Wound management for seniors requires a plan curated by a knowledgeable professional as well as dedicated care in order for the wound to heal properly. Since the elderly are more susceptible to wounds often due to their limited mobility, insufficient diet and quality of their skin they must take extra precautions. Preventing a wound is ideal but in some situations wounds develop. Identifying a wound in its initial stages will help minimize the effects and enable faster healing.
In this article we will cover:
- What is a Wound?
- Types of Wounds
- What Are Possible Complications of Wounds?
- Interventions in Wound Care
What is a Wound?
A wound may not sound like such a big deal to an infant or a young adult, because at earlier stages of life, healing process is highly regenerative. However, the same wound can take months or more to completely heal for an elderly individual since the skin begins to degenerate. This degeneration is significant as we age, add to that an injury or wound, the healing process becomes extremely impaired. And, if not treated in a timely and dedicated manner, this wound can sometimes prolong to a chronic wound that may never completely heal. For seniors suffering from other illnesses like diabetes, the healing process gets delayed further.
For this reason, elderly wound care is an essential component of the tasks assigned to an adult child or nursing staff of an elderly. In many cases, the objective of the caregiver is to manage the wound rather than complete eradication, since the latter is highly unlikely.
Types of Wounds
Wounds can typically be classified into two types:
Acute wounds are classified as wounds that heal faster. They heal at a predictable rate and follow the regular healing process. These wounds require minimal intervention and often heal by itself. Some examples of acute wounds include: surgical wounds, abrasions, lacerations and puncture wounds.
On the other hand, chronic wounds heal over time and need to be treated in a variety of ways along with wound dressings. Unfortunately, seniors and diabetic patients are more likely to experience chronic wounds.
These are easily the most common type of wounds. According to a report by The Agency for Healthcare Research and Quality, more than 2.5 million people in the United States alone develop pressure ulcers annually. Pressure ulcers are caused by unrelieved pressure on bony prominences of a body, such as the heel, hips, tailbones and ankles. Pressure ulcers, also commonly known as bed sores can be avoided by providing optimum care to the patients. Following are some recommendations for avoiding pressure ulcers through optimum pressure management:
- Use of appropriate support surface
- Changing positions at least every two hours in bed and every hour in a chair
- Avoid using doughnut-type devices
- When lying on the side, use pillows between legs
- Avoid lying directly on a trochanter
There are various kinds of pressure sores. According to Tina Nardi, RN and wound care specialist, these pressure sores are caused by immobility and positioning external pressure against a bony prominence. To learn more about wound care, please watch her detailed webinar linked in this article.
These occur due to occlusion or flow restriction to the artery. These are very painful and mostly difficult to heal or treat. Vascular ulcers usually develop between the toes, over the lateral malleolus and the phalangeal head. The treatment of arterial ulcers include controlling diabetes, quitting smoking, controlling hypertension and a daily exercise program. Patients may also need to wear stockings and require close monitoring.
Some patients experience numbness as an after effect of diabetes. This numbness usually occurs in the lower extremities which can result in an injury going unnoticed- hence leading to further complications. They body’s immune system is extremely low in diabetic patients, due to which its ability to promote healing or fight infections is greatly compromised. All these factors combined lead to high risk of chronic wound development.
Watch our Wound Care presentation
What Are Possible Complications of Wounds?
Each year millions of patients are affected by chronic wounds resulting in a significant impact on their quality of life and contribute to their mortality and morbidity. One of the greatest complications occurs from treating wounds caused by reopened or infected surgical wounds. The fact is, as we age, we are at higher chances of needing surgeries, but our degenerating skin isn’t always supportive – leading to higher risks of infections and wounds unable to heal completely. If left unattended, they can become chronic and life-threatening. The following are a few of the most common complications that occur with chronic wounds in seniors:
This is the most common cause of wounds not being able to heal properly. Microbial contamination of wounds can lead to localized infection, sepsis, colonization, multi-organ dysfunction and even lead to limb and life-threatening infection. The infection generally occurs in the deep inside the wound tissue due to the presence of biofilms. Biofilm contributes greatly to preventing the wound from healing due to prolonged inflammation.
The infection in a chronic wound may spread through the tissue to underlying bone, causing an infection in the bone. This is most common in patients suffering from foot ulcers caused due to diabetes and could result in hospitalization. Up to 60% of seniors suffering from foot ulcers caused by diabetes will develop this infection at some point. In extreme cases, it could even lead to amputation of the lower extremity to avoid infection spreading up the limb. Many times, antibiotic therapy, paired with extreme care can limit the risk of amputations.
This is commonly known as skin damage caused by moisture. Periwound skin damage looks like white or pale skin with a prune-like wrinkled appearance, also called maceration. This is caused by over-hydration and affects the skin in the periwound area rather than the wound. This skin is not considered injured but rather more prone to problems with friction and pressure and can prevent a wound from healing or closing completely.
Interventions in Wound Care
Chronic wounds can take a toll on the patient and the caregivers both personally and financially. Hence, it is highly recommended that these wounds are taken care of in a timely manner. As discussed earlier, even a small wound in the elderly could become life-threatening. It is important to take immediate action and provide dedicated care in order for the wound to completely heal or prevent it from spreading.
Chronic wounds require special care and monitoring, not always possible by an unprofessional caregiver. However, a prolonged stay in unfamiliar environments like a hospital can take a toll on their mental and emotional health, which would further hinder their healing process. The treatment location can make a difference.
Consider receiving wound care for yourself or a loved one at home. Homecare agencies typically have nurses available who specialize in wound care. The most important takeaway is that timely interventions can provide elderly with the optimum care they require and deserve so identifying the beginning of a wound is imperative.