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JCN supplement
2015,Vol 29 No 5
DEMENTIA
have always enjoyed distasteful. As
their perceptions of taste and smell
change, people often develop a
preference for sweet food.
Communication problems can
also mean that people with dementia
are not able to express their dietary
preferences and may spit out food
they do not wish to eat or hold it in
their mouths to be disposed of later
(Morris andVolicer, 2001).
Depression is a common feature
in dementia and is known to affect
appetite — with one-third of over-
65s and half of over-75s living alone
(Age UK, 2015), there is a risk of
social isolation as well as a lack of
motivation to shop, cook and eat well.
Nutrition can have a serious
impact on wound healing
(Thompson and Fuhrman, 2005),
with malnourished patients being at
a higher risk of developing pressure
ulcers and wound infections as well
as having delayed wound healing
(Stechmiller, 2010).
Mobility
People with dementia are often
described as ‘wandering’. Research,
however shows that there is usually a
reason for this — they may be bored,
looking for the toilet or simply lost
(Alzheimer’s Society, 2013). It is also
common for people with dementia
to ‘lose track’, for example, they may
have set off with a particular goal in
mind, such as visiting the shops, but
then forgotten their purpose.
Memory loss may cause people
with dementia to forget that their
walking ability is not as good as it
once was and that they should be
using a stick or a frame. This puts
them at a much higher risk of falls
than other older people — a problem
accentuated by deteriorating spatial
awareness and coordination as
well as increased risk of postural
hypotension. They are also prey to
all the risks common to older people
such as environmental hazards, poor
eyesight, polypharmacy, pain and
unsuitable footwear.
With the high risk of falls comes
a high risk of injury — especially
skin tears (see below). As dementia
progresses and people’s mobility
declines, walking can become
slower and the gait more unsteady,
with some people becoming bed-
and chair-bound. This immobility
causes an increased risk of pressure
ulcers (see below) (National
Pressure Ulcer Advisory Panel
[NPUAP], 2014).
A person with dementia may not
remember where the toilets are or
how to complete the task once they
get there, struggling with clothing or
arriving too late for example. This can
lead to an increase in incontinence or
inappropriate urination or defecation
(Andrews, 2013). Incontinence can
be very embarrassing and difficult to
manage for people with dementia
and their family and can lead to social
isolation and stigma (Alzheimer’s
Disease International, 2012). As
dementia progresses, control of bowel
and bladder function may gradually
be lost, leading to the risk of moisture
lesion development.
SKIN TEARS
A skin tear is a traumatic injury that
occurs due to shearing forces or blunt
trauma and causes the epidermis to
separate from the dermis (partial-
thickness wound), or both the
epidermis and the dermis to separate
from the underlying structures
(full-thickness wound) (LeBlanc et
al, 2011). Skin tears are most often
sustained on the extremities such as
the legs, arms and dorsal aspect of
the hands (LeBlanc et al, 2011).
There are a number of risk
factors for skin tears such as age
(more common in older people),
gender (more common in females),
dry fragile skin, and having
comorbidities such as chronic heart
disease or renal failure (Stephen-
Haynes et al, 2011). Many skin tear
risk factors — such as impaired
mobility, poor nutrition or hydration,
and cognitive impairment — may be
directly associated with dementia.
Management
When a skin tear has been sustained,
the main aims of management are to
preserve the skin flap, approximate
the edges of the wound if possible
and reduce the risk of infection.
Assessment should establish the
type of injury as well as when, where
and how it occurred (Cooper, 2006).
Examination of the wound should
be undertaken to determine
the following:
`
Location
`
Dimensions (length, width, depth)
`
Percentage of viable/
non-viable tissue
`
Degree of flap necrosis.
The skin tear should be
categorised using a tool such as the
STAR classification system (
Table 1
)
(Carville et al, 2007).
The following steps should be
taken when managing a skin tear
`
Clean the wound
o
use saline to irrigate the wound
and remove any debris. Apply
pressure to the wound to
control any bleeding
o
gently pat dry the surrounding
skin to avoid further injury.
`
Approximate the skin flap
o
if the skin flap is viable, gently
ease the flap back into place
and use the flap as a dressing.
Record any approximation
(Cooper, 2006)
o
for flaps that are difficult
to align, consider using a
i
Practice point
Protection is vital in maintaining
skin integrity. Keep the skin well
hydrated by maintaining nutritional
intake and fluid balance. Patients
with dry skin on their arms and
legs will benefit from a twice-daily
application of an appropriate pH-
friendly moisturising cream.
Red Flag
Skin tears
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