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Wound Care
With our aging population, chronic diseases like skin conditions, diabetes, and other vascular diseases
are becoming increasingly common. They can cause severe emotional and physical distress to patients
and their families. As a person gets older, many physical changes occur that can be attributed to aging.
Skin tends to become thinner and loses some of the moisture and connective tissue support that makes
it strong. The body’s repair mechanism for skin also falters.
A wound is defined as an injury where the skin is torn, pierced, punctured or cut either as a result of an
infliction or a surgical incision.
Wounds are categorized as chronic or acute wounds. An acute wound generally proceeds through an
orderly and timely reparative process resulting in sustained restoration of anatomic and functional
integrity. A chronic wound, on the other hand, is the one that does not heal in an expected way and in a
predictable amount of time.
Acute Wounds
Acute wounds are injuries that are exposed to air with a breakage in the skin. They are extremely painful
to the victim who develops a high risk for infection. There are five kinds of open acute wounds:
• Abrasions are caused by a friction between the skin and a rough surface that scrapes off the topmost
layer of the skin. Most of the time abrasions do not result in serious injuries. They are commonly
referred to as scrapes.
• Incisions are clean cuts made by sharp objects, like knives, razors, or glass. They usually cause deep
injuries and result in heavy loss of blood.
• Lacerations are tears into the skin. This kind of wound involves damage to the skin tissue and
extensive damage to underlying tissues. A major concern with this type of injury is hemorrhaging or
heavy bleeding.
• Punctures are usually caused by nails, needles, or some other pointed objects. They can cause
damage to the underlying organs and result in internal bleeding. This kind of wound is often prone to
tetanus infection and should be immediately treated by a doctor.
• Gunshot wounds are caused by a bullet driving into or through the body, similar to a knife entering
into the body. These cause two kinds of wounds; one at the site of entry and one at the site of exit.
Chronic Wounds
Chronic wounds do not involve any external bleeding. However, they are just as serious as open acute
wounds. There are three categories of closed wounds:
• Contusions are also called bruises that are caused by blunt force. They are trauma that damages the
tissue under the skin.
• Hematomas are also called blood tumors. They are caused by damage to blood vessels that cause
blood to collect under the skin.
• Crushing injuries are caused by an extreme amount of force applied over a long period of time.
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Risk Factors for Wounds in the Elderly
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History of previous injuries/skin tears
Impaired mobility or vision
Poor nutrition and hydration
Cognitive or sensory impairment
Co-morbidities including chronic heart disease, renal failure, or cerebral vascular accident
Dependency on others for showering, dressing or transferring
For the majority of us healing is a simple and rapid process, and although a wound might leave a visible
scar, it is not associated with persistent pain and distress. However, in the elderly, healing is a long and
painful process that adversely affects quality of life.
Slower healing is a result of decreased blood flow and a reduced rate of cell turnover in the epidermis.
Seniors tend to have significant co-morbidities and are on multiple medication regimes that significantly
impact healing. Due to decreased immunity, poor nutrition, and co-morbid medical illnesses, they are
also at a higher risk for skin and soft-tissue infections.
Phases of Wound Healing
The entire wound healing process is a complex series of events that start as soon as an injury occurs and
continue to work for several days, months, or years depending on the severity of the wound. A wound
typically heals in the following stages:
• Stage 1: Inflammation begins immediately and lasts for two to five days. In this stage, the wound
begins to heal from inside and the body starts to repair the affected tissues. During this stage, the
wound typically continues bleeding and the blood clots begin to form at the surface of the wound.
Blood vessels also start getting narrow, which reduces the oozing of blood.
• Stage 2: Epitheliazation is where the skin starts to regrow underneath and heals the wound. This
stage lasts for a few weeks. During this stage, the edges of the wound start growing closer and
binding, as the new skin begins to develop.
• Stage 3: Angiogenesis begins soon after the epitheliazation stage and is characterized by new blood
vessels growing underneath the new skin to replace the old injured blood vessels.
• Stage 4: Remodeling is when the scab that covers the wound comes off and the scar becomes
noticeable. The scar tissue protects the site of the wound and the healing is complete.
Wound-Care Facts
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Abrasions, lacerations, punctures, or ruptures can damage the skin;
Skin is the first and the most effective defense against various infections or radiations;
Delayed wound-healing can lead to increased susceptibility to infection;
Hearing and vision deteriorations make it difficult for the patients to make decisions regarding healing
and treating wounds;
• Because of cognitive impairments, healing process is impaired;
• The purpose of medical care for wounds is to prevent complications and preserve functions.
As people grow older, they become more susceptible to the risk of dementia, diabetes, vascular diseases
and are at a high risk of developing chronic wounds. These wounds are often complicated by pain and
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infection, and can force seniors to stay in hospitals or nursing homes for much longer than expected.
Taking adequate steps in diagnosing chronic ulcers and optimizing medical treatment is a must. Health
care providers will emphasize the importance of nutrition and proper wound care for the management of
all chronic and acute ulcers and wounds. Almost all ulcers and wounds can be properly cared for with
wound healing diagnosis and management.
Most home health care agencies provide in-home assistance for wound care for those seniors residing
in their homes and aging in place. Assisted living facilities and CCRCs may also include wound care
services as part of the service plan.
Source: Senior Care Resources
http://www.senior-care-resources.com/wound-care-for-seniors-facts-and-risk-factors/
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