Specific Issues in Pressure Ulcer Management in the Geriatric Population

Transcription

1 Specific Issues in Pressure Ulcer Management in the Geriatric Population Aimée D. Garcia, MD, CWS, FACCWS, FAPWCA Associate Professor, Department of Medicine Geriatrics Section, Baylor College of Medicine Medical Director, Wound Clinic and Consult Service Michael E. DeBakey VA Medical Center Insert academic affiliation, practice or hospital logo(s) of preference here. Product and/or sponsor logos not permitted, per CME guidelines.

2 Disclosures Stockholder: none Grant/Research Support: none Medical/Scientific Boards: Insert Company Name Insert Company Name Speaker s Bureau: 3M Medline Honorarium: 3M Medline Organogenesis Consultant: Organogenesis

3 Objectives Discuss issues specific to the Geriatric population in pressure injury prevention Identify strategies to minimize risk of pressure injuries in the Geriatric population

4 Specific issues in Geriatric patients Aging skin Dementia Multiple medical co-morbidities Failure to thrive/anorexia

5 Aging Skin

6 The Aging Skin Dermis Site of most major changes Types Intrinsic Extrinsic Fisher GJ. The Pathophysiology of Photoaging of the Skin. Cutis, 2005 Feb;75(2S):5-9

7 Aging Skin Decrease dermal-epidermal turnover Decreased subcutaneous fat deposition Decreased elastin Decreased cutaneous microvasculature Flattening of the rete ridges Decreased mitotic activity Thinning of epidermis 10-50% Atrophy of stratum spinosum Slow replacement of lipids Reddy M. Skin and wound care: important considerations in the older adult. Adv Skin Wound Care 2008; 21: Zouboulis CC, Makrantonaki M. Clinical aspects and molecular diagnostics of aging skin. Clinics in Dermatology (2011); 29: 3-14.

8 Reddy M. Skin and wound care: important considerations in the older adult. Adv Skin Wound Care 2008; 21:424-36

9 Dementia Types of dementia Alzheimer s type dementia Lewy body dementia Multi-infarct dementia Pick s disease-frontotemporal dementia

10 Dementia One of the most common reasons for placement Inability to understand safety issues Places patient at risk for many clinical problems

11 Dementia Agitation Increased risk for friction/shear damage Ability to understand instructions Offloading Infections Bedbound patients UTI, pneumonia Anorexia/dehydration

12 Multiple Medical Co-Morbidites Diabetes mellitus COPD CHF PVD Malignancies Parkinson s disease CVA Inflammatory diseases Rheumatoid arthritis Polymyalgia rheumatica Autoimmune diseases

13 Anorexia Decreased appetite Caloric intake goes down as we age Slowing down of metabolism Decreased physical activity Not an issue if no weight loss Dehydration Decreased thirst drive Medications Medical conditions Changes in taste Food does not taste as good Sense of smell Need stronger flavors

14 Anorexia Medications Pain medications Carbidopa/levodopa Hydroxyurea Metronidazole Dental issues Poor fitting dentures Poor dentition Pain Lack of Access to Food Inability to obtain Inability to Prepare Depression No evidence that PEG tubes prolong life in advanced dementia

15 Skin Changes at Life s End (SCALE) Skin is the largest organ system Skin can fail All preventive strategies were put in place Kennedy terminal ulcers Hospice

16 Conclusions Recognize the factors that may be unique to this patient population Clearly document the factors that may be impacting wound healing in a Geriatric patient

17 Specific Issues in Pressure Ulcer Management in the Geriatric Population Aimée D. Garcia, MD, CWS, FACCWS, FAPWCA Associate Professor, Department of Medicine Geriatrics Section, Baylor College of Medicine Medical Director, Wound Clinic and Consult Service Michael E. DeBakey VA Medical Center Insert academic affiliation, practice or hospital logo(s) of preference here. Product and/or sponsor logos not permitted, per CME guidelines.