Preventing Occurrence of Pressure Ulcer to Geriatrics

Pressure ulcers (sometimes called as pressure sores, decubitus ulcers, bedsores), is a common medical complications, particularly among the physically limited or bedridden elderly. For a number of elderly individuals, pressure ulcers may become chronic for no apparent reason and may remain so for longer periods, or may continue even for the remainder of his/her life. It is a localized injury of the skin and its underlying tissue, usually over a bony prominence, which results from pressure or pressure in combination with shear or friction. A large number of grade 3 and 4 pressure ulcers become chronic wounds, and the afflicted individual may even die from an ulcer complication (sepsis or osteomyelitis). Its presence in a geriatric individual constitutes a number of symptoms that will lead to a lot of pathological conditions. These accumulated effects of impairment due to an individual immobility, nutritional deficiency and chronic diseases involving multiple systems. The aging skin of the elderly person is susceptible to pressure ulcer. It is one of the most dangerous, life-threatening diseases an elder can get.

Geriatric individuals have thinner skin, which makes them more vulnerable to damage from even minor pressure. Pressure ulcers are more likely to occur if geriatric individuals have one or more of the following conditions:

• Fragile skin
• Bedridden or in a wheelchair
• Are 70 or older
• Have a chronic condition, such as diabetes or vascular disease, which prevents areas of the body from receiving proper blood flow
• Cannot move certain parts of their body without assistance, such as after spinal or brain injury or if they have a neuromuscular disease like multiple sclerosis
• Malnourished
• Suffer from a mental disability such as Alzheimer’s disease
• Have urinary or bowel incontinence

Pressure ulcers that are left untreated can be life threatening. There are six staging categories of pressure ulcers as herein enumerated: (1) Suspected Deep Tissue Injury, (2) Stage 1, (3) Stage 2, (4) Stage 3, (5) Stage 4 and (6) Unstageable. These mentioned six stages of pressure ulcers are clearly explained by Wound Source (etiology, risk factors, complications as well as its treatments and interventions). If you are still interested to delve deeper for additional information the said website by Kestrel Health Information, Inc. supports related articles.

The untreated pressure sores can lead to a wide variety of secondary conditions, including: sepsis (bacteria entering the bloodstream); cellulitis (inflammation of body tissue, causing swelling and redness); bone and joint infections; abscess (a collection of pus); cancer (squamous cell carcinoma).

When an individual is bedridden, pressure sores can occur in a number of areas, including: back or sides of the head; rims of the ears; shoulders or shoulder blades; hipbones; lower back or tailbone; backs or sides of the knees; and heels, ankles and toes.

The objectives of treating a pressure ulcer would include avoiding any preventable contributing circumstances, such as immobilization after a hip fracture or acute infection. Once a pressure ulcer has developed, however, the goal is to heal it by optimizing regional blood flow (by use of a stent or vascular bypass surgery), managing underlying illnesses (such as diabetes, hypothyroidism or congestive heart failure) and providing adequate nutritional food. If the ulcer has become chronic, the ultimate goal changes from healing the wound to controlling symptoms (such as discomfort, foul odor, infection, and pain) and preventing complications. Such action can contribute to the patient’s overall well-being. Another important factor is by provision of necessary support to the patient’s family.

Prevention
Pressure ulcer can arise due to neglect, such as leaving the elder wet for long periods, not turning them on proper schedules, and so on. This kind of neglect is a serious abuse, and can cause more suffering, and eventual death of the elder. Enumerated below are Agency for Healthcare Research and Quality (AHRQ) recommendations for the prevention of pressure ulcers:

• Assess skin daily
• Clean skin at time of soiling – keep them dry at all times. Avoid hot water and irritating cleaning agents
• Use moisturizers on dry skin
• Don’t massage bony prominences
• Protect skin of incontinent clients from exposure to moisture
• Use lubricants, protective dressings and proper lifting techniques to avoid skin injury from friction/shear during transferring and turning elders
• Turn and position bedbound clients every 2 hours if consistent with overall care goals
• Use a written schedule for turning and repositioning clients
• Use pillows and other devices to keep bony prominences from direct contact with each other
• Raise heels of the bedbound clients off the bed
• Use lifting devices (Trapeze, bed linen) to move elders rather than dragging them in bed during transfers and position changes
• Reposition chair or wheelchair elders EVERY HOUR. In addition, if elder is capable, have them do small weight shifts every 15 MINUTES. Pressure ulcers can form in less than an hour!
• Don’t massage reddened bony prominences
• Avoid drying out the patient’s skin, use lotion after bathing
• Avoid hot water and soaps that are drying when bathing elders
• Manage moisture by determining the cause, use absorbent pad that wicks moisture

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