UNIT 4: COMMON DISORDERS IN THE AGING 4.2 CARE OF AGEING SKIN AND MUCOUS MEMBRANES

Pressure ulcers (PU) are ischemic lesions localized to the skin and underlying tissues with loss of skin substance produced by prolonged pressure or friction between two hard flat.

They are a serious and common problem in older people. Represent one of the major complications of immobility situations. Its proper management is an indicator of quality.

It is estimated that at least 95% are preventable.

The incidence rate is 1.7% per year between the ages of 55-69 years and 3.3% between 70-75 years. In the residences is 9.5% in the first month of stay, and to 20.4% at two years.

Risk factors:

- Pathophysiological: skin lesions, > 40 years, nutritional deficits, disoriented, comatose state, oxygen transport disorders, Immobility (confinement to bed or wheelchair), sensory deficit (heat, pain), skin exposure to high temperatures moisture, fecal and / or urinary, pressure or external forces, friction and shear.

- Derivatives of treatment: immunosuppressive treatments, immobility

- The environment: lack of health education and patient caregivers, work overload, professional Discouragement               

- Situation: wrinkles on clothes, lack of hygiene, immobility, brush with objects.

Evidence:

• The Braden Scale and the Norton scale scales are used to identify elderly patients at risk of developing pressure ulcers.

• The Braden Scale has a sensitivity of 83-100% and a specificity of 64-77%, the Norton scale has a sensitivity of 73-92% and a specificity of 61-94%.

• The Braden Scale has been tested on medical-surgical units, intensive care units and nursing homes for elderly care. The Norton scale has been tested in hospitals with elderly.

• Research data show that measured functional concepts Braden scale are better predictors of risk than medical diagnoses.

• Essential laboratory tests include blood count, coagulation, ESR and biochemical.

• When there is a pressure sore eschar can not be accurately estadiate until the eschar is removed.

• There are research data linking high risk for pressure ulcers in individuals with spinal cord injuries and depression mean scores high.

• Alcoholism is an important risk factor.

• The participation of individuals in treatment and education regarding psychosocial care is associated with positive results ulcers.

• All individuals at risk should have a systematic evaluation of the skin at least once a day, paying special attention to bony prominences.

• The results of the skin assessment should be recorded. Inspect each site to assess the status and integrity of the individual's skin or for early signs of injury: erythema, temperature, fissures, dry or wet.

• Establish a routine cleaning of the skin. The frequency of skin cleansing should be individualized according to the needs.

• Use warm water and use cleaning agents that minimize irritation and dryness of the skin.

• During the procedure should be the minimum force and friction on the skin.

• Do not apply massage over bony prominences and minimize skin exposure to moisture caused by incontinence, perspiration or wound drainage

• Skin lesions due to friction or shear forces can be minimized through changes in the movement or transfer techniques and proper body position. They can also be reduced with the use of lubricants, protective dressings (such as hydrocolloids) and pads.

• Regarding nutritional assessment, this should include:

- Weight

- Signs of moisture

- Determination of minerals and vitamins need

- Laboratory data and lymphocyte count, serum albumin.

• Maintaining levels of activity, mobility of individuals through rehabilitation treatment.

• Use positioning devices such as pillows or foam wedges to protect bony prominences on direct contact between them, in people who are confined to bed.

• Mantain pressure distribution and no wrinkles on the bed. The pressure relief devices must be prescribed individually to be effective and to not interfere with other aspects of mobility and personal autonomy.

• The use of devices reducing pressure can increase the range of motion when the pressure is relieved. Although rubber devices cause venous congestion and edema.

• It is also important body alignment.

• Elderly people in bed should be repositioned every two hours, if it is consistent with the treatment of the individual.

• Suspend ankles in the air, using pillows or boots that rise.

• Lift without dragging the individual, using sheets of movement. Raise the peron's body for the position changes with the help of another person.

REFERENCES:

·         Abuchar Canyon, HM; Adarve Balcazar, M, Brown Duke, AV. Prevention of pressure ulcers in hospitalized adults. ACOFAEN Guides. Lascasas Library, 2005; 1. Available in http://www.index-f.com/lascasas/documentos/lc0028.php> [Accessed 13 May 2013]

·         Treaty of geriatrics for residents. Spanish Society of Geriatrics and Gerontology. [Home Site] [accessed May 18, 2013] Available at: http://www.segg.es/tratadogeriatria/main.html