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Diabetic Wound Management in Long-Term Care

Senior man looking at doctor adjusting bed while sitting on wheelchair

Caring for a wound is important for people of any age, but for diabetics, and especially seniors it’s crucial. Older patients living in long term care facilities are often not physically active, and some are completely bed bound. According to the American Diabetes Association (ADA), long term care facilities are host to a larger number of seniors dealing with diabetes.

For these patients, the risk for developing pressure ulcers or bed sores, and diabetic foot ulcers (DFUs) is much higher than the general public. Since many are not up and moving around regularly, blood flow is decreased. Remaining prone or sitting in one position too long can open the door to skin irritations which could lead to infection.

During this time of uncertainty surrounding the coronavirus and social distancing, many may wonder about the care they or their loved ones will receive from healthcare professionals at a long-term care facility. When regular checks are done, it’s difficult if not impossible to maintain social distancing. Top healthcare providers have had to adapt to this new threat and are making great strides in this area of wound management.

Who’s at Risk

Wound care is considered for those who have developed a wound that hasn’t begun to heal within two weeks or is not completely healed at the six-week mark. For diabetics, it’s difficult to manage wounds as high blood sugar (hyperglycemia) could lead to nerve damage and a loss of feeling.

Chronic wounds such as pressure ulcers (bed sores) and diabetic foot ulcers are quite common in long term care facilities according to the National Center for Biotechnology Information (NCBI) website. These types of facilities tend to see higher numbers of patients with type 2 diabetes. Uncontrolled diabetes can result in an impaired healing processes.

The rise in occurrence can be attributed to wounds such as venous leg ulcers, arterial insufficiency, DFLs and pressure ulcers, as well as the fact that the numbers are on the rise for seniors requiring surgery. This puts them at higher risk for infection and wound healing complications.

Many residents have compromised immune systems, which in the current time of social distancing makes them at high risk for developing the coronavirus. These patients have a higher likelihood of developing serious complications. Too much stress can also play a part in the body’s ability to heal. Changes in facilities, new care team members, and the worries about the pandemic can put added stress on older patients.

Careful Evaluation

The complication of potential wounds makes careful patient evaluation a requirement. Skin assessments and risk evaluation for those who are at risk of developing pressure ulcers is crucial, especially when a patient changes facility.

The NCBI suggests evaluating patients on the following Braden Scale criteria:

  • Sensory – how well they communicate sensory input and sensation level
  • Moisture – the degree of moisture the skin is exposed to
  • Activity – how active the patient can be considering the degree of allowable mobility
  • Mobility – how easily they able to change positions
  • Nutrition – patients normal diet intake
  • Friction or shear – how the patient moves

 

Senior patients must be observed regularly, even while maintaining safety precautions and proper distancing.  Healthcare professionals are required to answer several short questions, pass a temperature check, and are expected to follow CDC and hospital recommendations for safety and sanitization during these unprecedented times.

Secondary complications can lead to a slow down in the ability to heal. Long term care facility staff need to be aware of any additional complications so they can properly evaluate and treat these issues. By working to control secondary issues, they can increase the chances of timely healing of wounds.

Delivery of Care

Reducing complications is key to wound healing and avoiding infection while battling the risk of the coronavirus. By treating the conditions of both diabetes and wound care, seniors will have a higher chance of healing. According to the National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), diet is a key component for controlling diabetes. If left uncontrolled, diabetes could hinder healing.

Healthcare professions should take into consideration a patient’s nutritional and fitness needs when evaluating them. Ensure a proper diet is being followed and caloric intake is monitored. While many long-term care facility residents are unable to exercise, physical therapy can help to keep the body moving and promote healing. Through proper care and consideration, wound care can be managed, and diabetes can be controlled in a long term care setting.

 

Author: Tracy Rairigh is a medical, business, and technical writer with a Writing in the Sciences Certificate from the University of Stanford Medical. With over 150 published articles in wound care, health and wellness and a degree in Engineering, she has a vast array of knowledge to pull from.

 

About the Author

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