There are many pre-disposing factors that contribute to skin breakdown and the likelihood of pressure sores the primary one being age related. If an individual is aged 70 and older the individuals skin density weakens. The individual will experience a decrease in the subcutaneous tissue (decreasing the body’s natural padding and insulation); a flattening of the epidermal-dermal junction which decreases the overall strength of skin (increasing the risk of skin tears or blistering); a decrease in the Langerhans cells and melanocytes (increasing the risk for allergic reactions and sensitivity to light); a decrease in fibroblast function (which increases the time required to synthesize collagen, slowing the healing process); a decrease in blood flow (which decreases skin temperature and delays healing); a decrease in oil and sweat production (contributes to dryness and flaking); a decline in the reproduction of the outermost layer of the epidermis may lead to the skins inability to absorb topical medications. All of these factors contribute as to why an elderly individual is more likely to be at risk of pressure ulcers other factors that aren’t related to age include: dehydration and malnutrition (as skin can become fragile); obesity; paralysis or impaired sensation; being confined to bed because of surgery or undergoing surgery longer than four hours; urinary and bowel incontinence; smoking; significant weight loss; Edema (swelling); prolonged time on a stretcher in an emergency room or in ICU; any history of previous skin ulcers (as scar tissue is weaker than the skin it replaced and will break down easier than intact skin); medications (sedatives, analgesics and nonsteroidal anti-inflammatory drugs); medical equipment (catheters, peg/rig sights and mechanical ventilation such as oxygen pipes and CPAP’s); medical conditions that affect blood supply, make skin more fragile or cause movement problems (diabetes, kidney failure, heart failure, multiple sclerosis, Parkinson’s disease, strokes, cancer etc); and an individual’s choice to refuse care despite being educated about the subject.