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PubMed1999

[Decubitus sores in geriatric medicine. Local and general treatment of pressure sores in the aged].

LOCAL CARE: Local antiseptics and antibiotics must be avoided to preserve the local bacterial ecosystem of the wound. If surgical debridement is not possible, hypercolloid, alginate or hydrogel dressings should be applied to achieve natural autolytic cleansing. The budding and epithelization phases are also treated either with oily or humid dressings or more modern hypercellular, hydrocolloid and polyurethane film dressings. Other treatments under evaluation include physical means (negative pressure, electrical stimulation) or use of recombinant growth factors. GENERAL TREATMENT: Surgical repair with flaps or grafts is not usually indicated in fragile elderly patients. Special attention must be given to all associated diseases (diabetes, heart failure, etc.) as well as protein-calorie nutrition. The objective is 35 cal/kg/d including 1.25-1.5 g protein/kg/d. TREATMENT OF COMPLICATIONS: Wound infection should be suspected in case of an inflammatory induration around the wound, fever, or delayed healing. Systemic antibiotics are indicated as for cellulitis. The wound is generally colonized by germs found on local bacteriological samples. Osteitis should be suspected if the wound is in contact with bone. In case of biopsy proven osteitis with positive culture, prolonged oral antibiotics are indicated. Tendon retractions should benefit from rehabilitation exercises and surgery in case of medical failure. Antalgesics may be required, either continuously or when making the dressings.

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PubMed1999

[Prevention of decubitus scars in the elderly].

IDENTIFYING RISK: Groups of elderly patients at risk of pressure sores must be carefully identified for effective prevention. Recommended risk scales are insufficiently used in everyday practice. Preventive measures must be rapidly implemented in order to reduce or eliminate factors contributing to the development of pressure sores. Risk factors include, among others, prolonged or heavy pressure, friction, shearing force, malnutrition, and bowel incontinence. POSITION: The position of patients with severe sensorial disorders should be changed every 2 or 3 hours. Bed rest should be interrupted as soon as possible, using a cushioned chair. Reclining in the strictly lateral position (with pressure on the trochanter) must be avoided. A 30 degrees dorsal inclination in the lateral position is preferable. The reclining-sitting position with a greater than 30 degrees inclination should be avoided as it increases the shearing forces applied to the sacrum. The ventral position is inappropriate for the elderly. PREVENTION AIDS: Mattresses, mattress covers, cushions and various other aids have been developed specifically for the prevention of pressure sores but the evaluation and choice of material requires careful assessment using pressure sensors. GENERAL MEASURES: Instruments designed to facilitate position changing help reduce the risk of friction. The general practice of massage, widely used in France, is not based on confirmed arguments of efficacy. On the contrary, certain studies would show that such methods can have unfavorable effects. Prevention of undernutrition and renutrition cannot be overlooked. Maintaining the patient in a dry environment (particularly in case of incontinence) and use of emollients to prevent skin drying are recommended. Written prevention protocols for education of patients, family, and health care personnel are indispensable.

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