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Virginia's ALZHEIMER'S COMMISSION ALZPOSSIBLE INITIATIVE

VIRGINIA ALZHEIMER CAREGIVER FORUM EDITED BY VACAPI's Education Core Chaired by Ayn Welleford, PhD, Marilyn Pace Maxwell and Cathy Saunders
SKIN CARE: Problems and Solutions for the Individual with Alzheimer's Disease
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ALZHEIMER'S AND SKIN CARE- CHALLENGES and SOLUTIONS

The issue of Alzheimer's and skin care - especially during the advanced stages of the disease - is one of the most difficult challenges to overcome in the process of caregiving.

Read below an illuminating perspective on the topic and submit your comments in our forum.

Health Professional's Perspective

Skin Care and the Individual with Alzheimer's Disease

by Judy Nelson, BS, RN

Skin is our lifelong protection from heat and cold, sun, undue exposure to germs or harsh chemicals, and injuries of all kinds. It’s not only a cosmetic matter but a necessity to pay attention to how our skin is faring over time. Skin care refers simply to the ways we protect our skin on an everyday basis by:

bathing
applying lotion
cleaning a cut with soap and water
using sunscreen outdoors
eating a balanced diet
preventing injuries such as burns, and
seeing a dermatologist when necessary.

It is estimated that over 70,000 people in America die each year from wound infections that begin with skin breakdown or “pressure sores.”

Skin care for persons with Alzheimer’s disease is really no different than it is for someone of the same age and general condition. The main difference is that as a person’s awareness decreases, their caregivers and family must take over responsibility and keep watch to prevent injury and infection. The need can appear gradually and inconsistently. As in other areas of self care, someone who has regularly done an activity, such as using lotion, may continue to do this for longer than expected—at the same time letting other aspects of care go. It is up to caregivers to notice if and when more help is needed. Outside observation and care is essential for a person who is quite sedentary, bed-bound, incontinent or unaware of their surroundings.

Most skin wounds begin in facilities, both in hospitals and in nursing homes. Figures vary, but it is estimated that over 70,000 people in America die each year from wound infections that begin with skin breakdown or “pressure sores.” Other names for this injury are pressure ulcers, bed sores or decubitus ulcers.

There are four stages of skin ulcers, from Stage I, the most superficial, to Stage IV, the deepest, extending into the muscles. These sores are slow to heal and easily infected, so prevention is paramount.

Aging in general causes skin to be fragile as the layers thin and lose their elasticity. Other risk factors are:

immobility
incontinence
poor nutrition/low weight
dehydration
anemia
diabetes
obesity
decreased level of awareness or decreased sensation.

Paying Attention: What to look for, what to do

Skin ulcer types, causes and care

Pressure sores are most frequently caused by prolonged pressure on a vulnerable area—a bony prominence like the hip, heel, tail bone, or ankle. When skin is squeezed between bone and the mattress or a chair, the pressure limits blood flow to the area. Within hours, this can lead to tissue death.

Always roll a person from side to side and gently remove soiled linen without pulling against the skin’s surface.

A person who can’t move in bed can develop a pressure sore in as little as two hours. If the skin appears reddened and doesn’t return to normal when weight is shifted, some damage has already occurred beneath the surface. Initially a sore starts as a red, painful area which eventually turns purple. Left untreated, the skin may break open and even become infected. Damp skin presents the greatest risk, so wet or soiled clothing and bedding must be changed quickly.

Friction injuries usually occur when skin rubs against a resistive surface like a sheet. When linen is pulled forcefully out from under a person, such an injury can easily occur. Always roll a person from side to side and gently remove (rolling up) soiled linen without pulling against the skin’s surface.

Shearing injuries occur when a person’s skin tends to stick to the bed or chair and pulls away from the underlying tissue as they slide down or are pulled or turned. The outer layer of skin can become separated from its blood supply just below the surface. These shearing forces frequently result in decubitus ulcers.

Prevention

Prevention involves lots of observation and some good, common sense.

Reducing friction by making sure a person is LIFTED and NOT DRAGGED during repositioning, and that linen is rolled, not yanked or pulled out from under him or her will prevent many injuries.

Inspect skin every day—several times for people confined to bed or chair. Pay special attention to pressure points or moist areas, and report any sign of redness or injury to a professional to check the area right away.
Clean soiled or wet skin quickly. Ideally, skin should be cleaned as soon as it is soiled. When that is not possible, use pads or briefs that absorb moisture and keep it away from the skin. Stool needs to be removed immediately.
Daily Bathing is necessary for comfort and cleanliness.
Use lotions, creams or oils to prevent dryness and cracking. Powder and lotion are both fine but together they can make a paste. Use one or the other for any one part of the body. Cornstarch can soothe like powder.
Change positions at least every two hours in chair or bed to limit pressure over boney parts.
Lift, Don’t Drag a person during repositioning, and roll linen, don’t yank or pull out from under the person. This will reduce friction and prevent many injuries.
Avoid donut-shaped rings or cushions as they can cause pressure on the skin over the sacrum.

In Bed:

Keep heels off the bed at all times—propped on pillows or person lying on side.
Use pillows for support or protection, such as for heels, elbows, or between legs.
Keep the head of the bed low (30 degrees at the most) to prevent shearing injuries.
Use Cornstarch like powder to smooth over rough surfaces in bed.

By paying attention and following through on care, it is possible to prevent uncomfortable, painful sores which can develop into life-threatening infections. Your patient or family member will be more comfortable and safer.

Judy Nelson, BS, RN, is the Adult Care Services Manager for Senior Connections, The Capital Area Agency on Aging in Richmond, Virginia. As such , she manages grants for respite and short term home care and assists families in assessing their care needs and finding resources in the community. For the past three years she has helped to organize and co-teach a week long seminar for family caregivers with Dr. Ayn Welleford and the VCU Department of Gerontology.

Ms. Nelson is a graduate of the University of Vermont with a Bachelor of Science in Nursing, and has worked at New York University Hospital in pediatrics and at Virginia Commonwealth University Medical Center as a consultant. After raising her children, she returned to nursing in public health, focusing on geriatric home care and is pursuing a Certificate in Gerontology. During her years as a visiting nurse, Ms. Nelson was impressed by the importance of good, daily skin care for elderly persons and the possible harsh consequences when it’s omitted.

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Educator's Perspective

When was the last time you had a conversation about appropriate skincare?

by E. Ayn Welleford, PhD - Chair & Associate Professor, Department of Gerontology, Virginia Commonwealth University

You can’t turn on the television or open a magazine without seeing a dewy skinned beauty espousing the benefits of some miracle skin care product. Among young and middle aged adults all-things-skin is a hot-hot topic.

I can’t recall the last time I saw an ad, heard a commercial, or read an article in the popular media about appropriate skin care among our old old, our most vulnerable and frail population. Somewhere along the way we lose our voice about the damage that can be done if we are not paying appropriate attention to adequate skin care. A Stage I pressure sore can appear in as little as two hours in our most frail elders. If uncared for and allowed to progress pressure sores can be fatal.

But think! When was the last time you had or overheard a conversation about pressure sores? Would you know one if you saw one? Do you think most people would? Would you know what to do about it? More importantly do you know how to prevent them from occurring? No one ever died from age spots, fine lines, wrinkles, crow’s feet, grey hairs. As Judy indicates in her article it is estimated that 70,000 people in America die each year from wound infections due to skin breakdown.

Judy describes numerous signs and preventive factors essential to proper skin care. Many pieces are at work here: daily observation, adequate nutrition, proper bedding, wise transferring and positioning, regular repositioning, proper bathing and hygiene, and essential products (my mother in care of my 96 year old grandmother prefers anti-monkey butt ointment, a favorite among bikers and long distance cyclists). Prevention requires knowledge, care, and the awareness that skin care can far too easily become wound care if unattended.

As I’ve mentioned regarding previous topics, how do we spread the word to Advocate-Educate, in an effort to improve care of our elders?

When was the last time you had a conversation about appropriate skin care among our oldest old? Join us on the 28th of September at 12:00 pm EST to learn more about this topic and share your ideas about how we can improve the lives of our elders (click here to learn more about this live discussion).

Dr. Ayn Welleford is Chair, VCU Department of Gerontology, Associate Professor,VCU Department of Gerontology, and Associate Director, Virginia Geriatric Education Center. Dr. Welleford received her B.A. in Management/ Psychology from Averett College, M.S. from the Department of Gerontology and Ph.D. in Developmental Psychology from VCU. She has taught extensively in the areas of Lifespan Development, and Adult Development and Aging. As an educator, researcher, and previously as a practitioner she has worked with a broad spectrum of individuals across the caregiving continuum. As a gerontologist she currently works extensively with formal and informal caregivers to improve elder care through education. Outside of the classroom and working with various community agencies, Dr. Welleford provides community education on a variety of topics, including: Steps to Aging Well, Building Successful Mother-Daughter Relationships, Intergenerational Programs, and Family Caregiving. Dr. Welleford conducts research, through mixed methodology, in the areas of caregiver burden, coping with distress, adult mother-daughter relationships, successful aging, and geriatric education. Click here to read more about Dr. Welleford's work.

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TELL US ABOUT YOUR SKIN CARE SOLUTION

Log into our forum and click on Skin Care to tell us which skin care solution worked for you and how!

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WE'RE LOOKING FOR VOLUNTEERS

Are you a caregiver who is willing to share experience, ideas, or thoughts about your respective caregiving process? Are you a health professional or paraprofessional willing to contribute with a written material to the newsletter or forum? Then we want to hear from you! We would love to feature your text and have you join the team of panelists we assemble for each live discussion.

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CONNECT-AND-LEARN OPPORTUNITIES IN YOUR AREA

Check with your local Alzheimer's Association Chapter, Area Agency on Aging or any such relevant source of services and training opportunities (search via the Senior Navigator for additional regional/local services and information centers).

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LIVE DISCUSSION

Click on the "play" button below to review the live discussion (webinar) hosted the 28th of September, noon, EST, and featuring Judy Nelson, Gale Davis and Dana RaBorg. The one-hour interactive presentation discusses the multiple challenges and implications of skin care for the individuals with Alzheimer's disease. The supporting slides are appended below.

ABOUT THE PANELISTS:

Judy Nelson, RN, BS, is a graduate of the University of Vermont with a Bachelor of Science in Nursing, and has worked at New York University Hospital in pediatrics and at Virginia Commonwealth University Medical Center as a consultant. After raising her children, she returned to nursing in public health, focusing on geriatric home care and is pursuing a Certificate in Gerontology. During her years as a visiting nurse, Ms. Nelson was impressed by the importance of good, daily skin care for elderly persons and the possible harsh consequences when it’s omitted.

Gale Davis, MS, joined the VCU Department of Gerontology staff in Fall, 2006. She is a Master’s Degree in Gerontology from VCU and undergraduate in Social Work from JMU. She is a Professional Geriatric Care Manager and member of the National Association of Professional Geriatric Care Managers. She teaches the course The Business of Geriatric Care Management for the Department of Gerontology. In addition Gale is the clinical site coordinator for GCM students at Senior Solutions of Richmond, a home care provider agency with a GCM practice. Gale’s work as Geriatric Care Manager started at Jewish Family Services of Richmond where she started their GCM Program and practiced there for 5 years.

Dana RaBorg, RN, has worked with Hill-Rom’s home care division for over 5 years providing the appropriate products to patients at risk for and with active decubitus ulcers. Dana provides inservicing to the staff of Home Care Agencies and Assisted Living Facilities in the Richmond and surrounding areas. She has received extensive training in pressure ulcer prevention and management of pressure ulcers through Hill-Rom. She also gained much knowledge of preventing and managing pressure ulcers while working as a Home Health nurse and also as being the Director of Nursing for Long Term Care facilities in the Richmond area.

Click here to download the slides.

To comment on this topic or discussion or newsletter, please register as a forum member (free for all) and enter your message - +1.773.784.8134 or send us an email at virtualcenter@alzpossible.org.

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LAST ISSUES

FALLING AND THE INDIVIDUAL WITH ALZHEIMER'S DISEASE >>>

EFFECTIVE COMMUNICATION WITH PHYSICIANS >>>

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NEXT ISSUE'S MAIN TOPIC

INCONTINENCE - The inability to control bladder or bowel function may occur in the later stages of Alzheimer's disease and can be connected to a number of factors including not being able to get to the bathroom quickly, not knowing or recognizing where the bathroom is located, having difficulty getting clothing off quickly enough or being busy and forgetting to go. Incontinence can also be caused by other physical illnesses and is sometimes treatable. Read our next issue to learn more about the topic and join us next month for another exciting live discussion.

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