Wound Care at Home for Older Adults

First aid for a fresh minor wound

1. Wash your hands with soap and water and wear clean disposable gloves if available. 2. Stop the bleeding: press firmly with a clean cloth or gauze for at least 10 minutes without lifting to look. Raise the injured limb if possible. A person on blood thinners may bleed longer; keep firm pressure for longer and see atrial fibrillation and blood thinners. 3. Clean the wound: rinse under clean running water for several minutes, or with clean boiled and cooled water or saline, to flush out dirt. Wash the skin around it with mild soap, away from the wound. Do not scrub inside the wound. 4. Remove only loose dirt with clean tweezers; do not dig for embedded objects. 5. Cover with a clean, non-stick dressing or a clean dry gauze held with a bandage or tape. Do not stick tape directly on fragile skin; use a gentle method as the nurse advises. 6. Check tetanus protection. A dirty wound, a puncture, a rusty-metal injury or an animal bite in an older adult needs a doctor's advice on tetanus vaccination if the last dose was long ago or unknown. 7. Record the time, cause and how it looks, and watch daily.

Avoid applying turmeric, ghee, honey, sugar, toothpaste, ash, coffee, chilli, mud, cobwebs, kerosene, lime, alcohol or hydrogen peroxide to wounds. They can irritate, cause infection and slow healing. Also avoid cotton wool that sheds fibres into a wound, and avoid strong antiseptic liquids on open wounds unless a nurse or doctor says so.

Skin tears

Skin tears are common in older adults, often on forearms, hands and shins, from bumps, grabs or adhesive tape. A flap of skin may still be attached. If the flap is viable, gently ease it back over the wound with a gloved, moist finger or a damp cotton bud, without stretching, and cover with a non-stick dressing; mark the direction of the tear on the dressing so that it is removed in the same direction as the flap. Because skin tears can heal poorly, show them to a nurse. Prevent them: moisturise daily, keep nails short, pad sharp furniture corners and bed rails, wear long sleeves or soft sleeves, handle limbs gently and use slide sheets rather than pulling; see flooring, rugs and trip hazards and bed rails: safety and risks.

Burns and scalds

For a small burn from hot water, oil or a stove: hold the area under cool (not ice-cold) running water for 20 minutes soon after the injury, remove rings and jewellery before swelling begins, and cover loosely with a clean non-fluffy cloth or cling film. Do not apply ice, butter, ghee, toothpaste, turmeric or home pastes. Do not burst blisters. Seek medical care the same day for any burn that is larger than a palm, blistered on the hands, feet, face, joints or groin, deep or white or charred, caused by chemicals or electricity, or in a frail or diabetic person. Call 112 for large or deep burns, burns to the face or airway, electrical burns, or if the person is breathless or collapsed. See kitchen safety for older adults.

Which wounds need a doctor

Seek medical care the same day (or call 112 where noted) for:

• bleeding that does not stop after 10 to 15 minutes of firm pressure (call 112 if heavy or spurting);
• a deep cut, a wound that gapes, is longer than about 2 cm or that shows fat, muscle or bone, which may need stitches within hours;
• a puncture wound, an animal or human bite, or a wound with dirt or a foreign object that will not wash out;
• any wound on a person on blood thinners that bleeds a lot or bruises widely;
• a wound after a fall with a head knock, confusion, drowsiness or vomiting (call 112);
• a burn as above;
• a wound on the foot or leg of a person with diabetes or poor circulation; see diabetic foot ulcers prevention;
• a wound that has not clearly improved in a week, or any leg ulcer;
• signs of infection (below);
• an area of skin that is dark, black, purple or breaking down over a bony spot (possible pressure ulcer); see pressure ulcers: stages and care;
• a person who is unwell, confused, feverish or very weak.

Changing dressings safely

• Wash your hands before and after, and wear clean gloves.
• Gather supplies first: clean dressings, tape, a clean waste bag, saline or clean water.
• Remove the old dressing gently, moistening it if it sticks, and dispose of it in a bag.
• Look at the wound and the skin around it: colour, size, drainage, smell, swelling.
• Clean as the nurse shows, wiping from the centre outward with a fresh swab for each wipe.
• Dry the surrounding skin gently and cover with a fresh dressing.
• Change when it is wet, dirty, loose or at the interval the nurse advises. Do not leave a soaked dressing in place.
• Do not reuse dressings or share supplies.
• Wash hands again and note the date, time and appearance.

If the wound is on a leg, elevate the leg when resting if the doctor agrees. Do not apply tight bandages or compression unless trained and cleared; compression can be harmful with poor arterial blood supply; see compression stockings: when to ask a doctor.

What helps and slows healing

Helps: enough protein, calories, fluids, vitamins and minerals; good blood sugar control; stopping smoking; keeping the wound clean, moist (as advised) and protected; rest and elevation as the doctor advises; managing swelling; treating anaemia and other illnesses; taking medicines as prescribed; gentle movement of the rest of the body. See malnutrition in older adults, how much protein do seniors need, indian meals for high-protein seniors and diabetes at home after 60.

Slows: diabetes with high sugars, smoking, poor circulation, swelling of the legs, malnutrition, dehydration, infection, repeated rubbing or pressure, certain medicines (such as steroids and some cancer treatments, which the doctor manages), kidney disease, anaemia and dementia that leads to picking at wounds.

Do not start supplements to speed healing without asking, particularly with kidney disease, diabetes or blood thinners; see supplements and medicine interactions.

Signs of infection

Watch the wound at every dressing change. Call the doctor the same day if there is:

• increasing redness spreading outward, or red streaks;
• warmth, swelling or hardness around the wound;
• increasing pain or throbbing;
• pus, cloudy or yellow-green discharge, or a bad smell;
• the wound opening, enlarging or deepening;
• fever, chills or feeling generally unwell (check with a thermometer; see digital thermometer guide);
• new confusion or drowsiness, which can be the first sign of infection in older adults; see delirium in older adults.

Call 112 for fever with confusion, fast breathing or heart rate, shivering, low blood pressure, spreading redness with severe pain, or collapse. A rapidly spreading, very painful, blackening or blistering infection, particularly in a person with diabetes, can be life-threatening.

Do not give leftover antibiotics or start any medicine on your own. Only a doctor decides if antibiotics are needed.

Preventing wounds in the home

• Clear clutter and floor hazards; use night lights; see home safety checklist for seniors.
• Check footwear and avoid barefoot walking; inspect feet daily, especially with diabetes.
• Use oven gloves and keep kettles, hot water and cooking oil away from edges; use a thermometer or test hot water before bathing.
• Keep knives sharp but stored safely, and use cut-resistant gloves if hands are unsteady.
• Moisturise skin daily and keep nails short.
• Protect from sun, insect bites and mosquito breeding.
• Trim sharp edges on furniture and bed rails, or pad them.
• Review medicines that cause dizziness or bleeding with the doctor; see polypharmacy and deprescribing.
• Use a reacher for items on high shelves to avoid climbing; see reacher grabber buying guide.

Long-term and leg wounds

Wounds that last more than a few weeks, such as leg ulcers from poor vein or artery flow, diabetic foot ulcers and pressure ulcers, need a diagnosis and a plan from a doctor or wound care nurse. The treatment depends on the cause: improving circulation, controlling blood sugar, relieving pressure, compression where safe and specialist dressings. Do not treat them with home remedies or long-term tight bandages. Keep appointments, follow the dressing schedule and report any change. See swollen legs in older adults.

When to ask a professional

A doctor or wound care nurse examines wounds, decides on tetanus protection, stitches and antibiotics, and plans dressings. A pharmacist can advise on suitable first aid supplies. A diabetologist or vascular surgeon helps with leg and foot wounds. A dietician supports healing nutrition. For senior services, call Elderline 14567. In an emergency, call 112.