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Pressure Sores

Friday June 26, 2015

As your loved one’s physical condition declines, they may spend more and more time in a wheelchair and in bed--and be at more risk for pressure sores. These are sores that develop when the blood supply is cut off to an area for more than two or three hours. Pressure sores become an issue when a person cannot move easily without help. The areas of highest pressure are: The hip, lower back or buttocks, shoulder blades and spine, back and sides of head, rim of the ears, heels, ankles and skin behind the knees.

Pressure sores (bedsores) are more common in a care facility than at home. That’s because

a) people are usually less mobile by then, and

b) they may not get the one-on-one attention they got at home.

However, they CAN happen at home, especially if you don’t know to look for early signs. Even with the best of care, pressure sores are a risk for people with any debilitating illness.

PreventionThe first line of defense.

The surfaces. A mattress made of medical quality high-density foam is both inexpensive and very good for someone with limited movement. Lacking that, you can cover an existing mattress with a pad of the same quality. An egg-crate foam pad does not provide adequate protection, even if it is quite thick. Other good mattresses and pads are those made with gel foam, alternating air and sheepskin. If your loved one is in a wheelchair, it’s a good idea to use a chair pad of similar quality. Don't forget the backs of the legs if your loved one sits in the chair with the feet raised.

Movement.  Once a pressure sore starts, it is hard to cure. Therefore, even with good surface protection, your loved one’s position needs to change every two to three hours. As his ability to move decreases, it becomes the caregiver’s task to make sure this happens. The shift doesn’t have to be major - side to back is great. However, the areas of the body experiencing the most pressure do need to change.

Massage. Massaging the “high pressure areas” at least once a day helps to maintain good circulation and tougher skin.

Nutrition. The skin needs adequate proteins and fluids to stay tough. Add healthy oils (fish or fish-oil supplements, olive oil, avocados, flax seeds) for elasticity and strength. Be aware that some medications, including steroids, can make skin more fragile and others, such as aspirin, which thin the blood and increase bruising.

Observation. Even with the best treatment and the most careful prevention, pressure sores can happen. Check on major pressure points at least once a week, daily if possible.

“When I was my Dad’s physical caregiver, checking for pressure sores was a part of our bathing process. When he entered an assisted care facility, looking felt intrusive. I assumed that the staff was checking—but apparently they weren’t. Dad developed an awful bedsore on his tailbone which became infected and led to his death.” Janice

Yes, the care staff should, and usually do, check for pressure sores but it doesn’t hurt to check yourself as well. (They have many other patients to care for, and things get missed even in the best of facilities.) It may feel intrusive, with both patient and staff, but be proactive. Look. If the skin is in good condition, tell the staff how pleased you are. Let them know you check! If it isn’t, ask that something be done immediately. Then follow up.

Treatment

Early sores. A pressure sore starts out as a mild redness that doesn’t go away. The skin may be tender, and warm or cool, compared to the surrounding skin. Caught early, it is easy to fix. Avoid putting any pressure on that spot until it returns to normal skin color. Additional massages with healing oils will speed the recovery. If the sores reappear, talk to the doctor or a physical therapist about ways to avoid this.

With broken skin: If the skin is broken, contact a doctor for immediate treatment. This includes a dressing to keep the area clean and moist and, of course, minimal pressure until healed. Medication depends what kind of infection, if any, is present. With deep sores, surgery may be required to clean out the dead tissue.

Pressure sores are no small thing when they are left undiscovered and untreated. A proactive caregiver can make sure that they are found early and treated appropriately. 

Some good references:

More about mattresses: http://www.thiscaringhome.org/virtual_home/bedroom_beds_mattress-overlays_guide.htm

More about chair pads: http://www.spinlife.com/buying-guide/seat-cushions/

Types of healing oils to use with massage:  http://everythingessential.me/bed-sores-pressure-ulcers/

More about pressure sores and their care:

http://www.mayoclinic.org/diseases-conditions/bedsores/basics/prevention/con-20030848

For information about Lewy body disorders read our books:

A Caregivers’ Guide to Lewy Body Dementia

Managing Cognitive Issues in Parkinson’s & LewyBody Dementia

 

Helen Whitworth, MS, BSNHelen Whitworth, MS, BSN
NWPF Blogger

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