Instructions for proper ulcer care in the elderly

A pressure ulcer is a localized injury that results from unrelieved pressure to the skin and underlying tissue. These ulcers usually occur over bony prominences such as the sacrum, ischial tuberosities, greater trochanters, heels and lateral malleoli. About 70% of pressure ulcers occur in people over age 65.

It is necessary to take proper care of ulcers in the elderly.

1. Causes of pressure ulcers in older adults

There are 3 main groups of causes of ulcers in the elderly:

Ulcers due to mechanical causes:
- Compression: Soft tissues are pressed against bony protrusions and contact surfaces such as beds, wheelchairs, etc., leading to vascular occlusion, ischemia, and hypoxia.
- Sliding: Sliding motion of the folds of skin, when lying on the side and weight causing the body to slide downwards. This phenomenon develops more strongly if moisture is added.
- Skin rubbing and stretching: Rubbing is the sliding action on each other between two surfaces: one is the patient's skin and the other is a hard outer surface such as the patient's bed or chair. This will cause the skin to wear away causing shallow wounds on the surface of the skin.
Neurological factors:
- Patients with loss or decrease in sensation: the patient is not aware of pain or discomfort, so he does not change position leading to impeded blood circulation.
- Paralyzed patient: The patient cannot move or turn, which limits the blood distribution to the muscle near the wound.
Another factor
- Malnutrition: inadequate nutrition or poor digestion also affects ulcer healing. The patient has a pathology that causes urinary incontinence, excessive moisture.
- Psychological: patients do not want to participate in ulcer prevention because they do not accept their own disability, are afraid to disturb family members.
- Wet skin: Prolonged wet skin can damage the epidermis of the skin, forming ulcers. This wetness is caused by excessive sweating, urinary incontinence, watery wounds, etc. Especially, this wetness also creates conditions for microorganisms including bacteria and fungi to grow, causing ulcers to develop. heavier.
- Skin resistance, age: When dry skin loses elasticity, it is easy for ulcers to appear.

2. Characteristics of Pressure Ulcers, by Stage

Stage I: Intact skin with non-blanchable redness
Stage II: Partial-thickness loss of dermis; no fat visible
Stage III: Full thickness loss, fat may be visible
Stage IV: Full thickness loss with exposed bone, tendon, or muscle

Multidex is suitable for the treatment of ulcers in the elderly at all stages

3. Treatment of skin ulcers in the elderly

Treatment of pressure ulcers is interdisciplinary and includes reducing or relieving pressure, wound cleansing, debriding necrotic tissue, using appropriate dressings and antibiotics, and ensuring good nutrition.

Steps to treat skin ulcers in the elderly with Multidex:

Step 1: preparation of site

Necrotic tissue should be debrided according to acceptable practice or as directed by an attending physician.
The site should be irrigated liberally with a sterile physiological 0.9% normal saline or a balanced salts solution.

Step 2: After irrigation, apply Multidex®.

For shallow wound – 1/4” thick over entire wound site
For deep wound – fill wound site to surface taking care to fill all undermined areas

Step 3:Cover with a non-adherent, non-occlusive dressing such as Covaderm Plus®, MultiPad™, Sofsorb®, or Polyderm™ Plus. If necessary, tape in place or use roll gauze or Stretch Net™ to secure dressing.

Step 4: Dressing change should be once a day on minimally to moderately draining wounds and twice a day on heavily exudating wounds.

Remove non-adherent dressing with care. If dressing adheres to wound, soak with saline for several minutes before removing so the fragile granulation tissue is not disturbed.
Flush site liberally but gently with a sterile, physiological irrigating solution to remove debris. This will leave newly formed granulation tissue undisturbed.
Usual frequency of dressing change is once a day, depending upon drainage and the type of secondary dressing.

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