To witness a family member or loved one bed bound is an emotionally draining experience. To be unable to do much to help their suffering and to provide the best of care makes the feeling worse. This article strives to offer some solutions and understanding for the layperson caring for bed bound patients in the context of home care.
Bed bound patients face a variety of issues, from manpower support, mental illnesses like depression, basic cleanliness and hygiene, bed sores, to chronic diseases like hypertension. Of this list, manpower issues usually rank highest.
Most bed bound patients in Singapore stay at home and are looked after by family members. Over time, this can take an exhausting toll on family members and an understanding of home-based care will be of immense aid to family as well as patient.
Understand the Cause for becoming bed bound
A patient can become bed bound for a multitude of reasons. A fracture of the spine, paralysis and coma post trauma, surgery, head injury, end of life causes, old age and the commonly encountered cerebrovascular accident are all situations which can cause patients to become bed bound. Understanding the causes can help prevent the problem from happening in the first place, while adjusting the care for such patients will improve the quality of life for these patients.
Ulcers or bedsores: Pressure ulcers and bed sores, if left unchecked, can cause serious complications over time.
Basic Hygiene and Cleanliness. Basic cleaning of patients, regular change of diapers, monitoring of bowel movements, are all important but physically very demanding.
Muscle atrophy. After prolonged periods of inactivity, muscles eventually lose their strength and muscle weakness sets in, making it a vicious cycle. The bed bound patient becomes more bound to the bed with the passing of each day.
Frequent Infections: Due to the sitting / lying posture, the lungs cannot fully inflate with each breath and hence respiratory infections are common. Due to the long term use of diapers, the urinary tract becomes easily infected.
Mental Illnesses. It is common for patients who are bed bound to become depressed. Love, care and attention, frequent companionship and empathy will go a long way in treatment of these patients.
Insomnia. It is common for bed bound patients to have poor sleep.
General Issues due to lack of activity:
Bed bound patients usually report a loss of appetite, loss of interest in all things big and small, and a general decline amongst all functions.
Challenges for the Caregivers
Caring for a bed bound patient is challenging. With the passage of time, the daily grind of caring for the bed bound patient will take its toll on the caregiver.
Enforcing personal hygiene, administering the correct medications, serving proper foods, ensuring regular exercise, and providing companionship for bed bound patients are but the basic fundamentals required.
To go beyond the above, turning the bed bound patient every 2-4 hours to prevent bed sores round the clock, suctioning and cleaning the airway, feeding through tubes, dressing open skin sores and wounds, care for urinary catheters are all farther challenges faced by caregivers faced with patient who have complicated medical problems.
It is hence normal for a caregiver to feel overwhelmed at some stage, resulting in high levels of caregiver stress. Thus, the provision of manpower, simply an extra pair of hands, will make a big difference when it comes to home care.
Risks faced by bed bound patients
Common risks include:
Development of bed or pressure sores which worsen if left untreated.
Formation of blood clots in the veins of the lower limbs. If these clots break off and get lodged in the heart, lungs or brain, it can cause farther complications.
Frequent infections and complications from the general lack of activity.
As an aside, do note that bed sores rank highest where nursing care is deficient. It usually begins with a mild redness to the skin but if left unchecked, the bedsores will infiltrate deeper into the skin layers and can erode the skin all the way down to bone if left unchecked.
Do’s and Don’ts
Perform daily skin inspection to check for reddening of the skin, especially in bony areas like knees, hips, shoulders, ears, tailbone, and buttocks.
If a bed sore is identified, cushion it immediately and seek medical help if the skin is broken.
Keep skin clean and dry. Clean the skin with mild soap and water; pat dry.
Moist the skin: Use body lotion to keep the skin lubricated. Use powder to dry the folds of the skins, such as armpits and under the breast.
Bedding and linen should be changed daily. In case of bed wetting, change the wet sheets immediately.
Keep the patient hydrated.
Have a balanced diet: A healthy and nutritious diet is very important to boost the patient’s immunity. Keep a diary to record all meals taken.
Exercise the patient: To prevent muscle weakness, exercises should be done, keeping in perspective the patient’s condition. If the patient can walk a little, help him/her walk around as per convenience.
Massage: Deep massages can help prevent blood circulation-related complications. Light massages are ideal for painful muscles and prevention of bedsores.
Positioning: Reposition the patient every 2 hours. Never drag the patient; always lift.
Keep limbs elevated: Both hands and legs should be kept a little elevated to prevent swelling and help blood circulation.
What to do in case of bedsores?
Unless experienced or trained, the first contact of bedsores should be handled by medical professionals as far as possible.
However, for first response, the best treatment of bed sores is to leave it open to air and to alleviate any pressure on the bed sore as much as possible.
With enough experience with the type of dressings to be used, the caregiver should learn from each episode and become familiar with the available treatments and methods used to clean bed sores.
The best method of treatment bed sores is prevention. So constant vigilance is the key.
The CDC (Centers for Disease Prevention and Control) indicates in recent posts that “Each year, millions of older people-those 65 and older-fall”. These falls can often be serious and there are strong indications that for seniors or those recovering or those with disabilities each successive fall increases the probability of an additional fall. In fact, also according to the CDC, there were 9.6 Million non-fatal injuries in the senior population due to falls, in the year 2015. An additional 33 thousand were fatal in that same year. (Go to the cdc.gov site for sources). These facts are clearly sobering but even more concerning since so many of these falls take place at home and could easily be prevented.
Contributing Factors to Home-based Falls
Seniors and others that have lost some level of independence face many challenges in the home, some intrinsic and others extrinsic, some related to home safety and some, surprisingly, related to caregivers. Here are some common factors that we all need to keep in mind:
Loss of full motor control
Medications that cause drowsiness and or dizziness
Home-safety issues that increase the dangers of mobility
Improper support devices to aid mobility
Lack of ongoing, appropriately paced physical activity
Of all of these clearly the easiest to eliminate or mitigate fall into a single category above: Home-Safety issues. This is probably the most critical of all of these since the elimination of any items in this category is likely to profoundly and significantly reduce the risk of falls in the home.
Caregivers and Their Role in Home Safety
Family caregivers or hired caregivers, for seniors and others, need to be acutely aware of fall-risk dangers in the home and help those in need of assistance avoid these dangers. Caregivers need to be proactive by ensuring the safety of those they care for through awareness, communication and correction of hidden and/or obvious home dangers. This can be accomplished through vigilance and involvement. For example caregivers should try to put themselves into the shoes of those they care for and predetermine what challenges they face in and around the home. It is challenging enough for those in need of care to merely accept their position of aging, disability or otherwise, and therefore caregivers need to be sensitive to the feelings of seniors and others while still be vigilant in keeping the home safe. Caregivers really do need to behave as unsung heroes or angels, operating in the background, and without making seniors or others in care feel worse for their loss of some independence.
Risk Mitigation and Steps to Safety
The CDC as well as other sources provide significant yet intuitive advice on how to minimize the risk of fall and injury. In fact the National Council of safety provides some excellent direction in its recent article “Slip, Trip and Fall Prevention will Keep Older Adults Safe and Independent” ( click here for source). Most of us can leverage a little thought on this topic and easily come up with a checklist of items to evaluate in our homes to make them safer for older adults, those recovering, or disabled. Provided below is a good start and may give you some additional thought and guidance. Please note that naturally, this is offered as a suggestion and not medical advice.
Cooking Equipment, Utensils, Dishes, Glasses and Food should be stored appropriately and easy to reach
No kind of throw rug or similar placed on a kitchen floor
Floors should always be free of any kind of spills (Oils, food, etc)
Use counter-top toasters where feasible, making them easily accessible
Where higher cabinets must be accessed a step stool with a handrail is should be easily accessible
Non-skid floor cleaners only for cleaning the floor
General Concerns with Carpeting
Wall-to-Wall carpeting should be completely and properly installed – no loose edges, tears, buckles or holes
While not always possible, solid colors are better in that they provide greater consistency for those that are mobility challenged – they also show edges more cleaning
Deep Piles and Shag styled carpets should be avoided
Bathroom Concerns and Safety
Ensure that bathroom mats are slip-resistant (and not old wherein the slip-resistance has worn) – ensure they are placed near the showering/bathing area
Ensure that there are mirrors at various levels to ensure that the client is not struggling or reaching to use a mirror
Where possible install grab bars near the toilet, bathtub and/or shower
The bathtub/shower floor should be non-skid, if this is not the case then ensure that non-skid safety strips are installed
Where feasible use a soap dispenser mounted in a very accessible area in the Shower/Bath
Where required, a shower chair is placed in the bathing area
The toilet seat should be the raised type or a toilet seat with armrests should be fitted to the toilet to ensure safe balance when sitting or getting up from the toilet
Key safety items should be within reach of the bed, for example on the night table. Consider safe lamp, flashlight, phone, cane, etc.
If appropriate, a raised height mattress to help with getting into/out of bed
The floor, particularly around the bed, should be free of clutter, papers and any other items
Nightlights are appropriately placed in the bedroom and along any routes to the bathroom
Outdoors and Around House/Apartment
This category naturally only applies in some cases
Ensure all walkways are clear of debris, branches, leaves, rocks and similar
Ensure all stones and masonry are solid not loose in anyway
Ensure all walkways and driveways are as level as possible
Ensure that all walkways are clean and not coated with moss, algae, Oil and/or other slippery substances
General Living Space Concerns
In areas that could be classified as pathways ensure that low furniture items are moved aside. Examples include coffee tables, folding end tables, ottomans, floor plants, etc
Light switches are all in working order and not obstructed
No Loose Rugs or throw rugs that can slide
Rooms and moving space are clear of furniture obstructions
Where applicable use sound activated lamps
Where applicable use glow-in-the dark markers on various items that require manipulation, for example cabinet handles, light switches, etc
All electrical cords for power, data, phone, etc are properly routed and secured and not anywhere near pathways or living spaces
All furniture in proper condition, sturdy and secure
Several cordless phones available, each marked with glow in the dark markers, and ensure that they can be located audibly (i.e. have a locate handset feature)
No loose tiles or floorboards
Night Lights appropriately placed throughout the house
Infrared sensor lights in certain areas where brighter light is required at night
Install carbon monoxide detectors were appropriate
Install smoke detectors were appropriate
If required, based on level of independence, arrange for medical alert device/subscription
Install detectors that also have emergency lights and/or install motion detected lighting where appropriate
There are people that don’t enjoy going to the emergency room to get patched up. Who does? There are many reasons for this which extends from embarrassment to fear. If you are the type of person that can handle self-patching, you should know exactly how to do it.
Firstly, you need to identify the type of wound. Different scratches and cuts require different care.
Scratches – these are the quickest healing sores. You need to wait for the liquid to clot so that you can apply a waterproof plaster over. You want to use a waterproof plaster because the plaster needs to stay on as long as possible to avoid any bacteria from entering your body. You might not need to add a plaster because of how quickly the skin heals.
Burns – If you ever get burned, the best way to treat it would be to apply a soothing gel. Cells have been damaged by the extreme heat and the skin is quite sensitive. Control the pain by either adding Aloe Vera products or aqueous creams.
Flesh Wounds – You might notice that these refuse to close up in short periods of time and often leave you with permanent scars. Before patching it up, you need to hold up the area which is bleeding above your head. This stops blood from escaping from that part of your body. Eventually, it should clot up and it will be safe to relax your body. Keep this wound open so that it can dry out. It’s also a good idea to gently pat antiseptic chemicals on whilst you are healing. Thereafter, put a bandage around the area so that you are protected from the skin breaking and give the wound a chance to heal. You need to free the area of any bacteria as much as possible.
Vein Hit – Perhaps you slip and fall, and end up on a piece of broken glass. Accidents happen so quickly. You never know what could happen. You need to apply as much pressure as you possibly can to this area. The more pressure you apply, the less blood will escape. Once again, you should hold this part of your body above your head so that not a lot of blood gets released. You will also need to apply ice to thicken the blood.
You need to see a doctor if any severe accidents happen or if you are unsure of how to treat the wound. Stitches are the quickest and easiest way to get patched up. Antiseptic chemicals and plasters can be found at any retailer or cash and carry wholesaler so it might be a good idea to keep some in stock for these eventualities. Hospitals usually make it a priority to get these chemicals for rapid treatment against bacteria.
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Seniors with Dementia may find it brain simulating to listen to their favorite songs. Family caregivers may help their loved ones in making a playlist of their favorite and nostalgic songs. Listening to soothing songs may also make your loved ones feel relaxed.
2. Making a Memory Bag
Your loved one can collect the things which may remind him or her about the best and fun teenage years of his or her life. Your loved ones can fill a bag with mementos and pictures which may boost their memory and enhance happiness. Family caregivers can help their loved ones in making a memory book to better recall the important and cheerful past events in their life.
In order to stay physically active your loved ones can start a daily exercise routine. Exercising comes in many forms and you can choose what can be the best suited exercise for your loved one`s routine and habits. Your loved ones can build confidence around specific skills and family caregivers can also accompany them in their exercise to enhance social interaction and enjoyment.
4. Going for Outdoor Walks
Your loved ones may enjoy walking outside to get refreshed. Exploring nature is an amazing way for your loved one to better enjoy life and find new interests which may enhance their overall mood. Going outside may also increase your loved one`s social interaction.
5. Visiting Familiar Places
By visiting familiar places your loved ones may enhance their mental health. Family caregivers can take their loved ones to places they enjoy the most which may spark their old memories. Your loved ones can visit places like their favorite museums, coffee shops, restaurants, and any public place which may boost their memory.
6. Building Stronger Social Bonds
Family gatherings can increase social interactions in your loved one and may create a sense of wellbeing in him or her. To build stronger bonds your loved ones can increase their social activities which can also reduce loneliness in them.
7. Going to a Zoo
Your loved one may take pleasure in going to a zoo with their grandchildren. To watch animals hopping around and getting fed can be an excellent sight for your loved one to cheer them up and feel relaxed. Your loved ones can also take pictures of birds in a park as a hobby which may boost their mood and keep them engaged.
8. Reading Books
Reading or listening audio books may have a calming effect on your loved ones. If they like poetry or fantasy stories then you can provide them with books according to their fondness. Reading books can be a meaningful activity for your loved one and may create a sense of satisfaction in them.
9. Make a Routine
Seniors with Dementia may find it useful to spend their day on a scheduled routine. Family caregivers can make a predictable and comfortable routine for their loved ones to remember and work on it daily with ease. Your loved ones can make a tailored routine according to their energy and wellbeing throughout the day.
Joseph Adsilg is a professional blogger and writer who loves to write about a variety of topics. His main forte is senior care and health and fitness. He follows latest trends and writes about the most effective things. He is currently working for Home Care Lancaster.