Page 42 - Retail Pharmacy March 2021

40 HEALTH WOUND CARE PATIENTS FEELING THE PRESSURE By Peter Howard. In the midst of a pandemic, faced with the terrifying threat of an infection that can be fatal, many of Australia’s elderly are rejecting traditional aged care solutions and opting to be cared for at home. In September, the Royal Commission into Aged Care Quality and Safety heard the current pandemic was likely to reposition home care in Australia’s aged care system, a view supported by Peter Gray QC, who, in his opening statement to the Royal Commission, said: “Covid is likely to reinforce people’s preference to age in place at home and do all they can to avoid admission to residential care.” This followed the release of data from the national survey by peak body Leading Age Services Australia showing one in three home care providers experienced a drop in new inquiries, with three-quarters reporting clients had cancelled home care services as a result of Covid-19. Those numbers have since returned to levels approaching pre-Covid times, but it’s believed we’ll see families continue to minimise their relatives’ risk of exposure to Covid by taking on the role of carer for the foreseeable future. While this is likely to create opportunities for community pharmacies, it’s a development for which they need to be prepared, particularly in the realm of wound care. Skin changes with age Our skin is subject to various factors related to ageing, making it more vulnerable to pressure ulcers. These include: • A reduction in the skin’s elasticity and • • thus its resistance to damage. A reduction in blood flow as people age. A decrease in the subcutaneous fat layer. “We need to be aware pressure injuries aren’t inconsequential wounds but something to be taken seriously. With Superman actor Christopher Reeve, immobility due to a spinal injury led to a pressure injury that caused sepsis and his eventual death.” Professor Carville recommends pharmacies download the National Pressure Injury Advisory Panel’s free guide on the prevention and treatment of pressure injuries and ulcers, available from internationalguidelines.com. Unlike bruising, where a sharp blow has damaged tissue and capillaries, leading to contusion, with pressure injuries the damage occurs when sustained pressure has been placed on a particular part of the body. This pressure interrupts the blood supply to the affected area of the skin, thus depriving it of oxygen and other nutrients needed to help keep the tissue healthy. The longer the interruption and the more frequently it occurs, the greater the risk of damage to the area. “If you can leap and jump for joy, your tissues are going to be reperfusing each time you move off that loaded area,” Professor Carville said. “However, if you have some cognition problem such as Alzheimer’s, or if you have restrictions due to physical immobility, such as severe arthritis, rheumatoid arthritis or other conditions, or if you have a medical device such as a plaster cast, a walking frame or a wheelchair, there’s a risk of pressure injuries occurring. “This means your seating and sleeping surfaces – so, your mattress and wheelchair, for example – need to be the right type of product and allow you The local environment will also affect skin, with incontinence a significant issue contributing to increased prevalence of pressure injuries. Both urinary and bowel incontinence will irritate the affected areas of skin, due to increased moisture and a change in the pH balance of the skin, making it vulnerable to infection and prone to the formation of pressure injuries. Not to be taken lightly Among the challenges facing those in aged care, whether at home or in a residential aged care facility, is the risk of pressure injuries, the condition previously known as bedsores, or pressure ulcers. Retail Pharmacy spoke to Professor Keryln Carville, Professor of Primary Health Care and Community Nursing at Silver Chain Group and Perth’s Curtin University, to gain more understanding of this common and potentially serious condition. “Pressure injuries are defined as localised damage to the skin and/or underlying tissue as a result of pressure, shear, friction or a combination of these factors, and usually occur over a bony prominence but may also be related to a medical device or other object,” she said. “Pressure injuries aren’t restricted to hospitals but occur across all health settings. They’re found in the community, in aged care and in independent living, and when found in the community, pressure injuries are usually related to immobility or inactivity. RETAIL PHARMACY • MAR 2021