What's an effective way to deal with a decubitus ulcer?

A fellow caregiver asked...

My mother is 72 and diagnosed with Alzheimer's 7 years ago. She is in the mid-stage now and wants to stay in bed all the time. She is still able to move about,but refuses. I make her get up and move and do all I can when I am around. I have home health aides coming to the house 2 hours per day 5 days per week. Last fall we battled for several months with a decubitus ulcer on her ankle. Now I am having issues with the beginnings of decubitus on her coccyx. I do the 1-2-3 peri tx bid, and when I notice areas of breakdown, I immediately hit them with Hydrogel. However, there is one area that is beginning to get away from me. It is currently only the size of a pencil eraser and not deep, but I wonder if there is a product out there or another treatment option that may work better to help it heal. I know the best thing is to keep her off it and moving, but that is becoming more and more difficult. Any suggestions? She is also incontinent of urine and stool at times. She refuses to get out of bed at night to void. I am now having her use Depends all the time.

Expert Answer

Jennifer Serafin, N.P. is a registered nurse and geriatric nurse practitioner at the Jewish Homes for the Aged in San Francisco.

First, I just want to say that it sounds like you are working hard to take good care of your mother, and I know it is not easy. Even in the nursing home, where we have nurses taking care of our residents 24/7, patients still develop sores. So, when pressure ulcers develop, do what I do. Look for the reasons that made them appear. Ulcers on the buttocks are usually are caused by: 1) immobility (as you already know), 2) moisture (incontinence), 3) pressure/friction/shearing forces and/or 4) poor nutrition. Any issue in one (or any combo) of these four areas can make a wound difficult to heal.

As Alzheimer's disease progresses, many people become uninterested in activities. My first suggestion to you would be to talk to your mother's healthcare provider about her not wanting to get out of bed. Try to ask your mom if she is having pain when up, which may be a reason she doesn't want to walk or sit up. Sometimes, just giving some Tylenol an hour before she gets up can help. Is she depressed? Does she get dizzy? Perhaps her provider can help come up with a good treatment plan to help her get moving. They might even be able to order you some home Physical Therapy, which might help figure out what is going on to make her not want to get up.

Secondly, lets discuss her incontinence. You are using wound gel when she develops a sore, but you should be using a barrier cream to help prevent the development of a sore in the first place. Perhaps this is what you mean by the 1-2-3 peri treatment, but I want to be sure. Barrier creams (like calmoseptine) can help protect the skin from moisture and friction/ shearing forces. You can try to talk to your mother's health care provider about ordering a special one for you, or you can try something like Desitin (works well but can be quite messy), which is available in any drugstore. When your mother is in bed, she needs to turn frequently, as laying too long in one spot will increase pressure, making ulcers more likely to develop. In the health care world, nurses usually change someone's position every two hours, around the clock (yes, even at night). Furthermore, since she is not getting up to void, she needs to be checked frequently for wetness, and cleaned and changed as soon as you notice she is wet.

Regarding nutrition, make sure that she is eating and drinking well. She needs protein to keep her skin strong, so good sources of this include milk products, meats, eggs, and some nutritional drinks.

Regarding wound treatment for the new coccyx ulcer she has developed, it really depends on how the wound looks. If is is red at the base, a gel should work, but you need to change the dressing if it gets wet or soiled, so check it every time she is incontinent. If the wound is yellow or black, you need to consult her health care provider for a different would treatment. I should mention that another thought might be that this is not a pressure ulcer, but an open area from a fungal infection, which would need a totally different treatment. You will need to have her examined by a health professional to be sure.

Hope that my suggestions help. Again, contact her health care provider if you need more help, or if she needs to be examined. Good luck!