Wound care in older adults

Older adults are prone to many types of wounds that can quickly become chronic and complex, leading to wide-ranging problems.Wound care experts and nurses Simon Palfreyman, associate teaching professor in the faculty of nursing at the University of Alberta, and Kimberly LeBlanc, academic chair of the Wound, Ostomy and Continence Institute, provided advice for good wound care.Here’s what they advised:Address the underlying problemPalfreyman said he sees patients who’ve had wounds for months, even years, where the underlying cause was never addressed.One example is pressure wounds on someone with limited mobility. Look for devices or equipment that could help, such as pressure-relieving seat cushions or mattresses or devices that offload pressure on heels.Another example is venous ulcers, where you need to address the underlying venous hypertension. “If you apply compression bandages, so you’re reducing that venous hypertension, then it’s more likely it will heal,” Palfreyman said.The diagnosis of the wound also has to be correct. For example, differential diagnoses for a venous stasis ulcer include a squamous cell carcinoma or a vasculitic ulcer, LeBlanc said. She added that a diuretic won’t help heal a true venous stasis ulcer in cases where there’s no liver or kidney disease or congestive heart failure.Choose the appropriate dressingMake sure the patient and other healthcare professionals know why you’re using that specific dressing and how it supports your goals for managing the wound. It could be to reduce odor, provide comfort, diminish pain or create an environment for the wound to heal.Many patients need nursing care because they don’t have the correct equipment or skill to manage wounds on their own. LeBlanc recounted a case where a physician had the patient treat a skin tear with a non-stick dressing from the pharmacy. It didn’t heal for six months. When LeBlanc changed the dressing to a silicone dressing with compression, the wound healed quickly. Most skin tears heal well if you can preserve that skin flap and cover it with a low-adherence silicone dressing for five to seven days, Palfreyman noted.Find a clinic that can do debridement, or learn how to do itDebridement is a cornerstone of wound management, but conservative sharp debridement isn’t part of some nurses’ scope of practice, can’t be performed in a patient’s home, and emergency departments tend to avoid it. Some home care agencies set up clinics where nurses with advanced training can do conservative sharp debridement, but not to the point of bleeding, which is often needed for diabetic leg ulcers, LeBlanc said.If you’re doing a sharp debridement, “Start conservatively and assess what impact that debridement is having on the wound healing,” Palfreyman said. “Just be mindful of the underlying tissues as well.”Treat the whole personDon’t underestimate the impact of wounds on a person’s quality of life.“There are people who don’t leave the house because they have a venous leg ulcer and it smells and they’re conscious about the odour,” Palfreyman said. “Or they don’t leave the house because it’s painful.” It impacts their socialization and their mental health.Co-morbidities and poor nutrition will influence how well wounds heal. Some people may be more prone to infection or have perfusion issues that delay healing.“The wound is attached to the person so you need to address and consider that whole person as well as just the wound,” Palfreyman said.Preventing woundsWound prevention can start in the physician’s clinic, LeBlanc said. Ask about things that might cause injury or damage to the skin, such as tripping hazards, incontinence or limited mobility. Inspect the bare feet of people with diabetes, and encourage them to do the same every day. Even a small wound should be treated right away by an expert, LeBlanc said.A regimen of moisturizing twice a day can prevent skin tears in older adults. Work with other healthcare professionals to improve mobility so pressure wounds don’t develop. Keep up-to-date on wound careOntario physicians can attend free weekly case-based wound management rounds held over Zoom. It’s part of project ECHO (extension for community healthcare outcomes) and participants get CME credits.Guidelines on wound prevention and management are available from Wounds Canada, Wounds U.K., the U.S. National Pressure Injury Advisory Panel and other groups.

Wound care in older adults

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