Silver Age Health | As the temperature rises, do a good job in preventing and treating bedsores

There are many elderly people who cannot move freely due to age or physical disability. In addition, they will maintain the same posture for a long time due to sleep time. This is likely to cause bedsores. Once bedsores occur, they are difficult to cure, which is a big problem for the elderly and their caregivers. In order to protect the scars, they cannot move freely, which will affect the sleep of the elderly and even fall into a vicious cycle of poor physical and mental function.

It is important to keep the elderly healthy physically and mentally and prevent bedsores. Today we will introduce some of the causes of bedsores and ways to prevent them.

What is a bedsore?

Bedsores, also known as pressure sores or pressure ulcers, are a symptom of damage, ulcers, and even necrosis caused by long-term pressure on the skin of the body, impaired blood circulation, ischemia and hypoxia of the skin and subcutaneous tissue. Bedsores are prone to occur on compressed bone protrusions, such as the coccyx, greater trochanter of the femur, inner and outer ankles, and spine. In the early stage of compression, the skin color changes and edema appear in the local area, followed by blisters, erosions, and ulcers, which can reach deep into the muscles and bones, seriously affecting the patient's quality of life. Bedsores can be seen at any age, but are most common in the elderly, especially those over 70 years old.

▏Causes of bedsores

1. Pressure factors. Elderly people with hemiplegia or disability are lying in bed or sitting in a wheelchair for a long time, and their skin is subjected to continuous pressure, shear force and friction, which leads to obstruction of blood circulation in the skin, lack of nutrition and necrosis.

2. Improper care. Bedridden elderly people need to turn over every 1 to 2 hours during the day and no more than 3 hours at night. If they maintain the same lying position for a long time, the local skin is easily compressed and necrotic. When redness or blisters appear, they should be promptly treated with bedsore cream to prevent the situation from further deteriorating.

3. Poor skin tolerance. Due to skin aging and loss of elasticity, people are more likely to develop bedsores, especially those with incontinence, who are easily irritated by moisture and dirt, which reduces the skin's resistance.

4. Malnutrition. Malnutrition leads to the deficiency of fat protective layer, protein, etc. For example: blood circulation disorder, subcutaneous fat degeneration, etc. In addition, friction, diabetes, elderly patients, decreased resistance, drug factors and smoking can induce bedsores.
There are many reasons for bedsores, but the biggest reason is "maintaining the same posture for a long time."

Therefore, to prevent bedsores, it is important to change the pressure points to prevent the elderly from lying in bed for a long time or sitting in a wheelchair in the same position for a long time. In addition, changing the body position requires direct contact with the elderly's body. Even if you judge that there is no problem and make the change, it may put a huge burden on the elderly's body and mind. Therefore, you should first observe the elderly carefully. If you ignore their health status, it will cause the symptoms to worsen.

▏ Areas prone to bedsores and complications

1. Supine position: occipital area, shoulder blades, elbows, vertebral protuberance, sacrum, heel, outer ankle, and toes;

2. Side-lying position: auricle, shoulder, elbow, hip, inner and outer sides of knee joint, heel, inner and outer ankles;

3. Prone position: anterior superior iliac spine, costal protrusions, knees, toes, shoulders or elbows, cheeks and ears.

Complications from bedsores

1. Sepsis. The bedsore wound becomes infected. When the infection is severe, the toxins of the bacteria can invade the blood and cause sepsis.

2. Skin cancer. If bedsores do not heal for a long time or recur repeatedly, they may induce cell atypia and increase the risk of skin cancer.

3. Cellulitis. Secondary infection of bedsore wounds with hemolytic streptococci and Staphylococcus aureus can easily cause extensive and diffuse inflammation of the skin and subcutaneous tissue, manifesting as cellulitis.

4. Bone and joint infection: If the ulcer surface penetrates too deeply and involves the bone and joint, it will cause osteomyelitis, infectious arthritis, etc., and reduce the movement function of the bone and joint.

▏How to care for bedsores

1. Turning over and nursing. Bed sores must be turned over and changed positions frequently. When a bedsore appears in a certain part of the body, the pressure on the wound must be relieved immediately, and another lying position should be adopted to rest to avoid secondary pressure on the wound. On this basis, multiple lying positions should be found to facilitate rotation and turning over to avoid bedsores in other parts of the body.

2. Protect the wound from pressure. The wound should not be subjected to secondary pressure or exposed to the outside. Apply bedsore cream and then bandage it with gauze to absorb excess wound exudate and create a moist and closed environment for the wound. Commonly used bedsore creams such as Shangdi and Xuanqing bedsore creams are conducive to the recovery of the wound.

3. Protection of bony protrusions. Elderly people who are thin usually have bony protrusions, which are prone to greater pressure when lying down. Therefore, soft clothing is needed to prevent the bony protrusions from being rubbed and ulcerated. In addition, when choosing a mattress, try to choose a soft and moderate mattress.

4. Protection of the buttocks and back. To make room for the body, you can also use pillows or clothes to spread the pressure on a larger area of ​​the body when lying down. For example, if you have bedsores on the buttocks and back, you can choose to lie on your side and put a triangular pillow or a soft pillow on your back to share some of the pressure on the back, avoiding excessive pressure on the hips and causing ulcers.

▏How to change the body position for the elderly during care

1. The segmented turning method divides the human body into three sections (head and shoulders, hips, and lower limbs) for turning. (1) First turn your face to the side. (2) Place the hand on the side opposite to your face on your abdomen and lift your shoulders. (3) Tuck your jaw in, tilt your head slightly forward, and hold the edge of the bed on the side you want to turn to. This will make turning relatively easy. (4) Bend your knees and turn to the side. This turning method is suitable for bedridden elderly people who are relatively heavy and have good skin nutrition.

2. Overall turning method: The patient lying flat is supported by one hand on the waist and the other hand on the thigh, and the patient is moved to the side of the bed. Then the patient is turned sideways to a 90-degree turning angle, forming a large turning. This turning method is suitable for bedridden elderly people who are not very heavy and whose skin nutrition is not very good. (1) From the perspective of protecting the affected side, the affected side should be placed on top and not bear the weight for assistance. (2) In order to make it easier to turn to the side, the elderly person needs to tilt his head forward and then face the healthy side. (3) The elderly person is asked to bend and put away his feet, which is conducive to the transfer of the center of gravity. (4) The caregiver puts his hands on the shoulder and knee of the elderly person on the affected side. (5) After telling the elderly person "let's turn this way", after feeling the elderly person's force, turn the elderly person to your direction in the order of knees first and shoulders later.

3. Small-angle turning method: Turn the patient to 60 degrees, with the waist and back leaning against the pillow. This turning method is suitable for bedridden elderly people who are light in weight, poor in nutrition, and thin in skin. When turning the bedridden elderly, the action should be gentle, and the elderly must be lifted before moving. Each time the patient is turned over, the skin condition of the pressure area should be carefully checked. Soft clothes can be placed in front and behind the coccyx to make the coccyx area appropriately vacant.

4. When changing from lying to sitting

First, follow the above method to move the elderly from the supine position to the bedside, then to the lateral position, and then let them sit up. When assisting them to sit up, they should follow the following method.

(1) Place your hand under the elderly person’s neck and tell them to “sit up with your elbows” or other instructions;

(2) While supporting the elderly person's upper body, lower their legs and pause for a moment when the elderly person's elbow on the healthy side is in position on the bed;

(3) Let the elderly person use their elbows to push the bed and sit up. If the elderly person cannot sit up by themselves, assist them to sit up;

(4) If the nursing bed is height-adjustable, adjust the bed to a height where the soles of the elderly’s feet can just touch the ground;

(5) Ask the elderly to sit out a little. Wrap the healthy hand around the affected arm and then move forward;

(6) Finally, confirm the elderly person’s sitting posture, such as whether the soles of the feet are on the ground, the feet are shoulder-width apart, and the upper body is fully raised.

How to prevent bedsores

For the elderly who are bedridden or in a fixed position for a long time, careful and meticulous care can prevent bedsores. Keeping the skin of the pressure area dry and clean and applying drugs that improve local blood circulation can prevent bedsores.

1. Maintain the correct body position, increase the number of turns, and avoid excessive local pressure. If the body position is forced due to illness, the body position should be changed every half an hour to two hours to reduce the pressure on the skin. You can use an air mattress, foam mattress, etc.

2. Avoid local skin irritation, keep underwear soft, breathable, clean and dry. The bed sheets are neat and flat without wrinkles or debris.

3. When using a toilet, choose an undamaged toilet, do not force it in or pull it hard, and if necessary, place soft paper or cloth pads on the edge of the toilet to prevent skin abrasions. When turning over, move gently to avoid skin abrasions.

4. Maintain good eating habits, balance meals reasonably, have three meals regularly, and avoid spicy food, fish, shrimp, strong tea, coffee, tobacco, alcohol, etc.

5. Maintain a relaxed and happy mood, and avoid daily high tension, anxiety and discomfort, which can easily induce disease.

It is important to detect and respond to bedsores in their early stages. If you are concerned about whether you have bedsores, you should consult a doctor or nursing expert as soon as possible. Although bedsores are difficult to treat, they can be prevented, so we should take precautions in our daily lives.

▏Diet for patients with bedsores

1. The dietary nutritional combination for patients with bedsores is very important. It is necessary to ensure nutrition while not letting the elderly gain weight, otherwise it will easily put pressure on the body and aggravate the condition. Therefore, it is necessary to achieve scientific combination, nutrition and health, including meat, eggs, milk, vegetables, fruits, soy products, and coarse grains.

2. Patients with bedsores rarely move and consume few calories, so they do not need to eat too much. Their diet should mainly consist of vegetarian food and supplemented by meat. The diet should include pasta, rice, and vegetables. They should eat meat once every two or three days, and it is best to stir-fry vegetables with vegetable oil to reduce fat intake. In the evening, they can just eat some porridge and cold dishes.

3. Bedsore patients should eat foods rich in vitamin B1, such as whole grains, beans, lean meat, animal offal, fresh vegetables, etc. In addition to dietary adjustments, scientific care from family members is also essential, which is also very important. Careful care can be said to be half the cure. Many patients' conditions worsen due to poor care, so patients should be turned over and scrubbed frequently to keep them clean.

Many diseases are 30% treated and 70% taken care of, which also shows the importance of recuperation, especially for the elderly with bedsores. They are unable to move around easily, and if they are not well taken care of, their condition will worsen. (Picture from the Internet)

Author | Li Aiping was born in Qiqihar, Heilongjiang Province. She graduated from Fuzhou Medical University and has 20 years of nursing experience. She is a national second-level nurse. She is an expert in food hygiene and nutrition, has a national nutritionist qualification, and is a science enthusiast.