Wound Care

With age, even a simple cut can escalate quickly

Good skin care is more important than ever as we age. Skin becomes thinner and more fragile, more prone to wounds that linger and pose a risk for infection and pain. 

A study in the Journal of the American Geriatrics Society finds that older adults are at higher risk of developing chronic wounds — injuries that take longer to heal, don’t heal correctly, or fail to heal after multiple months.

“Older adults’ skin is more fragile due to normal changes in the thickness, flattening of the layers, and natural moisture content. These changes make elderly skin more tissue paper-like, drier, less elastic, and more permeable to environmental insults,” says Sandi Jiongco, family nurse practitioner at Edward-Elmhurst Health, who also holds an advanced practice certification in wound care. Older adults are also more likely to have a co-morbidity such as heart failure, hypertension, diabetes, or more years of sun exposure — all of which can affect blood circulation, decreasing skin barrier function and overall ability to heal. This contributes to chronic wounds. 

Some medications common among older adults, such as blood thinners, may also exacerbate wounds. 

For a person taking a blood thinner, “a small bump can lead to bleeding under the skin, which can lead to a wound,” Jiongco says. “Steroids further weaken the skin and also affect a patient’s blood sugar.”

Reduce the risk with good skin care

Reducing the risk for developing a chronic wound starts with skin care basics. 

“It’s important to do routine skin care, to keep your skin clean and moisturized — but don’t use an anti-bacterial soap,” Jiongco says. Anti-bacterial soaps can cause dry skin, eliminating the moisture necessary to heal wounds. They also remove the helpful bacteria on skin. 

When a person suffers a cut or abrasion, Jiongco cautions patients not to pick at the wound. Instead, if there is a flap of skin, she tells them to flatten it out over the wound, which protects it and promotes healing.

She recommends applying an adaptic dressing — a greasy mesh gauze designed to not adhere to the wound. 

If a wound still hasn’t healed after four weeks, (or earlier if the person has a history of wounds that don’t heal), Jiongco says to contact a wound care specialist.

Be aware of pressure wounds

Pressure wounds, also commonly known as bed sores or decubitus ulcers, commonly plague older people. 

“It’s a wound that’s caused by a lack of circulation,” says Katy Capito, district director of clinical services at Brookdale Senior Living, Inc. “It’s common in people who sit for a long time in one position.”

Bedsores (Pressure Ulcers) graphic. Skin and tissue injuries result from prolonged pressure on the skinPressure wound severity falls in stages one through four, with four being the most serious. In some cases, a wound can be serious enough to require a person to change their living situation, for example, from assisted living to a higher level of care. 

“If the wound is advanced beyond a stage two, we need to talk about skilled nursing — a higher level of care,” Capito says. 

Pressure wounds are all about prevention, through moving and shifting position as much as possible. 

“We are going to help them move or encourage physical therapy,” Capito says.

Sometimes just shifting how a person is sitting makes a difference. “We call it off-loading — shifting your weight to let the blood flow back to your butt or other area,” Jiongco says. If incontinence is an issue, keep skin clean, dry, and protected from urine and stool enzymes with a barrier paste (such as Desitin, A+D, or Boudreaux’s Butt Paste).

Those who already have a wound may find that sitting on an air cushion eases their discomfort. Jiongco doesn’t advise sitting on a donut, which she says adds more pressure. Instead, she recommends an air cushion with waffle-like indentations. 

“You want the patient to sink into it, but not bottom it out so they are touching the surface below the cushion,” she says. 

As a general rule, Capito says that mobility prevents pressure wounds.

“We encourage people to leave their apartments,” she says. “No one has to, but we encourage a more social, engaged lifestyle.” 

Besides being as physically active as possible, both Capito and Jiongco also recommend eating a healthy diet with enough vitamins and protein to help your body heal wounds. 

And Jiongco says not to neglect your body’s largest organ. “You want to take care of your skin. It’s the window to your body, and it’s protective.”

Originally published in the Summer/Fall 2023 print issue.