The Skin You’re In: Preventing Pressure Ulcers

Good skin health is important to living a full and active lifestyle

By Corrie Dinwiddie, RN
Oxford HealthCare Wound Coordinator

The skin is the largest organ of the human body. According to the online journal LiveScience.com, the average person’s skin counts for 16 percent of their total weight, and spans a surface area of 22 square feet. It is also one of the most important organs for our general health, helping to:

  • Maintain your body temperature
  • Protect you from germs
  • Gather information for your nervous system
  • Assess and react to your surroundings (e.g. heat, cold, pain, sensory touch)

To function properly, your skin needs adequate attention and proper care. A break-down in your overall skin health can put you at risk for injury and disease.

Possible Skin Problems

Even if you have healthy skin, problems may occur if you are immobile for long periods of time, especially in a lying or sitting position. When this happens, pressure from your body weight on the bed or chair surface cuts off the blood supply to skin. As a result, those skin cells don’t get the oxygen and nutrients they need to survive, and a pressure ulcer may result.

Pressure ulcers occur from prolonged sitting or laying

The condition mainly occurs on skin areas that cover a bone or bulge, such as heels, shoulders, hips, and upper buttocks. Pressure ulcers have many names, including:

  • Bedsore Decubitus (de-KU-bi-tus) ulcers
  • Dermal wounds
  • Pressure sores

Risk Factors for a Pressure Ulcer

You may be at risk for a pressure ulcer if you are experiencing:

  • Limited activity or confined to bed
  • Reduced tactile sensation (sense of touch)
  • Chronic, complicated medical problems such as diabetes, obesity, smoking, poor circulation, and spinal cord injury
  • Increased skin moisture from bladder or bowel control issues
  • Poor diet or nutrition Low protein intake, especially if nutrition is already poor

Older adults are more at risk for a pressure ulcer, as are patients who slide down in the bed. Sliding down can cause friction that may tear delicate or already damaged skin.

Symptoms of a Pressure Ulcer

If you have a pressure ulcer, you may have burning, aching, or itching at the site. The injured skin may be red or bruised, or have a purplish discoloration that continues even after you shift position. People with darker skin tones may not show redness or discoloration, and some may need to compare the injured area with uninjured skin tissue.

A pressure ulcer may feel firm or mushy, and may be warm to the touch. Swelling and tenderness are common, and a blister or shallow sore may develop. Sometimes a clear or blood-tinged fluid may drain from the ulcer area. If un-noticed or un-treated, the wound may deepen and extend into the fat layer or adipose (ADD-ih-pose) tissue, or even down to the bone. Pressure ulcers are sometimes categorized in stages (Stage I, Stage II, etc.), based on how deeply the tissue is injured.

Stages of bedsores and pressure ulcers

What Can You Do to Help Prevent a Pressure Ulcer?

You and your family members are important to the prevention and care of a pressure ulcer. Your skin health can be improved when general steps are taken, including:

  • Not smoking
  • Daily exercise (even bedridden patients need activity)
  • Good nutrition
  • Maintaining a healthy weight
  • Adequate hygiene
  • Moving and turning
  • Asking your family or caregiver to help you move and turn if you are confined to a bed or chair

How Do Hospitals and Nursing Homes Prevent Pressure Ulcers?

Your nurses and doctors will begin a plan of care to help keep your skin healthy. If you are not able to move yourself, the hospital or nursing home staff will help you move and turn. They may use special skin care products to protect your skin, and connect you with a dietitian to help you improve your diet. If your nurse or doctor suspects an ulcer, he or she will work to relieve pressure on the area. In some cases, a special mattress or bed may be used to help redistribute pressure.

Even though your skin is one of the most complex and important organs in your body, caring for it is not complicated. Follow these simple steps, and ask your doctor if you have further concerns about potential pressure ulcers.

When Do You Know Loved Ones Need Care?

By Pam Gennings, Executive Director Special Projects*

Over the years I have talked to many family members who come home for the holidays and become concerned because they have noticed “changes” in their loved one or their circumstances.

They are not always sure if home care services are needed or if their concern is unfounded. The following indicators can be used as a guide to help determine if your loved one could benefit from home care services.

Medical Condition

  • New diagnosis
  • New medications or treatments ordered by a physician
  • Terminal illness
  • Recently discharged from a hospital or nursing facility
  • Physician has restricted activity during a period of recuperation—this could be a few days or several weeks
  • Frequent falls or fear of falling
  • Confusion, forgetfulness, depression or other changes in mental status
  • No longer able to/should not drive or driving is very limited
  • Frequent trips to the doctor, urgent care or ER
  • Uses an assistive device (cane, walker, wheelchair or stair climber) to help with balance or walking
  • Is required to take several daily medications

Caregiver Relief

  • The person being cared for should not be left alone and may require 24-hour supervision
  • Spouse/family members work
  • Caregiver appears to be stressed and overwhelmed
  • Spouse/family members in poor health
  • The person being cared for needs more assistance than the caregiver is able or willing to provide

Strong Desire to Remain at Home But is Unsure of How to Manage Because…

  • There is limited support from family or others
  • Spouse is in poor health
  • They worry about emergency situations
  • Family does not want loved one to be alone
  • They need assistance with housekeeping, laundry, meal preparation, shopping, bathing, hair care, medication reminders, transportation, or other essential daily tasks

If your loved one has one or more of the indicators listed above, call Oxford HealthCare and ask to speak with a Care Coordinator.

A qualified home care professional will:

  • Identify needs and available services
  • Evaluate funding sources and community services
  • Coordinate services upon request 

*Pam Gennings has a Bachelor’s of Arts and has worked in the field of Geriatric Social Work and Care Coordination for more than 30 years. She started working for Oxford HealthCare in 1993. During the course of her career she has helped thousands of people find resources to remain in their homes as well as provided guidance to families that were facing difficulties with their aging loved ones.

Brothers and Sisters and Parents. Oh My.

Senior Lifestyle

By Carol Combs, MSW, Oxford’s Memory Care Coordinator

Caring for a parent is hard. And sometimes, often in spite of the best of intentions, siblings can make that care more complicated. Often, one child becomes the primary caregiver for a parent and may become resentful that other siblings aren’t helping as much as they could. Some siblings may skirt caregiving responsibilities with excuses of “I don’t have enough time,” or “I just don’t have the money.” Sometimes one sibling might refuse help or advice from others, certain they can best handle things by themselves.

Many families don’t take time to consider the best supporting role each member could play while caring for a parent. There is a lot to do, but by supporting each other and sharing responsibilities, families can make caregiving a success. Share the load. Pitch in. There are always ways to help. Make phone calls, offer emotional support, run errands, or simply give someone a break.

When it comes to caring for a parent, brothers and sisters have to work together, and communication is the key to working together.

Family meetings can be instrumental in determining roles, pooling resources, and allowing everyone a voice. Open communication is the best way to overcome disagreements, resolve conflict, and reach consensus on the hard decisions your family faces.

But teamwork takes effort. There may be disagreement on what is best for your parent. Conflicts may arise out of present anxiety and fear of what lies ahead. Caring for a parent may re-ignite sibling rivalries thought long since over.

The best way to handle these struggles is often to simply acknowledge them and discuss them honestly. Admit your concerns and limitations, and embrace those of your brothers and sisters. Remember that you’re all after the same thing: what is best for your parent.

Sometimes it is best to agree to disagree. If you reach an impasse, consider involving an impartial observer, such as a social worker or counselor who can help families work through issues and stay focused on the task at hand.

Consider these tips for winning support from your siblings:

  • Ask for help clearly and directly. Be specific.
  • Be realistic—don’t ask for the impossible.
  • Try to accept your siblings as who they are, not who you wish they were.
  • Listen to your siblings’ concerns openly, without judgment, and carefully consider their feedback.
  • Consider the relationship your sibling has with your parent and look for tasks that work within that relationship. If your sister can’t be with mom for long without arguing, send her out shopping, or ask her to do some paperwork.
  • Be careful how you ask for help. If your tone reflects anger, your brothers and sisters are more likely to react in unhelpful ways.
  • Avoid making your siblings feel guilty. Guilt makes people uncomfortable and defensive, which only hurts things in the long run.
  • If your family isn’t able to assist with caregiving, explore outside resources for help.
  • Perhaps most importantly, be sure to take care of yourself. You have to be healthy to be up to the challenge of caregiving.

Families have long, complicated histories, and with the challenges of caregiving it is often hard to communicate without overreacting or misinterpreting. Dealing with siblings over parent care can be difficult, complex and emotional, but it is important to understand your emotions and to try to have sympathy for your siblings’ feelings as well, even when you disagree.

Family dynamics were in place prior to the need for parent care, and you may not be able to resolve existing conflicts to your satisfaction right now. The important thing now is to get support for yourself so you can find peace during your caregiving journey.

Oxford Health Care offers numerous home care programs that can provide you the help, support and relief you need, so you can enjoy time with your loved one and continue to care for them at home. If you have questions, our Care Coordinators will be happy to assist you.

Touch Is the Language of Compassion

By Carol Combs, MSW, Oxford’s Memory Care Coordinator

Everyone needs tender loving care, and someone with dementia such as Alzheimer’s disease is no exception. In fact, because dementia robs people of language, non-verbal communication becomes even more important. Non- verbal communication is critical when dealing with dementia, and touch is a powerful way to connect with someone who is losing other avenues to communicate.

Tactile stimulation can help when language is failing. Anything individuals can touch, feel or manipulate with their hands helps fill the void left with loss of language. It is actually the brain that “feels”—so tactile stimulation is brain stimulation.

People with dementia don’t lose the capacity for human emotion or recognition of a caring touch, even in the late stages of the disease. A hug, handshake, pat on the arm, hand lotion massage or stroke of the hair can relay feelings of compassion and care. And of course, a smile is a universally understood expression!

Studies have identified the physical benefits of touch, including: lowering blood pressure, decreasing pain and heart rate, improving mood and lowering stress. Touch can also benefit those with dementia by calming them. Massaging the hands or handholding can reduce agitation; help ease the feelings of isolation, loneliness and boredom; and, encourage feelings of well-being.

We need to respect a person’s preferences for physical touch and explore ways to make contact that are comfortable to the individual. If someone is highly agitated, use caution in your approach, as the individual may not accept you entering his/her private space. However, while we do need to be respectful of someone’s comfort level, that should not stop us from finding ways to nurture those in our care.

“Love is not a memory—it’s a feeling in the heart and soul, never to be forgotten. This disease can take away almost everything, but not the love,” wrote Michele DeSocio in Living Proof that Alzheimer’s Can’t Steal Love.

Oxford Health Care offers numerous home care programs that can provide you the help, support and relief you need so you may enjoy time with your loved one and continue to care for them at home. If you have questions, our Care Coordinators will be happy to assist you.

Sources: Esther Heerema MSW, alzheimers.about.com, American Massage Therapy Association

Walk a Mile in Their Shoes

By Carol Combs, MSW Oxford’s Memory Care Coordinator

After my recent hip surgery, I not only gained a new hip, but also a newfound understanding of what it must be like for those who are ill, disabled and homebound.

I have always been a very independent person, so being dependent for almost everything during my recovery did not come easy for me. I needed help to get up from a chair, get into bed, to use the bathroom and bathe. I couldn’t stand long enough to fix a meal. I was frustrated and impatient with myself, even though I was told to expect weeks or months of recuperation.

Empathy is the ability to understand and share the feelings of another. We all try to empathize, and sometimes say, “I know how you feel.”

But, do we really?

Maybe instead we should just say, “This must be difficult for you,” and offer support and a hug. As you encounter those who are struggling and need care and support, think about how challenging their lives may be and try to “walk a mile in their shoes.” I know I will.

Fortunately, I had a great caregiver in my husband and other family members. I am very grateful, because I know that not everyone has that kind of support. If you or someone you know is in need of help and support—whether it be short term or long term help—please call and speak to one of our Care Coordinators, they will be glad to assist you.

 

George’s Beautiful Journey

By Marian Michaliszyn, Oxford Hospice Chaplain

Serene Forest PathWhen George was a child, his mom told him that “religion is good, but take it in small amounts.” So many years later, when he decided on hospice care, he declined chaplain visits for himself. He did request visits for his wife, because he thought it would help her after his death.

What George did not count on was the connection he and I made during the months I visited. Our visits began with general conversation, which then led to issues he’d had on his mind for decades.

George wanted to talk about his life journey starting with his childhood during World War II. He shared about high school and how he and his friends fixed up an old roadster and took turns driving it. He told me about a wonderful girl he met in high school who became his wife.

George spoke of his time in the Korean War and how the GI bill led to his career in communications. He considered himself a “self-made man” whose life choices and decisions brought him from California to Missouri.

Eventually, our conversations turned to religion. He told me about his experience at a tent revival at age 11 and about dismissing God and embracing science. Perhaps remembering his mother’s advice, George often said, “Religion had the last 3,000 years of rule in the lives of humans and now it’s time to let science have the next 100 years to shape society, and then see which is better.”

One day, we had a very powerful visit. When I arrived, George wanted to get away from his house so we could talk privately. We went to his boat dock, and George stated that he had a horrible night. He was confronted by the reality of his death and what happens afterword. There was a feeling of darkness and foreboding, and for the first time in his life he did not feel in control.

As we talked about the reality of death and making peace with God, I actively listened and offered faith resourcing as we discussed the meaning of life and George’s spiritual journey. As we shared with each other, George came to a place of resolving his questions of faith, religion and having peace in his spiritual life.

Not long after that visit, George died. When I went to see his wife and family, they shared how they all noticed George’s peaceful smile on his face. This was a great comfort to his family.

It was a privilege to share this part of George’s journey, and a privilege to continue the journey with bereavement support for his wife and children. With all the experiences, questions and concerns he shared, I was honored that he trusted me to be a non-judgmental listener.

What an amazing life he lived, and what a beautiful journey.