actinic purpura, causing large, purplish bruises often on the hands and forearms with little or no trauma.

How Mental Health, Cognition, and Social Factors Affect Bruising and Pain Awareness

Memory problems such as dementia or Alzheimer’s can impair a senior’s ability to communicate pain or injury, Dr. Sibley points out. As dementia progresses, caregivers need to be especially vigilant and watch for visual signs of pain such as grimacing, calling out, avoiding use of a body part, or increased agitation.

“Pain may manifest as agitation or withdrawal because the individual can no longer express what they’re feeling,” she explains.

In addition to cognitive challenges, mental health conditions like depression or anxiety can increase the risk of falls and bruising, both through medication side effects and direct effects on balance and awareness.

Social factors also play a critical role. Loneliness and neglect can worsen outcomes for older adults. Dr. Sibley notes that seniors living alone may fall without anyone nearby to help. Self-neglect can mean a person is unaware of their need for care or rejects assistance, increasing the risk of untreated injuries and bruising.

When to Worry About Bruising

Most bruises in older adults fade within about two weeks and are generally not cause for concern. However, certain warning signs should prompt a call to your loved one’s healthcare provider:

• Bruising without any known injury
• Bruises that grow in size or become more painful over time
• Bruises that take longer than two weeks to heal
• Frequent bruising, especially in unusual places like the back, torso, or face
• Bruises accompanied by swelling, lumps, or numbness
• Bruises that appear after starting a new medication
• Bruising after a fall, particularly if there is head trauma or possible broken bones

If you notice any of these symptoms, it’s important to see a doctor to rule out more serious concerns such as clotting disorders or internal bleeding.

When Bruising Suggests a Fall or Mobility Issue

Sometimes bruises are more than just bumps; they may be a sign of changing mobility or balance. Frequent falls might mean difficulty with strength or coordination. If you notice this pattern, it could be time for extra support or safety updates at home.

Dr. Sibley emphasizes the importance of early identification of balance issues, vision and hearing problems, and other physical challenges. She recommends gait training with physical therapy when appropriate.

Springpoint recommends fall-prevention strategies such as:

• Removing loose rugs and clutter from walkways
• Installing grab bars in bathrooms and near stairs
• Ensuring proper lighting throughout the home
• Encouraging the use of walkers or canes as needed
• Scheduling regular vision and hearing checks

Taking these steps can reduce the risk of falls and the bruises or more serious injuries that come with them.

Could It Be Elder Abuse?

Bruising can sometimes be a sign of abuse or neglect. Experts note that accidental bruises tend to be small and found on arms or legs, while bruises from possible abuse may appear on the neck, back, chest, or face, sometimes shaped like handprints.

Dr. Sibley urges caregivers to watch for behavioral changes such as withdrawal, anxiety, fear, irritability, agitation, or attempts to avoid certain caregivers.

“If you notice your loved one suddenly becoming more withdrawn, fearful, or irritable, or trying to avoid a particular caregiver, it’s important to pay close attention,” she said. “These behavioral changes can be warning signs of abuse or neglect.”

If abuse is suspected, adult protective services (APS) can provide support, resources, and intervene when necessary, including removing the abuser from contact with the older adult.

How to Prevent and Treat Bruising in Seniors

While bruising can’t always be prevented, there are many ways to reduce risk:

• Eat a balanced diet rich in vitamins C and K
• Discuss supplements with a doctor if deficiencies are suspected
• Use sunscreen and moisturizers to protect fragile skin
• Review medications regularly with a physician or pharmacist
• Keep the home safe and free of tripping hazards

If a bruise occurs, the R.I.C.E. method (Rest, Ice, Compression, Elevation) is a simple and effective way to treat mild injuries. Applying ice within the first 24 hours can help reduce swelling, while elevating the area can minimize pain and inflammation.

Keeping an Eye Out and Knowing When to Act

Most bruising in seniors is part of the aging process, but it’s important to watch for changes. New medications, more frequent falls, or bruises in unusual places could signal a more serious issue.

At Legacy Community Health, we’re here to support you and your aging loved ones. If you notice increased bruising, mobility changes, or have questions about what’s normal, don’t hesitate to reach out. We can help you navigate the next steps and ensure your loved one stays safe and well.