SKIN CARE and the INDIVIDUAL WITH ALZHEIMER’S DISEASE · Skin Care and the Individual with Alzheimer’s Disease Virginia Alzheimer’s Commission AlzPossible Initiative SKIN ULCER

Skin Care and the Individual with Alzheimer’s Disease Virginia Alzheimer’s Commission AlzPossible Initiative

SKIN CARE and the INDIVIDUALWITH ALZHEIMER’S DISEASE

Panelists:Judy Nelson,Gale Davis,

Dana Raborg

September 28, 2007


Skin CareSkin Care

Skin is our lifelong protection from heat and cold, sun,undue exposure to germs or harsh chemicals, andinjuries of all kinds.

Skin care refers simply to the ways we protect our skinon an everyday basis by:

• bathing

• applying lotion

• cleaning a cut with soap and water

• using sunscreen outdoors

• eating a balanced diet

• preventing injuries such as burns, and

• seeing a dermatologist when necessary.


IDENTIFYING RISK FACTORSIDENTIFYING RISK FACTORS

RiskFactors

IMMOBILITYDECREASED LEVEL OFAWARENESS OR

DECREASED SENSATION

INCONTINENCE

POOR NUTRITION/LOW WEIGHT

ANEMIA, DIABETESOR OBESITY

DEHYDRATION

Aging in general causes skin to be fragile as the layers thin andlose their elasticity. Other risk factors are:



Most skin wounds begin in facilities, both in hospitals and inMost skin wounds begin in facilities, both in hospitals and innursing homesnursing homes.

It is estimated that over 70,000 people in America die eachyear from wound infections that begin with skinbreakdown or “pressure sores.” Other names for thisinjury are pressure ulcers, bed sores or decubitus ulcers.

There are four stages of skin ulcers, from Stage I, the mostsuperficial, to Stage IV, the deepest, extending into themuscles. These sores are slow to heal and easily infected,so prevention is paramount.

STAGE I (most superficial) STAGE IV (deepest)



MEDICATIONS can affect the skin by: Increasing sensitivity to sunlightIncreasing sensitivity to sunlight. Examples: doxycycline,

amiodarone, hydrochlorothiazide.

Causing dehydrationCausing dehydration. Dehydration can result in dry skin and otherchanges in the skin. Examples: furosemide.

Increasing risk of bruisingIncreasing risk of bruising. Examples: warfarin, clopidogrel,aspirin, gingko.

Impairing wound healingImpairing wound healing. Steroids (topic and oral) can causewounds to heal more slowly. Examples: hydrocortisone, prednisone.

Causing nutritional deficienciesCausing nutritional deficiencies. Medications can worsennutritional status by impairing vitamin absorption, causing dry mouthand loss of appetite, or impairing swallowing. Poor nutrition can affectthe skin.

Check for warnings on the prescription vial or patient leafletregarding risk of bruising or sun sensitivity.

Discuss possible skin-related medication effects with yourpharmacist or prescriber.


SKIN ULCER TYPES, CAUSES AND CARESKIN ULCER TYPES, CAUSES AND CARE

1

PRESSURESORES

2 3

SHEARINGINJURIES

FRICTIONINJURIES



Pressure sores are most frequently caused by prolongedPressure sores are most frequently caused by prolonged

pressure on a vulnerable areapressure on a vulnerable area—a bony prominence like the hip,

heel, tail bone, or ankle. When skin is squeezed between bone

and the mattress or a chair, the pressure limits blood flow to

the area. Within hours, this can lead to tissue death.

Always roll a person from side to side and gently remove soiled

linen without pulling against the skin’s surface. A person whoA person who

cancan’’t move in bed can develop a pressure sore in as little as twot move in bed can develop a pressure sore in as little as two

hourshours. Damp skin presents the greatest risk, so wet or soiled

clothing and bedding must be changed quickly.



Friction injuries usually occur when skin rubs against aFriction injuries usually occur when skin rubs against a

resistive surface like a sheetresistive surface like a sheet. When linen is pulled forcefully

out from under a person, such an injury can easily

occur. Always roll a person from side to side and gently

remove (rolling up) soiled linen without pulling against the

skin’s surface!

Shearing injuries occur when a personShearing injuries occur when a person’’s skin tends to stick tos skin tends to stick to

the bed or chair and pulls away from the underlying tissue asthe bed or chair and pulls away from the underlying tissue as

they slide down or are pulled or turnedthey slide down or are pulled or turned. The outer layer of

skin can become separated from its blood supply just below

the surface. These shearing forces frequently result in

decubitus ulcers.


PREVENTION

Inspect skin every dayInspect skin every day—several times for people confined

to bed or chair. Pay special attention to pressure points

or moist areas, and report any sign of redness or injury to

a professional to check the area right away.

Reducing friction by making sure a person is LIFTED andperson is LIFTED and

NOT DRAGGEDNOT DRAGGED during repositioning, and that linen is

rolled, not yanked or pulled out from under him or her

will prevent many injuries.

Clean soiled or wet skin quicklyClean soiled or wet skin quickly. Ideally, skin should be

cleaned as soon as it is soiled. When that is not possible,

use pads or briefs that absorb moisture and keep it away

from the skin. Stool needs to be removed immediately.


PREVENTION

Daily bathingDaily bathing is necessary for comfort and cleanliness.

Use lotions, creams or oils to prevent dryness andUse lotions, creams or oils to prevent dryness andcrackingcracking. Powder and lotion are both fine but togetherthey can make a paste. Use one or the other for any onepart of the body. Cornstarch can soothe like powder.

Change positions at least every two hoursChange positions at least every two hours in chair or bedto limit pressure over boney parts.

Lift, donLift, don’’t drag a person during repositioning, and rollt drag a person during repositioning, and rolllinen, donlinen, don’’t yank or pull out from under the persont yank or pull out from under the person. Thiswill reduce friction and prevent many injuries.

Avoid donutAvoid donut--shaped rings or cushionsshaped rings or cushions as they can causepressure on the skin over the sacrum.


PREVENTION

In Bed:

Keep heels off the bed at all timesKeep heels off the bed at all times—propped on pillows orperson lying on side.

Use pillows for support or protectionUse pillows for support or protection, such as for heels,elbows, or between legs.

Keep the head of the bed lowKeep the head of the bed low (30 degrees at the most) toprevent shearing injuries.

Use cornstarchUse cornstarch--like powder to smooth over roughlike powder to smooth over roughsurfacessurfaces in bed.


RESOURCES and DISCUSSION

Discuss solutions at www.alzpossible.org (click on “forum”)

Resources and references will continue to be posted on thenewsletter (www.alzpossible.org/newsletter/jul07.html)


TODAY’S PANELISTS

Judy Nelson, BS, RN is the Adult Care Services Manager for Senior Connections, The CapitalArea Agency on Aging in Richmond, Virginia. As such, she manages grants for respite and shortterm home care and assists families in assessing their care needs and finding resources in thecommunity. For the past three years she has helped to organize and co-teach a week longseminar for family caregivers with Dr. Ayn Welleford and the VCU Department of Gerontology.Ms. Nelson is a graduate of the University of Vermont with a Bachelor of Science in Nursing, andhas worked at New York University Hospital in pediatrics, at Virginia Commonwealth UniversityMedical Center as a consultant and in public health nursing for the past 12 years.

Gale Davis, MS joined the VCU Department of Gerontology staff in Fall, 2006. She is aMaster’s Degree in Gerontology from VCU and undergraduate in Social Work from JMU. She is aProfessional Geriatric Care Manager and member of the National Association of ProfessionalGeriatric Care Managers. She teaches the course The Business of Geriatric Care Management forthe Department of Gerontology. In addition Gale is the clinical site coordinator for GCMstudents at Senior Solutions of Richmond, a home care provider agency with a GCM practice.Gale’s work as Geriatric Care Manager started at Jewish Family Services of Richmond where shestarted their GCM Program and practiced there for 5 years.

Dana RaBorg, RN has worked with Hill-Rom’s home care division for over 5 years providing theappropriate products to patients at risk for and with active decubitus ulcers. Dana providesinservicing to the staff of Home Care Agencies and Assisted Living Facilities in the Richmond andsurrounding areas. She has received extensive training in pressure ulcer prevention andmanagement of pressure ulcers through Hill-Rom. She also gained much knowledge of preventingand managing pressure ulcers while working as a Home Health nurse and also as being theDirector of Nursing for Long Term Care facilities in the Richmond area.

Documents

SKIN CARE and the INDIVIDUAL WITH ALZHEIMER’S DISEASE · Skin Care and the Individual with Alzheimer’s Disease Virginia Alzheimer’s Commission AlzPossible Initiative SKIN ULCER