Pressure Injuries - A Common problem in elderly people

Updated: Mar 10

Kumar is becoming increasingly despondent, his son was planning to shift him to the nursing home. Kumar is a widower, he lost his wife to a heart attack three months ago, after which he started feeling even more lonely and abandoned. He was in the supine state for almost eight months. Being a heavy patient his caretakers found difficulty in repositioning him every two hours, as a consequence, he has developed first stage bedsore. He constantly complains of a lack of concern and care from his caregivers. This is not the story of one Kumar but several other elderly adults.



Old age, the last stage of the life process, witnesses multiple chronic diseases leading to immobilization and eventually resorting to bed! According to the Longitudinal Ageing Study of India (LASI) estimate, the number of aged populations in the country by 2050 would be over 319 million.


According to WHO estimates, by 2050, the population above 60 years will nearly double from 12% (in 2015) to 22%. With ageing, there is a decrease in both physical and mental capacity.

Why are Bedsores dangerous in older adults?

Though life expectancy above 65 years has improved, there remain a high risk of diseases and more prone to bed-bound care in old age. The supply of blood to the skin decreases in the recumbent position. In addition, flattening and thinning of epithelial layer is observed, subcutaneous fat decreases, moreover, the elasticity of collagen fibres is lost. This increases the vulnerability of an older person to bedsores. It is observed that there is decreased tolerance to hypoxia. the decrease in oxygenation to the tissues damages multiple organs and leads to fatal complications.


The presence of chronic disease (comorbidities) is persistently high and climbing in older people, including, cardiovascular diseases, diabetes, neurodegenerative disorders among others. In addition, anaemia, incontinence, frailty, malnutrition is common with ageing. The development of pressure ulcers is due to several factors, primarily because of immobility and poor perfusion. The other factors include loss of sensory perception, poor nutrition, diabetes, chronic wounds, infection, among others. The skin of older people provides less protection against injury which increases the intensity of pressure ulcers. These together result in deterioration of physical and mental health, in addition, to extending the hospital stays that increases the cost and often lead to early mortality.


Older people with decreased body mass, albumin, and haemoglobin should be given utmost care as they are at high risk of developing pressure ulcers in association with comorbidities. Older age-related neurodegenerative disorders, like dementia, Alzheimer's disease, Parkinson's disease, are found to increase with passing time. Progression in these kinds of diseases is manifested in difficulty in eating, several episodes of infection, loss of sensory perception, which make them more susceptible to pressure ulcers.


At varying degrees, the functioning of the kidney decreases with ageing. The conditions like diabetes and hypotension further impair its functionality. And due to this imbalance, there is an imbalance of homeostasis functions, that results in a poor perfusion rate. Thus, indirectly supplements the development of pressure ulcers.


The presence of anaemia and malnutrition is a serious problem to be addressed. It impairs immune and hormonal functions. This readily causes changes in the skin that could potentially lead to a reduction in the subcutaneous tissue and cause muscle atrophy, which is suitable for the development of bedsores.


Infectious diseases are an add-on problem, as it reduces immunity and deteriorates health, it takes a longer time to heal the wounds. That poses uncertainty of the development and cure of pressure ulcers. a very often infected person is given sedatives that possibly could be a reason for urinal and faecal incontinence. The presence of moisture causes direct damage to the skin.


What is the take-home message?

Caretakers must provide greater care by minimizing bedrest, in addition, should ensure judicious usage of medication and pay attention to its side effects. Caretakers should make sure the older adults are provided nutritious meals, as ensuring a healthy weight is critical in preventing skin damage.

Ensure repositioning every 2 hours to optimize oxygen and blood supply in the old-age patients. A repositioning schedule is crucial for older adults! Regular monitoring at-risk areas and protecting at-risk areas with additional cushions could do some help. In the long run, cushion and foam mattresses do only a little help in preventing bedsores.


SOURCES

https://www.who.int/news-room/fact-sheets/detail/ageing-and-health

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781120/

https://www.jstor.org/stable/20024436

https://www.researchgate.net/publication/326785466_PROBLEMS_FACED_BY_OLD_AGE_PEOPLE


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