Aging: What We Need to Know About the Fragility of Old People’s Skin and Hospital Wound Care Centers

Products for better skinCountless hours. Billions of dollars. How much is spent to keep skin healthy, moisturized, wrinkle-free, unblemished, soft?

Why the disconnect between beautiful skin and the pictures of old people’s wrinkled faces and veined, spotted, unattractive hands.

Are we aware of what happens to skin as we grow old?

Collagen is depleted. That impacts skin.

Sr. Advisor R has always paid attention to skin. She says, having been a redhead when young, that she was careful to moisturize and avoid too much sun when she moved to a warm climate in her 20’s. Yet in her late 90’s, her skin is fragile. It seems thin, almost transparent and bruises easily

As posted last Saturday,  Sr. Advisor R had a nonhealing leg sore. When I mentioned R’s sore in answer to “How’s R?” the 90-year-old questioner quickly pulled up one leg of her slacks about 5″ to show me her ankles and the bruises above them. Said they’d been there for ages, one sore took three months to heal. She only wears slacks now.

R’s bruise was caused by–what to us would be–a nothing. She says for many years it was a slightly reddish area that she thought was a bit tender yet paid it no attention. This fall, however, the slightly reddish area became an open sore which would begin to heal, then open again and get larger.

Her excellent doctor prescribed antibiotics, which did very little good at the beginning, and offered only slight improvement 2 months later–at which time the wound was larger and began to be painful. That’s when her doctor wrote out a prescription for a home-care nurse to come regularly and tend to the wound. R expected the nurse that week, but because of a mix-up no one was coming until the next Monday.

We phoned Senior Advisor S. RN, who did us a favor and came over late afternoon, reporting she’d never seen a worse looking wound and R needed to go to a Wound Care Center asap…..which we did early the next morning. The Doctor in the ER was impressive. The sore was tender and painful and his experienced hands examined the sore and gently removed some of the dead skin (debris they call it) to get a better look. IV antibiotics were ordered and begun immediately and we were told R would remain in the hospital for a few days.

Upon release from the hospital, home-care nurses were scheduled for twice a week. R was to see a Wound Care doctor at the hospital’s Wound Care Center on Fridays. Different nurses came the first week and part of the second week–no continuity. R noted they lacked coordination and possibly communication because sometimes they didn’t have correct supplies. They never contacted the Wound Care doctor with updates and should have. Bottom line: the nurses were discontinued; R sees the doctor once a week. She still has an elastic bandage 24/7  on the leg with the sore. I think that protects the leg as well as improving circulation; and better circulation helps healing.

When R goes to the Wound Care Center her sore is measured and photographed with a ruler next to it. The photo is transferred to a computer for comparison. The wound is tended to, new ointment is applied, and all is wrapped with the elastic bandage. It was heartening to see the photos from the previous weeks lined up, showing progress: a smaller sore each time.

Dr. Dhillon (M.D.C.H.M.D) an exceptional Dr. from what I have seen, offers this information. Wounds in older people often come from:

  • bumps
  • nodes in legs
  • arthritis
  • diabetes

His advice:

  • A 50% reduction in the size of a sore/wound is to be expected in 4 weeks. If not, go to a hospital’s Wound Care Center.
  • If there’s swelling, redness, no reduction in size in 2 weeks, an older person (or someone with diabetes) should go to a Wound Care Center and be checked.
  • If a lotion or cream containing vitamin E is available, it may be helpful to old skin. They use this kind of lotion (through a hospital supply company I believe) at the Wound Care Center. (We’re going to look for it–nonprescription–at drug stores.)

R could have been spared the worry and the depressed feeling that comes with trying hard to do the right thing, yet making no progress. In trying to help parents age well, we wish we’d understood the important role of wound care centers sooner.

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