Bedsores – a feared complication in patients with Alzheimer’s disease

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About Alzheimer

Alzheimer’s disease cause changes in the brain that worsen over time. Decay and dying brain cells, cause gradual loss of memory. It is the most common cause of dementia – group of diseases that cause progressive loss of brain intellectual and social capacities – severe enough to prevent daily activities. If Alzheimer’s disease is in an advanced stage, complications arise and it can endanger the patient’s life, one of the complications being bedsores.


Contents

1. About Alzheimer
2. Stages of Alzheimer’s disease
3. Complications of Alzheimer’s dementia
4. Causes and prevention of bedsores
5. Treatment of bedsores
6. Epithelization phase
7. Conclusion


Stages of Alzheimer’s disease

Alzheimer’s disease progresses slowly, in its evolution distinguishing three stages:

1. Early stage can be identified only in retrospect. It can go unnoticed or be confused with “overloading”, “half-hearted” or “aging”. Alzheimer’s onset is very difficult to identify; the patient can be: apathetic, uninterested in old activities or try new things, irritable if they fail to perform certain tasks. Also, patient’s capacity to make decisions is diminished, become more concerned about their self-interest losing the interest for the others, forget recent events and tend to recur.

Intermediate stage is clear. The patient often forget recent events, is confused about time and space and can get lost in places which are not familiar, forget the names of the relatives and friends, becomes careless with personal hygiene and sometimes even forget to eat, get angry or upset very quickly.

Advanced stage is characterized by the need for a patient to be cared for by another person. At this stage, the patient is no longer able to cope with daily activities (dressing, washing, eating) admits no relatives or friends, constantly repeating certain phrases or sounds, is restless, can become aggressive, become incontinent, has difficulty travel.


Complications of Alzheimer’s dementia

The most common cause of death in Alzheimer’s patients is aspiration pneumonia, which appeared at an advanced stage when the patient has difficulty swallowing. Depending on how early the disease is diagnosed, the patient’s general condition and degree of damage to the lungs, it can be treated with antibiotics and support of breathing devices.

Another complication that can lead to death is bedsores, skin lesion that occurs as a result of continuous pressing of tissue between the bone and bed / chair (prolonged immobilization). The period in which the tissues resist pressure effect, without suffering injuries, is about two hours. This effect is mainly influenced by the intensity of pressure, and the general condition of the skin. For example, elastic younger skin, is more resistant to pressure than a thin aged skin. In addition, the patient’s overall health plays an important role in the development of pressure sores, immobility of advanced dementia patients is a complicating factor.

Other complications that can occur are falls, fractures, malnutrition and dehydration, all of which can be risk factors for the occurrence of bedsores.


Causes and prevention of bedsores

In principle, pressure sores can form in any area of the body. However, the greatest risk occurs in areas that are over a bone protruding, with insufficient subcutaneous adipose tissue. Consequently, the most vulnerable areas are the sacral area (area where the spine ends), the calcaneal (heel), greater trochanter (hip) and malleoli (the sides of the ankles). Approximately 95% of bedsores occur in these areas.

Besides the direct effect of pressure, there is danger of some friction forces. In particular bottom area is affected by the occurrence of these forces, for example when the patient is pulled into a new position, instead of being raised, or if it slips on the bed surface due to insufficient support of the legs.

In addition, due to the advanced stage of incontinence installation in dementia bottom area skin is aggressively exposed to urine and feces, becoming fragile. Keeping it dry with appropriate incontinence products and protect them.


Treatment of bedsores

A key measure of treatment for bedsores is the pressure removal from the affected area by mobilizing the patient. For complete removal of the pressure, the patient should be positioned so that bedsores do not bear weight! Even if the patient is placed on a soft surface (eg. in bed) it is essential that the affected area (bedsores) do not come into direct contact with the bed. Patient positioning should be done accordingly, taking into account the location of the wound.

Bedsores location: Right hip
Correct position: Oblique position, left, 30 degrees dorsal
Observations: Contraindications – any lateral position

Bedsores location: Left hip
Correct position: Oblique position, right, 30 degrees dorsal
Observations: Contraindications – any lateral position

Bedsores location: Sacral area
Correct position: Oblique position, left at 30 degrees; Oblique position, right at 30 degrees; Position at 135 degrees
Observation: Contraindications – back position

Bedsores location: Heel
Correct position: Oblique position, left at 30 degrees; Oblique position, right at 30 degrees; Without contact, by using special pillows
Observation: If no contact position is assured, the patient can stay in dorsal position

The position that involves the lowest risk for the patient is at an angle of 30 degrees (left or right). 90 degrees perpendicular position creates pressure points at the hip and is not recommended. For oblique position at 30 degrees (right or left), the patient is placed on a soft mattress with the head supported by a small pillow. Inclination of 30 degrees (from the bed) is created by placing a soft pillow, long in back side. At the knee level can position (between the legs) another pillow to avoid the occurrence of bedsores in this point of contact.

To place the patient on back position requires a mattress anti-bedsores it have a special design that provides decompression zones in regions prone to bedsores.

Also, the patient reposition to a maximum period of two hours is essential for successful treatment!

Incorrect positioning can lead not only to appearance or worsening of existing pressure sores but also respiratory deficient, circulatory, stiffness in the joints or contractures.

Therefore, before initiating any treatment should be established individually positioning plan that includes the use of adjuvant products both static and dynamic (air cushions, coils, mattress anti-bedsores). This plan must be rigorously observed by all persons involved in the treatment and care of patients with dementia.

Local treatment of bedsores with modern hydroactive bandages

Depending on the degree of tissue damage, pressure sores (pressure ulcers) pass through 4 stages:

- In stage I the skin is intact, but is red; the red color remains even if the local pressure is removed.
- In stage II layer of skin is removed and can have the appearance of abrasion, blister or broken vesicle.
- In stage III ulcer is deep, through all layers of the skin and can reach fascia.
- In stage IV deeper tissues, muscles and fascia are affected; ulceration can lead to bone and pockets may form fistulas.

In stages III and IV is danger of generalized infection (septicemia) that endanger the patient’s life.

Hydroactive treatment of bedsores (decubitus ulcers) with modern wound dressings is possible in stages I, II and III. Stage IV, whit muscle and bone damage (possibly marrow infection), is an indication for treatment with hydroactive bandages only after appropriate surgery (cleaning deep bedsores by surgical procedure). At this stage (IV) the dressings prepare the wound for closure through plastic surgery.

Treatment with modern hydroactive dressings consists of non-invasive wound cleaning, keeping the healthy tissue intact, by stimulating the formation of granulation tissue (new cells) and stimulating epithelisation (wound closure). These dressings create the necessary conditions to support the natural healing process of evolution in each of its phases (Phase I – Cleaning / exudate, granulation phase II and phase III – the epithelization). Due to the specific mechanisms of absorption, hydroactive dressings reduce microbial load and achieves optimal control of the amount of exudate by absorbing excess secretions and maintaining a balanced moist environment necessary for the proliferation of new tissue.

Cleaning or exudative phase

The dressings softens the necrosis, remove fibrin deposits (yellow), dead cells and germs. This cleaning method provides multiple benefits for wound healing. The procedure is selective because only devitalized tissue is removed, while healthy tissue is kept intact, not traumatized. In addition, wet dressings maintain, protect and stimulate the cells responsible for wound cleaning and proliferation of new tissue. Another advantage is the method itself, devoid of “side effects”, easy to put into practice and is painless for the patient.

Granulation phase

The moment when the wound is clean creates the necessary conditions for the formation of new tissue. Particular attention should be paid to the wound base to be maintained continuously in a damp balanced environment. If the wound is dry, the cells that contribute to the formation of new tissue and blood vessels die, the healing regressing or stagnating.


Epithelization phase

During the epithelization phase, dressings maintain a moist balanced environment, protecting the newly formed epithelium from cell detachment and accelerating the healing process. At this stage one of the main benefits of hydroactive dressing is the non-traumatic exchange, without newly formed tissue damage.

Keep in mind that therapeutic success for bedsores is possible only through correct choice of appropriately dressing for the evolutionary phase of the healing process. Local treatment must necessarily be accompanied by permanent and accurate patient repositioning.


Conclusion

People with Alzheimer’s have special needs and require special care, which can be challenging for those who care of them. In the advanced stage of disease, scarring is a common complication with major impact on the life of the patient.

One of the methods that do not require surgery and proved fully effective in the topical treatment of bedsores is based on the use of modern dressings. By their multiple cleaning action, infection control and granulation and epithelialization process stimulating, hydroactive dressings offer a viable, painless and easy to apply alternative.

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