A Place for Mom's Family

 

Bedsores

By Jeannette Franks, PhD

Family members with someone in long-term care need to be knowledgeable and vigilant about decubitus ulcers-the dreaded bedsores.

Bedsores, also called pressure sores, pressure ulcers, or decubitus ulcers, are skin wounds resulting from prolonged pressure on the skin in contact with a bed or wheelchair. Bedsores are painful, take a long time to heal, and are often a precursor of life-threatening complications such as skin and bone infections.

The human body is designed to be in constant movement, even while we sleep. We constantly shift positions, always unconsciously readjusting ourselves in bed, at the computer station, watching TV, or whatever active or inactive pursuit engages us.  

This article continues at Bedsores and Personal Care Services.

Thank you for the very informative article regarding bedsores. My mother is currently in long-term care and it seems that she is suseptible to bedsores. I have been trying to gain as much knowledge as possible on the subject. You briefly mention specialty beds and mattresses which is the method of treatment (and also prevention) that finally seems to be making all the difference for her. Her caregiver has put her on a product called the Aircell XL. I guess it's classified as a low air-loss mattress. I am curious if you have any experience or information on the difference between these various types of beds and which are the most effective. Again great thanks for the information in your article.

Good morning! I am sorry to hear your mother has been having issues with her skin. The low air loss mattresses, are a great help. There are some other things that will help this issue, also. Be sure she is being kept turned and repositioned, and that she does not lay in such a way as to have skin touching skin-ie:don't have her legs crossed and touching skin to skin. Using soft pillows as support for limbs to get her comfortable when turning for sleep will help relieve pressure on her skin. Another very important thing about having healthy skin is good nutrition. If she actually has open areas, taking a supplement of zinc and vitamin C can help boost her nutritional state to promote healing, and the doctor could prescribe that if they feel it would help. Probably the most important part of maintaining healthy skin is cleanliness. If she is incontinent, she should be changed as soon as she is wet or soiled. Lauren Gould , RN

Incontenance could be an issue and cause.  Many patients in nursing homes get overlooked for bladder issues because as a society we have become to expect this in our elderly population.  The bladder is a muscle and due to age, illness (such as a stroke), childbirth, the muscle weakens and causes more frequent urination.  There are medication solutions to helping the bladder but many of these medications will also cause other side effects including dizzyness which might result in falls.

Another solution is to strengthen the bladder through e-stem (external) or inter stem (internal) therapy.  A small and constant electic shock of the bladder witl cause the musle to contract and allow one to hold the bladder longer, resulting in less frequent urination.  Inter stem, which works much like a pace maker for the heart, is inserted into the bladder and controled by a small battery that is inserted under the skin.  The constant shock of the bladder may allow a person to go several hours instead of several minutes without urination.  The proceedure is relatively simple and there is a test that can be done to determine if the proceedure is likely to help.  Even for bed bound patients the proceedure could enhance the quality of life, reduce mediation needs and reduce skin breakdown.

For more information you can contact a urologists or contact me and I will get you more infomration.

Scott Middleton is CEO of Agape Senior, a housing and health care provider for senior adults in South Carolina. Agape provides assisted living, independent living, hospice care, primary physician care, pharmacy and medical equipment. http://www.agapesenior.com/

 

Nice write-up.  Just to comment on a couple of points you raised:

 

Personal inspection:

As you noted, you need to actually check under the covers.  This is just so important.

Few family members will want to actually check on the work that's being performed. Much too often, supervisors don't thoroughly check, either. Creases in the skin can hide small problems that soon become big ones.

If you don't feel comfortable performing the inspection yourself, find or hire someone who will. It will be a great service to your loved ones. The sores and discomfort that so often result are completely avoidable. Also, if the staff knows that you may verify, the full level of care is likely to improve.

 

Use of lotions:

Use the best cleansers and lotions you can get. Even if your client or loved one is in a long-term care facility, you will still want to look into this. Find out what is being used, and if necessary, bring in samples of your favorites. Be prepared to ask your physician directly for prescriptions for the most appropriate products, and then make sure the caregiver or care facility actually gets them. If a lotion is prescribed in a facility, you will want to be sure it is kept aside for his or her use and not put with the general supplies.

You may have to insist, but it's worth it. Of course these only work if used daily, and properly.

Bathing should be performed at least daily, with additional follow-up bathing as necessary. Prosducts for rinse-less bathing are available at some pharmacies and most medical supply stores. After the bath, lotion should be applied, and thoroughly massaged into the skin so there is no residue. You should be checking for the possible development of sores while doing this.

 

Modified versions of high-end hospital beds are available for home:

The picture to the side is a home care setup, with a highly sophistiacted mattress and control unit on a very standard bedframe. this happens to be one hihgly regarded manufacturer's mattress, but a handful of manufacturers have competing products.

This bed looks modest, but it is one piece of equipment that can really help.  This particular rolls gently on a timer, to very sophisticated settings (variable and sectioned tilt, one-side-only shifting, etc.)  This also has a percussion feature for - for example - use with vent patients.

For those who can't move themselves in the bed, make sure that when they are hospitalized or in long-term care they have a prescription for the best possible bed.  These beds are expensive though. Unless there are pre-existing bedsores, which there shouldn't be, it may be difficult to get reimbursement. It is still worth it to try, and your client may find it worthwhile anyway.

You can't buy the entire hospital-version of this bed for home, but you can get this mattress and control unit that can be used on appropriate home bed frames. Again, it doesn't look like much, but it can make a tremendous difference in your loved one's comfort and well-being.

 

There are a number of other areas of practical application, but this is a very good start.