Wound care management in older adults at home

Guidance on wound care management for older adults at home

Taking care of any cuts, scrapes, and other open wounds promptly is always a good idea to prevent infection, however for older adults this is especially important, as neglecting these can lead to more serious consequences. While not all wounds can be treated effectively at home, many can, so it is beneficial to understand when and how to manage wound care for an older loved one. Here, we are exploring why older adults tend to get wounds more often, what some of the most common causes are, why proper wound care is critical for older people, tips and advice for performing wound care at home, when you should seek medical attention, and how home caregivers can help with wound care. At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about wound care, we can help. 

Why do older adults tend to get wounds more often?

Older adults are more susceptible to wounds for a number of reasons, and studies have supported this, finding they are more likely to have chronic wounds than younger people. Prevalence rates for skin tears have been found to be as high as 41%, and while most people will heal from a small scrape in a few days, older adults usually find this takes longer, which means there is more time for infections and other complications to occur. In addition, older people tend to experience health problems that can compromise skin integrity and make wounds more likely, such as diabetes. There are two main reasons wound care is more important for older adults:

1. Skin changes – As we age, our skin becomes less resilient; collagen and elastin diminish, blood vessel walls thin, sweat glands stop working as efficiently, and more. This can make skin less able to cope with minor injuries, so more care is needed to help them heal. 
2. Slower healing – It is well documented that wound healing tends to take longer for older adults, and this includes both minor skin injuries and more serious issues like broken bones. Usually, within a few days of a wound appearing, skin cells migrate together to close it. This process requires coordination from immune cells, and as people age, the communication between these immune cells and skin cells slows down. Studies suggest ageing can prolong the inflammatory phase of this process, which is why it takes longer for older people to heal from injuries.

How do wounds happen? 

Skin tears, scrapes and other small injuries typically happen on the body’s extremities, such as the feet, legs, hands and arms. Some of the most common ways these might occur in older adults include: 

• Falls – Older people are more likely to experience falls than other groups, due to reduced balance and slower reflexes. The Public Health Outcomes Framework (PHOF) reported that from 2017 to 2018 there were an estimated 220,160 emergency hospital admissions due to falls in patients aged 65+, and an estimated 66.6% of these patients were aged 80+.
• Skin trauma – Older adults tend to require more help with daily tasks such as transferring in and out of bed, and during this process a loved one or carer may accidentally cause skin trauma due to reduced awareness of the pressure being put on skin. Similarly, an older person doing daily tasks themselves may cause accidental injuries to skin due to diminished sensory perception. 
• Equipment damage – Many older adults regularly use equipment such as wheelchairs, walking sticks and more, which can cause injuries if accidentally knocked against skin. 
• Adhesive dressings – Older adults may have more medical procedures (such as bloods drawn, etc.) which can lead to adhesive dressings being applied and removed, causing potential tears to delicate skin.
• Medications – Certain medications can cause the skin to thin and healing to take longer than usual. Since older adults are more likely to be taking medication, this could increase the risk of injuries to skin. 
• Medical treatments – Older adults are more likely to be undergoing pharmacological treatments for health conditions, and certain medical treatments can cause damage to the skin. This could be stomas, catheters, injections, or something else. 
• Chronic wounds – Studies have found chronic wounds (wounds that struggle to heal on their own), which include venous leg ulcers, diabetic foot ulcers and arterial insufficiency, disproportionately affect older people. This is thought to be because most of these wounds are associated with conditions that are more common for older people. For example, studies have found instances of venous leg ulcers are 3-4 times as high in people aged 80+ than in those aged 65-70.
• Surgical recovery – Surgical procedures are common in older adults and pose a risk of incisional wounds that take time to heal. These must be managed according to instructions from medical professionals, but in many cases this can be done at home. 
• Accidental burns – Reduced skin sensation and slower reactions can lead to accidental burns from hot surfaces such as the cooker, or hot liquids such as tea or coffee.Studies have found older people have a “reduced capacity to recover from burn-injury trauma compared with younger patients”
• Bumps and bruises – While minor bumps or collisions can cause short-term bruises in the younger population, older people may incur more bruising due to reduced vision or spatial awareness when moving around the home. Bruises may also look more severe in older people due to thinner skin, and take longer to fade. 
• Pressure Ulcers – Sometimes referred to as bedsores, pressure ulcers are pressure injuries occurring on the skin when a person has been in the same position for too long, such as in bed or sitting in the same chair. These tend to happen mostly on bony areas of skin, such as hips and tailbone. 

When caring for a loved one, even the smallest injuries should be cleaned and managed appropriately. If signs of complications occur, medical attention should be sought to ensure these do not become worse. As well as potential pain and discomfort, even minor scrapes on skin can become a problem for older people due to reduced skin sensation, slower healing times, less effective immune systems, and more. If you notice a wound is not healing after several weeks (or notice signs of infection such as warmth or redness around the wound, yellow or green discharge, an unpleasant odour, fever or chills, pain, nausea or vomiting) you should seek medical attention to ensure there are no further complications.It is also extremely important that you seek urgent medical attention if you have any of the signs of sepsis. This is a serious infection that should be treated as an emergency, and you should go straight to your nearest A&E for treatment. The signs of sepsis include: 

• Confusion, disorientation or slurred speech 
• Diarrhoea, nausea or vomiting 
• Severe muscle pain 
• Breathlessness or fast breathing 
• Urinating less than usual, such as not urinating for an entire day
• Loss of consciousness
• A high or low body temperature
• Cold, clammy or pale skin, or chills and shivering 
• A racing heartbeat
• Dizziness or feeling faint

How can wound care be done well at home? 

While it is important to intervene and ensure larger or deeper wounds are checked by a medical professional, most minor wounds can be taken care of in the person’s own home, provided effective wound care management is adhered to. Some of the steps involved in wound care at home include:

• Applying pressure until any minor bleeding stops (excessive bleeding may require a visit to the hospital) 
• Gently cleaning the wound with mild soap and water to remove any debris and avoid bacteria entering the site 
• Carefully applying an antiseptic ointment to prevent infection
• Using sterile, gloved hands to ensure any flaps of skin are placed back in their natural position and as close together as possible before covering
• Covering the wound with a sterile dressing or bandage, being careful not to pull on delicate skin 
• Changing the dressing regularly (this may be required once or twice a day), particularly if it becomes wet or soiled
• Keeping a close eye on the wound for signs of infection – this could be pain, redness or swelling
• Encouraging the person to keep the injury site elevated (if possible) to reduce swelling and promote healthy circulation
• Encouraging good nutrition and hydration to support the body’s natural healing process

When would medical attention be needed?

Most people see minor wounds begin to heal in a few days, however older adults may take longer for this to happen. There are a few circumstances in which you will need to seek medical attention for a wound, such as:

• If the wound has not shown signs of healing within around a week, you have a health condition that impairs healing, or it seems to be taking longer than it should to heal
• If the wound continues to bleed excessively after several minutes of applying pressure 
• If the wound is particularly deep in the skin 
• If a foreign object may be embedded in the wound
• If the wound has been caused by something that could harbour dangerous bacteria, such as rusty metal or a bite from an animal 
• If there are any signs of infection, such as redness, warmth, swelling or pus
• If there is numbness or tingling around the wound (this could be a sign of nerve damage) 
• If the older person has diabetes or a compromised immune system 

If any of the above apply, visit the doctor or an urgent care facility as soon as possible to ensure there are no infections or other complications.

How can wounds be avoided?

Older people and their caregivers can take proactive steps to minimise the risk of wounds. Here are a few things that could help:

• Maintain a regular exercise routine to improve strength and balance, which reduces the likelihood of falls
• Make modifications to the home environment by removing hazards that could lead to injuries – this could include things like moving loose rugs, putting away clutter, and rearranging furniture that tends to (or could) cause bumps and scrapes
• Improve lighting in the home to make it easier to see any potential hazards and avoid them
• Use home modifications such as grab rails to enhance stability and prevent falls
• Apply moisturiser to skin daily in order to maintain skin elasticity and avoid dryness, which can lead to skin becoming more easily wounded 
• Avoid having long nails or wearing sharp jewellery (for both the older adult themselves and the caregiver) to avoid accidental scratches 
• Wear long-sleeved clothing to keep arms and legs protected from any damage 
• Wear proper footwear with good traction to prevent accidental slips
• Maintain good general health through nutrition and hydration to promote immunity

How can a caregiver help an older person with wound care?

Caregivers can provide simple wound care in the person’s own home by cleaning, sterilising, applying appropriate dressings, ensuring proper hygiene during dressing changes, and more. When it comes to wound care for older people, taking precautions to prevent infections is so important, so if you are caring for a loved one and would like to make sure this is done effectively, you can bring in a Care Professional to help. As well as wound management, Care Professionals can offer emotional support during the healing process, as some wounds can cause discomfort, reduced wellbeing, reduced mobility and more – this can impact an older person’s quality of life, so having a professional around who can assist and boost morale can be very helpful. At Home Instead, our Care Professionals are trained to the highest clinical standards and can work alongside your own doctors and health teams to ensure you receive the best care at home. Whether you require hourly care for a few hours a week, a couple of hours daily, or 24-hour live-in care to support your wound care needs, we can help provide the bespoke, person-centred care you need. Reach out to the Home Instead team to discuss this, and allow us to create a personalised package to support you.