Wound Care

Everyone gets a cut or scrape once in a while, but in the senior population, wounds are much more serious. Blood does not flow as easily as it used to and minor injuries can become major if not properly treated. A caregiver needs to know some basic prevention and also treatments for their loved one.

Wound prevention

The first place to assist with a loved one’s wound care is in preventative measures. The skin is the biggest organ of the body and often, the most neglected. Every day a person’s skin is exposed to irritants, chemicals and also prone to injury. As people age, the skin becomes drier, especially with those who are dehydrated—a category where many seniors find themselves.

Increasing water intake, as well as using a multivitamin designed for skin preservation, can help prevent dryness and further skin deterioration. A caregiver should invest in an intense moisturizing lotion, avoiding those with scents.

A caregiver must keep a watchful eye on the integrity of a loved one’s skin. Check at least once a day for changes in color or temperature, as well as rashes, sores or painful areas.

When washing, a mild soap is recommended—one without the “antimicrobial” and “antibacterial” properties. Use warm water and pat dry; don’t rub skin that is thin and at risk of tearing easily.

Long sleeves and pants offer an extra layer of protection against skin problems. A caregiver should encourage a loved one to be aware of what they wear, and how using an extra pillow or blanket can help avoid friction and prevent skin tears.

Finally, establish a schedule. This can be for toileting, body rotation and, if possible, exercise. Changing position and moving around keeps skin stronger and less likely to develop serious issues.

Skin tears

A skin tear, or scraped area, is a very common wound in the senior population. As we age, the layers of the skin change and the epidermis thins. The skin is then more vulnerable to tears, bruising and infection with a less effective barrier to help protect it.

Simple things like bumping into a wall or shifting around in bed can cause tears. Wheelchair injuries actually account for 25 percent of skin tears; and transfers and falls, another 30 percent.

Most skin tears occur on the hands and arms, and also during daily routines such as dressing, bathing, transferring, etc. Managing these tears is the tough part. If the initial tear is small, a loved one may not think it is serious and refrain from notifying a caregiver. This is not the ideal situation, as the tear can easily become larger and soon be presenting as a serious wound. How a skin tear is managed initially can have a drastic effect on the future.

Since skin tears can be painful, caregivers should use a non-adherent dressing that will help maintain a moist, clean environment for the wound to heal. They should also try to minimize the number of dressing changes and use of adhesives and tape.

If a skin tear does occur, here are some first-line defense tactics a caregiver can use to dress a skin tear and minimize infection.

  1. Pour ionic silver powder over the wound. It is antimicrobial and will keep away infection.
  2. Apply a moisturizer which contains Vitamin C or grapeseed extract. Do not apply this to the wound itself, but the skin around it, making the skin stronger and less vulnerable to more skin tears.
  3. Place a hydrogel sheet over the wound—a cushioned bandage with no adhesives.
  4. Secure the sheet with elastic net dressing over the arm/leg that has the skin tear. It holds the sheet without tape—another opportunity for skin tears.
  5. Repeat this every day with a new hydrogel sheet until the wound heals.

Infected?

If a wound appears infected, it probably is. Here are some telltale signs:

  1. Red and swollen skin around the wound
  2. Drainage or a foul odor
  3. Warm skin around the area, compared to other nearby skin
  4. Pain associated with the area
  5. Puss, discharge and/or odor

Infections can seriously affect the control of your blood sugar and can quickly lead to other serious complications. Monitor a loved one’s wounds for these symptoms and if they are persistent, don’t wait to get professional attention. An infection can spread quickly to many other areas of the body and cause more damage and concern than necessary, if not treated in a timely manner.

Pressure Ulcers

A frequent type of wound in the senior community is a pressure ulcer. The National Pressure Ulcer Advisory Panel defines this wound as a “localized injury to the skin and/or underlying tissue, usually over a bony prominence, as the result of pressure, or pressure in combination with tear and/or friction.”

When activity lessens and age increases, people are at a definite risk for developing pressure ulcers, more commonly known as bed sores. The pressure from sitting or lying on a certain area of skin over an extended period cuts off circulation to small blood vessels in the skin. This in turn inhibits oxygen and nutrients from reaching that area through the bloodstream. When the skin is left with no oxygen for a long time, the tissue dies and ulcers develop.

There are several stages of pressure ulcers and each becomes more dangerous as the ulcer progresses. If a person develops pressure ulcers, they need to be re-positioned frequently. If a loved one is in bed, this must occur at least every two hours and if in a chair, every hour. A good rule of thumb is to notice if pink, reddened or discolored areas remain on skin longer than 30 minutes after the position change; then the frequency of repositioning should be increased

A health care professional can teach caregivers how to properly change the dressing on a pressure ulcer and also how to prevent further infection. These sores are painful for a loved one and may take a while to heal.

For Diabetics

Diabetic wound care is especially important because of increased susceptibility to infection. Every 30 seconds, someone loses a lower limb from complications with diabetes. With diabetes, there is no such thing as a minor wound. A small foot sore can turn into an ulcer and if not treated, lead to amputation. Many amputations can be prevented by daily care and awareness of a loved one’s skin condition.

Here’s a list of supplies a caregiver should have on hand for their diabetic loved one in case of a wound:

  • Lotion: use it regularly
  • Normal saline (available by prescription) or hydrogen peroxide for cleaning wounds
  • Antifungal cream if you have athlete's foot or other fungal infection
  • Triple-antibiotic cream for dressing cuts or scrapes
  • 4x4 sterile gauze pads for covering wounds
  • The phone number for your local wound care center or doctor's office

The American Diabetes Association gives these tips to help avoid complications of wounds from diabetes:

  • Keep skin clean and dry
  • Apply talcum powder to parts of the body where moisture is likely to develop
  • Avoid bathing or showering in extremely hot water
  • Prevent dry skin by using moisturizers and running a humidifier in your home during cold, dry months
  • Treat cuts immediately, avoiding use of harsh agents such as alcohol or iodine
  • See a dermatologist for unresolved skin problems

There is a variety of wounds a caregiver needs to be watching for while monitoring a diabetic loved one. Regardless of the type of wound, prevention and awareness is a caregiver’s first line of defense. Some precautionary measures can help minimize the occurrence of wounds, but also give a caregiver confidence in knowing how to handle the situation, should it present itself.