Hidden Eldercare Problems

3 Often-Overlooked Aspects of Personal Care
Senior Woman With Adult Daughter In Park

Helping an older adult with personal care means you have a lot to keep track of. But even conscientious caregivers often miss potential signs and sources of trouble. Beware the following problems, which are often "hidden" from caregivers' awareness:

Hidden Pressure Sores

So-called "bedsores" aren't limited to the bedbound. Pressure sores can affect anyone who spends long periods in limited positions (such as in a wheelchair or lounge chair). Those who are overweight and have folds of skin that touch are especially vulnerable. And you don't want to wait until there's an open sore that the person is complaining about. Though it's not pleasant for either of you, make an effort to check these skin folds during bathing to watch for signs of redness or chafing. Apply cornstarch to help keep the area clean and dry, and mention open sores immediately to a doctor.

Hidden Urinary Tract Infections

The trouble with a urinary tract infection (UTI) is that your loved one may not realize something is wrong or may not be able to articulate it. Among the signs of UTI: more frequent urination or new episodes of incontinence -- or delirium, a sudden decline featuring disorientation or a decline in cognitive abilities. These behaviors aren't always linked in people's minds to UTI.

Hidden Ingrown Toenails

Ingrown toenails -- when the corner of the toenail grows into the soft flesh around it -- can be extremely painful. You may not notice the condition, however, until your loved one begins to limp, fall down, or refuse to walk. These behaviors may not immediately be linked to something as small as a toenail by either you or the person suffering from it. Don't ignore an older adult's feet. If you're not comfortable trimming nails regularly, make appointments with a podiatrist. If you do the job yourself, trim them straight across, rather than rounding the nail, to reduce the odds of it becoming ingrown. The big toe is most often affected.


over 3 years ago, said...

Two things particularly impressed me: (1) I wouldn't have made a connection between folds of skin that touch and bedsores. I wonder how frequently caregivers check the skin folds of obese patients. (2) Likewise, I had no idea that UTIs could cause disorientation and cognitive decline. I will pass this along to my mother's caregivers (in assisted living). They may not be aware of these issues either, given that the staff at such facilities are generally woefully underpaid. Thanks so much for all the valuable information you give us.


over 3 years ago, said...

Thank you about the reminder of "folds" and to check them out.


over 4 years ago, said...

All of it. My husband is incontinent and wears diapers so it is hard to tell if he has a UTI or not. Getting a sample from him is almost impossible and his cognitive status is already messed up, so it is hard to tell if he has a bladder infection.


almost 5 years ago, said...

Re: ingrown toenails. Excellent information as it is very important for the caregiver to routinely check for this condition, since the person with AD may not be able to express the pain. However, it should also be noted that it can get worse than "just" ingrown toenails, it can also result in a fungal infection, and "painful dystrophic mycotic toenails with subungual debris and onychomycosis." This quote is from a friend's medical chart at a nursing home, which goes to show that even if the person with AD is in a SNF, it is vital for the friend/relative/caretaker to check the person's nails weekly and demand a podiatric consult when necessary. It is not easy to trim elongated, thick toenails and this should be done by a professional.


almost 5 years ago, said...

About a year ago my mother's HMO began a special podiatry program, serving elderly adults with some foot problems on the same basis as those with risks from diabetes. Though she passed away before she could make much use of it, it was appreciated.


almost 5 years ago, said...

Skin folds can also develop yeast or fungal infections.


almost 5 years ago, said...

Tip top information, glad to know. thanks


almost 5 years ago, said...

I understand about in grown toil nails I use to get them all the time. I have a hard time with my husband and his toe nails because he cannot stand to have his feet touch. What sould I do?


almost 5 years ago, said...

I would recommend podiatrist over nail salon. Mom's even came to the house when it became more difficult for her to go out. And covered by insurance. You can always polish them or put lotion on them but for trimming ingrown nails, podiatrist is the way to go.


almost 5 years ago, said...

My mother has had all of these. Good to know.


almost 5 years ago, said...

How about trying a pedicure at nail salon?


almost 5 years ago, said...

Reminders to look at hidden, not so obvious areas for breakdown of skin integrity.


almost 5 years ago, said...

wanted to comment ingrown toe nails. covered by Medicare and your secondary insurance. My husband goes to a podiatrist every 10 weeks.


almost 5 years ago, said...

a few things i learned caring for my mom: a red area is by definition a stage 1bedsore. keeping 'dry and clean' is not the way to go. the key to avoiding bedsores is removing the pressure. so, during waking hours, change positions every 1-2 hours. heels and elbows are also places bedsores will occur. So keep pillows under heels and elbows, too, if necessary. rojo cushion, gel pad, or in advanced stages, a special air mattress will minimize bedsores. you need to cover the area with a&d or another butt paste type ointment. for stage 2 bedsores, there are duederm patches which protect the sore while it heals. also good nutritional status is critical to avoiding bedsores and fast healing. re toenails, use a podiatrist. period. They can properly handle this. as for uti's, confusion is often the first symptom, so I believe any new or sudden or increased confusion should first be treated with a urineanalysis and proper treatment if needed. proper hydration is important. but so is immaculate hygiene and especially so in incontinent patients. 2 peri baths daily pus 3x weekly showers are a must. and clean, dry depends. always.


almost 5 years ago, said...

Do be wary if a person begins "talking crazy." A MRSA UTI began my mother's final slide last year. She had been diagnosed with congestive heart failure a couple of years prior to her death. After the MRSA UTI diagnosis and hospitalization came apparent recovery, followed by pneumonia and hospitalization for that. Reported: septic UTI upon admission to the hospital for pneumonia. Less than a week later she was released but then passed away within two hours. Prior to each hospitalization low-level antibiotics were prescribed and taken and seemed to have an initial effect, followed by relapses until the higher-powered antibiotics were finally administered in hospital. Official Cause of Death: cardiac arrest. Extreme concern with possible bedsore formation had big stiff "booties" on my mother's feet, causing her extra discomfort and posture problems in the hospital bed. But MRSA is after all of us, everywhere. The medical transportation people and Emergency Room personnel appreciated being directly informed of MRSA in her recent medical history.


almost 5 years ago, said...

Your story is not reported often, but very common. God bless you for reminding us about this lethal combination. I have MS and frequent episodes of UTI along with inability to use my hands to pour out drinks. I always fight dehydration when I don't have caregivers often enough or conscientious enough.


almost 5 years ago, said...

advice to trim nails "straight accross" to help avoid ingrown toenails-useful info.


almost 5 years ago, said...

There in a type of nail file made especially to help combat ingrown toe nails: http://www.footsmart.com/c-ingrown-toenail-foot-health-products-48.aspx


almost 5 years ago, said...

Yes. Good points were presented that you would not normally think of yourself.


almost 5 years ago, said...

Please can someone suggest how to get rid of big toe nail problem.The nail-cutter does not reach the affected area properly.The village barbers used to cut nails with great precision(using a knife-like instrument) but they are no longer available,the times have changed.My toe nail gives me constant pain.Some good suggestion will be highly welcome,thanks in advance


almost 5 years ago, said...

A UTI is extremely difficult to detect, especially in a person with dementia. My mother, bless her heart had both. She could never remember to drink the fluids. As the dementia progressed so did the frequency of her UTI's. I could have her drink placed right in front of her but she didn't know what it was for. If I placed the straw in her lips she couldn't take in enough anyways to counter the lack of fluids in her system. The UTI actually took away her ability to stand up so she could no longer walk. These things are really serious in the elderly. After 5 months of continual UTI's and 7 hospital or ER visits for hydration, sadly my mother passed away 4 months ago the day after her 85th birthday. Her cause of death on her death certificate- Urinary track Infection leading to sepsis.


almost 5 years ago, said...

Office visit to a podiatrist for ingrown nails is covered by health insurance.