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DEMENTIA
12
JCN supplement
2015,Vol 29 No 5
better with these mattresses, and they
can contribute to healing in pressure
ulcers up to grade three.
Education and patient information
for this group needs to be assessed
on an individual patient basis (Kilroy-
Findley, 2010) ensuring the format is
relevant (i.e. in the correct language
and in‘easy-read’ if necessary). Where
patients are unable to understand
instructions, nurses need to assume
to several factors that are associated
with dementia and the progression of
the disease (
Table 2
).
When looking at pressure ulcer
prevention within this group of
patients, it is sometimes necessary
to think ‘outside of the box’. For
example, the use of alternating
mattresses for those patients with
advanced dementia at high risk
of pressure ulcer development is
indicated in the NPUAP (2014)
guidelines. However, when they
are nursed on these surfaces,
patients with advanced dementia
can often experience restlessness
and increased confusion, as they
are unable to understand why
the bed is moving underneath
them. This means that they can
constantly attempt to get out of bed.
Similarly, an explanation of how this
equipment works is difficult for them
to understand and the information
quickly forgotten.
In the authors’experience, it is
far better to nurse these patients on
a high-specification foam mattress
and ensure that good skin care and
position-changing regimens are
consistently in place.
Hybrid mattresses with a foam
outer casing and an alternating cell
insert are also now available. The
movement felt on this type of mattress
is minimal and it is the authors’
experience that patients sleep much
responsibility for reminding or
helping them to change position.
INCONTINENCE-ASSOCIATED
DERMATITIS (IAD)
Incontinence-associated dermatitis
(IAD) is the clinical manifestation
of simultaneous inflammation
and erosion of the skin through
prolonged exposure to various
sources of moisture, including faeces,
urine, perspiration and wound
exudate (Gray et al, 2007) — these
areas of skin degeneration are also
referred to as moisture lesions.
IAD is most commonly
experienced by people with faecal
and urinary incontinence as this
causes the skin’s pH to become
increasingly alkaline, resulting in skin
irritation and breakdown (Langemo
et al, 2011). Prolonged excessive
exposure of the skin to moisture then
leads to inflammation and dermatitis
(Voegeli, 2012). If left untreated,
symptoms include inflammation of
the skin, redness and, in severe cases,
swelling and blisters.
IAD can be located anywhere
on the perineal area (except bony
prominences — this would indicate
Table 2:
)DFWRUV DVVRFLDWHG ZLWK GHPHQWLD DQG WKHLU HIIHFW RQ ZRXQG GHYHORSPHQW
Factor
Problem
`
Mobility
`
Difficulty in changing position or repositioning;
declining mobility
`
Poor diet and hydration
`
Reduces the strength and healing capacity of
the skin
`
Incontinence
`
Causes damage to the skin which can result in
pressure ulcers if not treated
`
Poor blood supply
`
Conditions such as diabetes or vascular disease
will increase the risk of ulcers
`
Agitation or restlessness
`
Friction on skin from clothes and bedding
can cause shear and friction, especially over the
elbows and heels
`
Medication
`
Can cause sedation and dry skin in
some instances
`
Communication
`
Patients are not as able to express pain; non-
verbal communication can be misinterpreted
Top tips:
`
People with dementia are 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.
`
Nutrition can have a serious impact on wound healing —
communication problems 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.
`
Many skin tear risk factors — such as impaired mobility, poor nutrition
or hydration, and cognitive impairment — may be directly associated
with dementia.
`
Most skin tears occur during routine patient care activities such as lifting,
washing or moving patients.
`
Ensuring adequate lighting and good positioning of small furniture
(night table, chairs etc) can avoid unnecessary bumps or knocks.
`
Never use a bed sheet to move the patient as this can contribute to
damage by causing a ‘dragging’ effect on the skin.
`
Encourage the patient to wear appropriate footwear and clothing to
reduce the risk of injury.
`
Use appropriate aids when transferring patients and adopting good
manual-handling techniques according to local protocols, e.g.
slide sheets.