How to handle elderly patients
The New Paper
SINGAPORE - Geriatrician Dr Sitoh Yih Yiow advises on what to look out for when treating the elderly.
THIN AND DRY SKIN: This is part of normal ageing as we tend to lose the layer of fat between the outer layer of skin and the deeper tissues.
This results in a few problems:
a) Easy bruising, which can arise simply by gripping a person firmly to assist in transfers or by simple knocks. Can be aggravated when the older person is taking certain drugs which may affect clotting.
b) Bedsores or skin tears. Alongside the loss of fat, blood vessels also become more fragile. So excessive or prolonged pressure on certain areas, especially when the patient is immobile, can easily lead to sores. Even pulling a patient up to a sitting position can lead to skin tears.
BRITTLE BONES DUE TO OSTEOPOROSIS: This is more common in older women, but can also happen in men. If the condition is severe, simple tasks such as turning or transfers, or even the act of coughing, can result in fractures.
"SHRUNKEN VEINS" : Blood vessels do get smaller and they may become "moving targets" with the changes that accompany ageing, making procedures like taking blood or setting intravenous therapy difficult. Post-procedure bruising is common and there is no easy solution to this problem.
DEMENTIA: In patients with dementia and who are hospitalised, the illness, medications and unfamiliar environment often increase the risk of acute confused states, which doctors call delirium.
Patients can hallucinate. They can also become agitated and restless, thus increasing the risk of falls and making care provision difficult.
Medication review and having familiar faces around, as well as review of care processes and environment, can be helpful.
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