WHO ARE THE ELDERLY

Currently reaching 65 years of age is the threshold beyond which the individual can be defined elderly, the aging process, however, is very individual and depends on many variables environmental, social, family and purely subjective; Thus the chronological age is less important than the biological age of a person or the actual physical condition and health, and frequently does not coincide with it. The term comes from the old Latin word “anteanus” and “antianus” whose same root “pre” means before; Elder is therefore an individual who “is” from before, so it may be older and not only age but also just to experience, in the workplace seniority is given by the time elapsed since the start of the relationship or the time from which an activity takes place.

For this purpose it is necessary to differentiate the concept of “seniority” and that of “old age”, it is inherent in the concept of incapacity for work while under the definition of “seniority” is not implied any incapacity in fact, as mentioned above, is may be configured in the elderly, a greater aptitude and competence to work related to the maturation of some specific experience. Biology of the body and ability to work and, more generally physical and functional autonomy are therefore strongly intertwined concepts; with age, physiological and structural changes occur in almost all organs of the body including the larger, more complex part of the body: the skin.

THE CAUSES OF THE ELDERLY SKIN FRAGILITY

The “fragility” of the elderly is certainly ascribed to the simultaneous presence of several pathologies that determines a health balance particularly unstable, but in our discussion concerns mainly the skin mantle or its effective ability to mechanically interface with the outside world that surrounds us , protecting us from sudden changes in humidity and the thermal injury.

The skin plays for our body the functions of a large blanket very technological, capable of thermal self-regulating in relation to the outdoor temperature, to protect the bone scaffold, to produce energy and heat to the need, to contract or relax in case of emotions or particular feelings, to selectively block dangerous substances for the body, etc. The skin, while covering the human being from the time of the caves, there is a phenomenal and sophisticated envelope of the last generation, a shell capable of interacting with the environment and with other individuals like no other invention of man can do.

The “tissue” of the skin is unique and original, no cloth or synthetic can imitate its features, flexibility, strength, ductility, and softness are indeed unique characteristics. The increasing age leads to increased fragility of the skin mantle thinning, dehydrates, loses a substantial proportion of elastic fibers and vasculature; the progressive and inevitable aging of skin envelope therefore constitutes a natural phenomenon in its essence, the speed of it, however, is extremely variable and depends on several factors:

  • the climatic conditions of latitude in which we live are very influential, especially in undervalued hot climates and sunny; insufficient protection from the sun or a low intake of water leads to a more rapid involution of the skin structure, with no mention of the possible deviations cancer, as well as a harsh climate will act – long-term – in the negative on blood formation in the skin resulting in fast thinning and hardening.
  • individual factors, genetic or acquired, with different influencing strongly the aging process of the skin.
  • systemic disease of organism or dermatological affections age prematurely the skin and alter the main functional activities with the result of making it more fragile

POSSIBLE INJURIES OF THE SKIN OF THE ELDERLY

With the above arrangements in case of “micro-traumas” inadvertent and insignificant, type of minimal or content traumas from the standpoint of purely mechanical make the “story” of skin wounds of elderly individuals, routine outdoor activities such as climbing on a bus or open the car door can be deadly enemy to the skin mantle, physiologically or pathologically impaired, of the elderly, but even the protected environment of the home is free from risk of mini-traumas. An improvident exploration of the fridge, maybe at night or without glasses, may lead to a close encounter between the leg and the edge of the door, one little energetic climb over the tub or a fall of the showerhead can cause a sudden leg contusion.

Murphy’s Law apart, the portion of the leg more affected by such mechanical trauma corresponds to the front face where the median or tibial bone is more protruding and the skin thinner (in all individuals of any chronological age). The level of mechanical energy inherent in the action of careless opening a door or in the collision is directed against a hard and rigid surface, it is often not very high but sufficient, in the circumstances described above, to produce a skin wound of variable severity that is often misunderstood or underestimated by the elderly; In fact, the initial local symptoms, the absence of a real bleeding, the apparent integrity of the epidermis, sometimes insufficient clarity of mind, delaying the awareness of the injury and its rapid decline. This usually take two paths:

–     in cases of blunt trauma or with apparent integrity of the skin mantle, the patient noted a gradual darkening of the affected area, a worsening pain and also triggered by touch, a swelling extending from a distance with a nagging sensation of local pilsation. The end of the story consists of spontaneous uprising of nearly of the skin over the trauma and exposure of gelatinous red area associated with unpleasant odor.

–    The other path of involution take when trauma results in the collapse of a variable portion of the skin with the local bleeding, presence of skin flap dark red and swelling around the wound; the patient is experiencing pain on movement of the flap of skin that sometimes, stuck in part, takes the form of a kind of Hatch which seeks to support the wound or remove.

HAW TO TREAT AN  INJURY TO A PERSON AGED

Not always the elder is mentally and physically in a position to self-medicate or otherwise bother to treat the wound or bruise of the leg, for contingent reasons stable or transient, family or household. Usually within hours of the trauma the elderly, if at all self, performed a brief disinfection and emergency coverage of the lesion; in the most fortunate of sharing the house with other family members or caregivers, he followed their advice and went from the doctor or at least to the pharmacy to get help or information on how to treat the injury.

The advice given will result in the purchase of gauze and disinfectant solutions for medicate, at different times, the wound; a question mark, not indifferent, lies in who will complete the work of dressing and if it will be respected, not only the time periods, but the basic rules of hygiene. The family tends to be well disposed towards the elderly, which is usually a recognized leadership role in social, and in turn takes care of their health needs; on the contrary is not always the caregiver provides care most technically competent, effective and caring towards the elderly. The loneliness of the patient worsens even more the lack of basic care, because the attitude of those who live alone is very special in all its manifestations and “medical” treatment are no exception.

The neck of the funnel is represented, however, in all circumstances, the appearance of the wound complications, usually local and not serious, but that sometimes border on being sent to the emergency room. Wound infection or a small hemorrhage secondary to a second trauma (in the absence of proper protection of the first lesion) are two events that occur frequently at not properly followed elderly, malnourished or hygienically dependents.

The discussion of problems of health and hygiene, family or social relationships of elderly individuals living alone, beyond the scope of this brief analysis, whose real goals are either give due importance to the characteristics of the wound not to underestimate  the possible complications both to suggest small behavioral rules concerning disinfection and local therapy. In the first part of the work we have described the mechanisms of action and the potential dynamics of the micro-trauma of the skin which may be subject elderly individuals, both independent and confined in their houses; the second is entrusted with the task of clarifying the acts necessary and useful for the treatment of skin wounds of the elderly.

The description of the basic rules that must be followed to treat a skin wound, the result of sixteen years of experience in the field of burnst and vulnology, force me to debunk the myths, breaking atavistic taboos and subvert the clichés of popular roots that are still in charge of operations useless or even harmful. If you have not yet consulted a doctor or a pharmacist in the mood for advice, let’s start with talking about the DISINFECTION or action to minimize the presence of microorganisms on the wound:

–    it must be conducted with products poorly harmful against cells remained healthy on the bottom of the lesion; the saving of intact tissue is always important and even more so in the elderly, where the possibility of cell replication is reduced. The decrease of the concentration of germs on the wound may also be obtained, not in chemical way, but in a mechanical way with a good washing with physiological solution, tap water boiled or even simple warm water directly from the nozzles of the shower; definitely are to avoided solutions such as Mercuro-chrome as well as coloring the wound and thus prevent evaluate the evolution, causes the formation of hard crusts that prevent cell migration constitutes the beginning of the healing of the wound. Hydrogen peroxide is eligible for the first (and only) initial cleaning, then be placed in the cabinet and held in readiness for a possible fall off the bicycle grandchildren …

In summary, it is best to simply wash away germs that eliminate innocent live cells.

How to approach the piece of skin that dangles like a lid on the wound?

I groped useful to replace it on the wound though due to its retraction will not cover more comprehensively the entire surface, I point up groped because the maximum observation time for his recovery vital (gradual color change from dark red to pink and difficulty lift it from the bottom of the wound) is 48-72 hours; beyond this time limit is no longer credible to its revitalization and therefore can be removed (by experts) or left in place only with the aim of biologic dressing. You will also need to protect the flap of skin with gauze (slightly moist) if we have availability in the home or with a piece of cotton or white linen set up with plasters (if you possess), or by the node and its edges (be careful Do not tighten too ..).

Washed and covered the wound can wait times for the next family organizational consulting medical specialists.

If the injury has taken away a slice of the skin and the wound is then open:

–    the procedure for the disinfection-cleansing is also easier and must be conducted with the same previous rules; since there is no natural cover flap of skin, it should be directly used a wet gauze or a clean piece of cotton or white linen. In both eventualities medications must be kept moist by spraying with saline or tap water (boiled if possible) every 4-6 hours until the specialist consultation; moisten the dressing means to avert the danger of adhesion and incorporation with the crust, events whose mechanical resolution is the cause of major pain and lengthening the healing time. I would not do embarrass anyone by saying that the wound can be safely washed in the shower, rinse thoroughly and then covered, no damage to the lesion, minor headaches to be able to seal the dressing and a lot of scientific literature on the subject, on our side.

The vulnologist or the finest interpreter of treatment of acute and chronic skin lesions of the elderly, is the benchmark treatment to prevent chronicity of an acute event and estimated unimportant, but that it can affect so limiting the existence an individual’s weak and alone.