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.

How to Protect Yourself from Phishing (pronounced: fishing) Scams

By Bryan Bardwell, Oxford’s Security and Privacy Officer

Don’t get hooked by crooks! Our latest blog post outlines several ways to avoid online scams.

Even in the relative safety of our homes, the world can be a dangerous place. Scammers will attempt to trick you and steal your personal information through various means, such as deceptive phone calls, going through your trash, or with fake emails, just to name a few.

In the digital age, one of the most dubious online scams is known a “Phishing”. Thieves send an email to target victims, often to thousands of people at a time. On the surface, the email appears to be a legitimate contact attempt, but is really a fraudulent message. When links within the e-mail are clicked or an attachment is opened, it triggers computer scripts that automatically download a virus or malware onto your computer. These viruses can capture personal information, such as your User ID and Password logins, bank details, Social Security numbers and credit card account information.

Phishing is a huge threat to homes and businesses because of the vast amount of important information most users store on their computer(s). They may have different messages, but ALL Phishing scams will have some sort of urgency involved in the message, such as: If you do not confirm your User ID and Password by 4pm, we will be forced to lock you out of your computer.

How To Avoid Phishing Scams 

  1. Scan your e-mails carefully and look for grammar mistakes and other inconsistencies.
  2. Verify the email sender’s address to confirm it was sent from a legitimate source. Most phishing scams will try to fool you with similar email addresses, but the email domain name (e.g. Bob@xyzbank.com) should match the web address of a real company.
  3. In addition, secure websites that require a login will all begin with https:// – That “s” indicates the site is Secure. (For example, Gmail’s email server is https://mail.google.com/mail).  Always look for https:// if you’re asked to enter a User ID and Password to access a website.  Legitimate secure sites will include all banks, credit card companies, and other email providers (such as Outlook, Yahoo, and Hotmail), as well as shopping websites like Amazon, Target, Walmart, EBay etc.
  4. Email fraud can be the easiest of all thefts – by simply adding Click Here somewhere in the email text, many victims are enticed to click on the link, and are then directed to a website that is not legitimate. The fake website may have similar graphics or logos to a real company, and will ask for your User ID, Password or to verify personal details. If you comply, it could compromise your computer. But there is an easy way to see through this type of click-through scam: To view the web address behind a “Click Here” link, hover over the link with your mouse without clicking it. A small window will pop up with a URL, such as https://www.xyzbank.com, as shown below.
  5. If you suspect that an email is a phishing attempt, play it safe – DO NOT open any attachments or click any links.

Hover your pointer over a link to see the destination website address.

What to Look For

Here is an example of a Phishing email:

Example of a Phishing email

What are the RED flags in this Phishing email?

  • Look for inconsistencies in the From: – is it a legitimate email address?
  • Check for an attachment. It will appear under the Subject: DO NOT open if you are unsure of who is sending you this information. Be very careful of .zip file attachments in any email.
  • Hover over Click Here to see the website where the link will take you. If you see a number or “http:” instead of “https:”, DO NOT click links or go to the site.
  • Note that there is no personal sender information (name, address, phone, email) signature in the email.

Failure to notice these telltale signs could result in “Phishers” gaining access to your private account information or other personal data.

Other Resources

To help combat Identity Theft, the Internal Revenue Service offers “Seven Steps for Making Identity Protection Part of Your Routine”.

  1. Review your credit card and baking statements carefully and often. Neither your credit card, bank or the IRS will send you emails asking for sensitive personal and financial information, such as asking you for updates to your account.
  2. Review and respond to all notices and correspondence from the Internal Revenue Service.
  3. Review each of your three credit reports at least once a year. Visit annualcreditreport.com to get your free reports.
  4. Review your annual Social Security income statement for excessive income reported. You can sign up for an electronic account at SSA.gov
  5. Shred any documents with personal and financial information.
  6. Review your health insurance statements; look for claims you never filed or care you never received.
  7. If you receive any routine federal deposits such as Social Security of VA benefits, you probably receive those electronically. You can use the same direct deposit for your federal and state tax refund which is safe and secure.

Why Go If My Loved One Can’t Remember My Visit?

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

When a loved one has Alzheimer’s disease, it changes the way friends and family interact with the person. Knowing what to say, or even how to act, can be challenging. The individual may not remember those who come to visit or remember prior visits.

When visiting a loved one with Alzheimer’s you may hear questions such as, “Why don’t you ever visit?” or “Who are you?” Such questions, as well as behavioral changes that accompany the disease, can make visiting difficult and uncomfortable.

However, there are some things you can do to help ease the discomfort and make your visit more pleasant for you and your loved one.

  • Focus on feelings – the content of the conversation doesn’t matter. The feelings and sense of contentment created will make a difference. Emotion lasts longer than memory. The emotion resulting from a positive visit can improve a person’s mood and influence the rest of the day.
  • Accept the person’s reality- don’t correct your loved one, just go along with it. If the person insists the grass is blue, agree. Telling the individual it’s really green can create agitation. Instead, offer reassurance and distraction.
  • Introduce yourself- avoid saying “Don’t you remember me?” because if the person doesn’t, it can be embarrassing. Introduce yourself with “Hi Mom, this is Susan.”  Save her the embarrassment or awkward moment.
  • Be respectful- don’t talk to Alzheimer’s patients like they are children. They have a lifetime of experiences, so show them the respect they deserve.
  • Bring an activity – long-term memory is often still intact. Reminiscing with pictures or photo albums can be comforting and encourage conversation. Play music or sing. Consider Music Therapy. Music can stir positive emotions, and individuals may be able to remember lyrics even though their ability to communicate has declined. Exercise improves brain circulation. Encourage movement of arms and legs, or toss a beach ball. Introduce your loved one to a GeriJoy Companion, a special tablet which provides social interaction, helps decrease loneliness and has shown remarkable success with Alzheimer’s and dementia patients.
  • Touch – hold a hand, stroke hair, hug. Touch is a powerful way to communicate when words fail. People with dementia recognize a caring touch, even in the late stages of the disease.
  • Minimize distractions – it will be more difficult to have a meaningful visit if there is too much noise or activity. Over stimulation can cause agitation. Try to find a quiet place or take a walk outside.

If you know someone with Alzheimer’s and are hesitant to visit, remember that the benefit of your visit may last long after you’ve gone.

For additional support or information, contact Oxford HealthCare. Oxford offers numerous programs that provide the help and relief you need—so you can enjoy time with your loved one and continue to provide care at home. For your peace of mind, advanced technology like Lifeline and GeriJoy helps provide added security when you can’t be with your loved one. To find out more about all Oxford has to help families, contact a Care Coordinator, today.

 

 

 

Be Informed for the Better During Stress Awareness Month

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

 

Stress is defined as mental or emotional strain or tension resulting from adverse or very demanding circumstances. Stress is inevitable—everyone deals with it. So, during Stress Awareness Month, it is an excellent time to learn more, recognize stressors, practice stress relief and get help as needed.

 

Stress isn’t all negative; positive stress can motivate and help with concentration. Setting goals and accomplishing them feels good and rejuvenates the mind and body for the next challenge.

 

However, most of the time, stress is associated with something difficult or negative. When stress becomes a way of life, it is very hard to relax and recover. When stress becomes chronic, a person’s physical and emotional health suffers.

 

Caregiving is a demanding and stressful role. Being a caregiver can be an extremely rewarding and gratifying experience, but it can also be daunting, challenging, exhausting and overwhelming—especially if caring for someone who is ill.

 

Whether you are caring for someone daily, occasionally, long distance or 24 hours a day, there will be stress. While you may not be able to change the situation, there are steps to help manage the emotional, physical and mental impact.

 

First, it helps to recognize what personally stresses you. The body treats these stressors as threats, which prompts the adrenal glands to release a surge of adrenaline and cortisol.

 

Adrenaline increases heart rate, elevates blood pressure and boosts energy supplies. Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream. It alters the immune system responses and suppresses the digestive system, the reproductive system and growth processes. This complex, natural alarm system also communicates with regions of the brain that control mood, motivation and fear.

 

When under constant stress, the body’s fight-or-flight reaction stays on alert. The long-term activation of the stress-response system and the overexposure to cortisol and other stress hormones can disrupt almost all of the body’s processes.

 

When under this kind of negative, constant stress, there is a significant risk of numerous health problems, including:

  • Anxiety and depression
  • Compromised immune system
  • Digestive problems
  • Heart disease and increased blood pressure
  • Sleep problems
  • Weight fluctuation
  • Memory and concentration impairment

 

Due to the health risks, it is very important for caregivers to learn healthy ways to cope with stress.

 

Stress management strategies include:

  • Eating a healthy diet, exercising regularly and getting enough sleep
  • Practicing relaxation techniques or learning to meditate
  • Fostering healthy friendships
  • Laughing—have a sense of humor
  • Keeping a journal—jot down thoughts as an emotional outlet
  • Seeking professional counseling when needed
  • Educating yourself—become informed about stress, disease process, etc.
  • Utilizing community resources that offer assistance and support
  • Visiting your doctor regularly
  • Finding opportunities for Respite Care—Oxford HealthCare can help
  • Chewing gum—studies have shown this simple act can lower anxiety and ease stress
  • Reminding yourself of comforting phrases that speak to you personally—God won’t give us more than we can handle. This too shall pass. Serenity Prayer. I can do this. Encourage yourself the way you would a friend.
  • Believing in yourself—find the necessary means to withstand stress and look forward to brighter days ahead.

 

Although April is officially Stress Awareness Month, we all know that stress affects us in some way, every day, year round. If you are a caregiver, it is extremely important that you also care for yourself. Oxford HealthCare offers numerous home care programs that provide the help, support and relief you need, so you may enjoy time with your loved one and continue to provide care at home. If you need help or have questions, contact an Oxford Care Coordinator.

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.

 

November is National Hospice Month and National Alzheimer’s Awareness Month

By Elizabeth Lee, RN, BA, CHPN Oxford’s Hospice and Palliative Specialist and Carol Combs, MSW Oxford’s Memory Care Program Coordinator

Hospice is a wonderful and caring option for people who are facing end of life illness. The primary goal of hospice care is to help maintain the highest quality of life in the last stages of an illness.

Hospice serves individuals with any terminal illness, including Alzheimer’s disease. The Hospice Interdisciplinary Care Team includes the physician, nurse, social worker, chaplain, aide and grief services. This team works together with the patient and family to help manage the unique needs of end stage Alzheimer’s disease and other related dementias.

Hospice focuses on comfort, support and managing pain rather than providing treatment. People with Alzheimer’s disease become more disabled over time; and with advanced dementia, individuals can no longer communicate their wants and needs. Focusing on the senses—touch, hearing and sight—can bring comfort when verbal communication cannot.

An Alzheimer’s patient could be eligible for Hospice care if they:

  • Are unable to ambulate without assistance
  • Are unable to dress or bathe without assistance
  • Are unable to swallow
  • Are unable to speak or communicate meaningfully
  • Have urinary and fecal incontinence
  • Have UTI’s (urinary tract infections), decubitus ulcers and/or aspiration pneumonia

The end of life path of hospice patients can be divided into one of three typical patterns:

  1. A short period of obvious decline at the end (typical for most cancers)
  2. Long-term disability with periodic intensification and unpredictable timing of death (typical for a patient with chronic organ system failure)
  3. Steadily declining function with a slowly dwindling course to death (typical for a patient with frailty, dementia or Alzheimer’s)

End of life decisions become more complicated if wishes have not been or cannot be expressed by the dying person. Families then have to speak for the person based on their knowledge of the individual’s values and beliefs.

What is the current quality of life, and how will the on-going treatment potentially impact quality of life?

Patients and families need to understand benefits versus burdens before treatment continues or is introduced. This requires truth telling and explanations in a language the patient and family are able to understand.

Family members caring for a dying loved one with Alzheimer’s often express relief—for the patient and themselves—when death comes. It is important to understand that these feelings are normal.

Hospice can help the patient and caregiver deal with the challenges faced in the patient’s final months, and offer grief support both before and after the loved one dies. Hospice helps ensure the highest quality of life while being treated with dignity and respect.

For more information about Oxford’s Hospice or Memory Care Programs, please contact one of our Care Coordinators, today.