clinical focus
Wound care
The ‘ hidden epidemic ’ of chronic wounds in aged care
By Elise Hartevelt
An Australian peak body is using Wound Awareness Week ( 15 – 21 August ) to push for the government to start recognising woundrelated harm in aged care .
Advocacy organisation Wounds Australia has said the Federal Government is sleeping on the job while 350,000 older people suffer daily from chronic wounds .
The peak body says its plea submissions to the 2022 – 23 pre-budget and the Royal Commission into Aged Care were ignored , calling the latter ’ s response an ” almost complete failure for older Australians ”.
“ Wound care is the missing piece of the puzzle in the Federal Government ’ s aged care reforms ,” Wounds Australia Chair Hayley Ryan said .
“ Wounds can lead to significant decreases in quality of life , to amputation , and sometimes even death .
“ We ’ re calling on the government to act , which will save hundreds of millions of dollars and prevent thousands from needing medical treatment each year .” They estimate the state can save over $ 166 million annually by providing appropriate treatment for venous leg ulcers , one of the most common wounds in older people .
According to their calculations , people with venous leg ulcers are spending $ 236 million in out-of-pocket expenses over five years .
“ Pressure injuries that are preventable are costing Australia ’ s health budget nearly $ 1 billion each year and result in over 500,000 lost hospital bed days ,” Ryan said .
“ The 420,000 Australians affected by wounds is leading to the budget forking out $ 3 billion in treatment , which is around 2 per cent of the health expenditure .” The peak organisation chose the catchphrase , ‘ the solution is bleeding obvious ’, to underline the need for appropriate funding and management of wounds in healthcare .
It is pushing for mandatory wound care units in aged care , tertiary courses and for the government to start reimbursing providers and in-home care for ongoing wound treatment .
“ The current recommendation was to look at experts within the hospital system , but that is not an appropriate approach —we know they do not have time ,” Ryan said .
“ At the moment , we ’ re seeing the worst workforce challenges in many centuries .
“ Wound care is really a specialty area , so we are urging experts to provide their services in the aged care areas .”
Ryan said there had been too many missed opportunities to improve the health of older Australians , which could have easily been remedied by taking affordable steps . “ We ’ re not asking much here —we ’ re asking for dignity and quality care for our ageing population .”
Calling it ‘ the hidden epidemic ’, the peak body said there ’ s often shame attached to people living with chronic wounds .
People don ’ t want to go out into the community with these wounds because they come with some odour , or fluid leaking through the dressings , Ryan explained .
“ So we find that the elderly person might isolate and not seek the needed treatment .
“ Then the pandemic added more fuel to the fire , where we ’ re seeing fewer people wanting to have their wounds treated ,
which we ’ re finding really hard to manage or heal at their later stage .”
Aged Care Insite also spoke with registered nurse and professor Marilyn Cruickshank from Griffith University , who agreed it ’ s an important issue that can lead to severe consequences .
“ Complications such as bloodstream infections are really dangerous for older people ,” Cruickshank said .
“ It can also just be very painful for people as well —it can lead to pain and suffering .”
Chronic wounds such as diabetic foot ulcers , venous leg ulcers and other pressure wounds are common in older people due to a combination of health factors that increases the risk .
As we become older , we lose collagen levels in our skin and have less fat underneath , Cruickshank explained .
“ Our skin integrity is not the same as when we ’ re young .
“ For example , you may bump into something . You might get a bruise when you ’ re younger , but when you are older , that can break the skin . “ And it will take longer to heal .” Other medical conditions such as reduced heart or kidney functioning and lower blood circulation through the skin also play a vital role in someone developing chronic wounds .
“ It ’ s like the swiss cheese model where it ’ s not just one thing ; it ’ s a collection of things that all predispose older people to wounds ,” Cruickshank said .
“ So it can be like a cycle , a perpetuating cycle .”
She said it ’ s essential that aged care homes have precautions in place so that residents don ’ t fall or hurt themselves . “ Having registered nurses in aged care homes helps supervise healthcare staff working there to make sure the residents are monitored and that there ’ s an escalation of care if required .”
She added aged care workers should also routinely check residents for wounds and have regular inspections .
For example , when residents are bathed or change clothes , nurses can inspect their skin integrity and look for red marks .
“ Or when they spend a lot of time in bed , nurses should ensure residents are turned frequently to mitigate the risks of pressure wounds ,” Cruickshank said .
“ Just having a close observation and knowing the patient so if anything changes , immediate attention can be given to prevent a wound from occurring or from getting worse .” ■
18 agedcareinsite . com . au