Guide to Proper Wound Care Nursing in the Elderly

• Acknowledge the impact of increased wounds on the elderly.  
• Identify common wounds in the elderly. 
• Understand the challenges of wounds in long term care. 

Older adults are more prone to injury and wounds from falls, pressure ulcers from being in the same position for long periods, and wounds associated with chronic conditions such as diabetes. Adequate wound care is essential to elderly nursing care because if wounds are not treated correctly, bacteria may spread and could affect other elderly patients in the facility.  

Improper nurse intervention or no nurse intervention in these wounds could put the elderly resident at risk of needing amputation or further surgical intervention and hospitalization. Nursing homes and adult care facilities need to ensure their staff members are educated on the type of wounds that could present in the long-term care facility and be prepared to treat wounds in patients to avoid further complications.  

Common Wounds Among Elderly Patients 

Diabetic foot ulcers:  

These ulcers are caused by changes in the foot bones of diabetic patients. These foot lesions are very common in these patients. The type and duration of treatment will depend on the severity of the lesion. 

Amputation wounds:  

After an amputation, complications may occur, and proper wound care is necessary for an amputation procedure to heal correctly and to avoid the wound becoming gangrenous.  

Pressure ulcers:  

These injuries break down the skin when it is under pressure for a prolonged period. Pressure ulcers are rated with stages to assist in distinguishing severity. Pressure ulcers disrupt the blood flow and keep oxygen from traveling to that area.  

This results in cells dying. The type and duration of treatment will depend on the stage of the pressure ulcer. These ulcers are prevalent in people with diabetes, so it is essential to change the patient’s position regularly to prevent pressure ulcers. 

Post-op wounds:  

Several nursing facility residents must get surgery for one reason or another. Postoperative care following the surgical procedure must begin immediately after surgery and continue after discharge. Complications of improper post-op care may include blood clots and infection. 

Skin tears:  

Elderly patients’ skin becomes more delicate and thinner with aging, and since they are also at an increased risk of falling, they are at an increased risk of receiving skin tears. A skin tear is a wound that happens when the layers of skin separate or peel back.  

Treating skin tears typically includes cleaning the wound and applying steri-strips to help the skin approximate and heal the wound. A dressing is applied over the wound. Skin sealants are also recommended versus adhesives, as adhesives can further damage delicate skin.  

Wound Care Challenges in Long-Term Care 

Lack of attention to non-pressure wounds in long-term care:  

Pressure ulcers tend to be the highest priority in long-term care. Although it is crucial to heal these wounds, it is just as important to pay attention to other wound types, such as skin tears and diabetic foot ulcers.  

Lack of collaboration between wound care professionals and long-term care employees:  

Wounds in older adults can be complex and take much time to heal. For this reason, collaboration between wound care professionals and long-term care employees is essential. This collaboration will help maximize the likelihood of healing.  

Lack of competency in the interdisciplinary team:  

No matter the type of wound, successful treatment is partly dependent on the competency of the entire patient-care team in the long-term care facility. This includes Certified Nursing Assistants (CNAs) who are an essential part of early detection and prevention.  

Long-term care nurses should identify and predict residents who are at the most risk for wounds. Therapists also help promote mobility and teach protocols for protective measures. 

Lack of education: 

Depending on the wound’s location, type, and how severe it is, the adhesives, ointments/creams, and dressings that can be applied will vary. It is vital to ensure the proper treatment is used for each wound type to promote healing and prevent further damage.  

The Bottom Line

In conclusion, pressure ulcers, skin tears, and diabetic ulcers are just a few of the wound types that occur often in the long-term care setting. These wounds can be complex and require attention to detail and specialized knowledge on how to heal these types of wounds.  

Ensuring attention is given to all types of wounds will help prevent infections, amputations, and the need for surgical intervention. This attention will also aid in achieving positive health outcomes and improve the quality of life for elderly residents.  

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