Wound Care in Hospice

In hospice care, the primary goal is to improve patient comfort and quality of life by managing pain and other symptoms. Unfortunately, sensitive older skin puts seniors at greater risk of developing wounds while in hospice care. These wounds can be intensified by poor circulation, diabetes, limited movement, and poor nutrition.

Common Types of Wounds in Hospice Care

Certain wounds are more common in hospice care, and each have their own unique characteristics:

Pressure wounds are the most common type of wound at end of life. Pressure wounds in older and terminally ill patients often occur due to skin failure – a natural occurring phenomena in the progression of terminal illness that causes the skin to break down.

Skin tears are typically the result of extreme friction that separates the outer layers of skin from one another. They usually occur on the hands, arms and legs of older patients.

Deep tissue injuries can form if the underlying soft tissues are damaged by constant friction, shear, or continued pressure. They are purple or maroon in color and have a different texture and temperature compared to surrounding skin. If not managed, deep tissue injuries can quickly progress, causing rapid deterioration of surrounding skin and forming a more advanced wound.

Venous ulcers commonly occur on the legs of someone who has been diagnosed with a venous disease. They develop in irregular shapes and are usually accompanied by painful swelling.

Malignant wounds occur when cancer grows beneath the skin and penetrates through the skin to form a wound. As the wounds and the cancer within them develop, the cancer blocks the oxygen supply to the tiny vessels around the skin, starving the skin of the oxygen it needs. Malignant wounds often have a strong malodor, bleeding, pruritus, and exudate that crusts.

Caring for Wounds in Hospice Patients

When treating wounds in hospice care, complete healing may not always be possible. However, there are steps that can be taken to reduce the chance of wound progression and the formation of future wounds.

Repositioning the patient can help relieve pressure. This is often done on a schedule to ensure pressure doesn’t build in one portion of the patient’s body. However, when a terminally ill patient feels more comfortable in a particular position and repositioning leads to increased pain, these turnings may be suspended or discontinued.

Good skin care can reduce the risk of pressure wounds. Use of emollients as a moisturizing treatment for the skin can prevent dryness and increase elasticity.

Improved support and protection including foam supports, elbow and heel protectors, or specialty pillows can help position the body in a way that reduces pressure and friction.

Proper management of incontinence can prevent excess moisture and bacterial infections that weaken the skin and exacerbate wounds. Assisting patients with toileting and ensuring they are clean and dry after toileting can reduce future wound formation.

Psychosocial Effects of Wounds

While there is an obvious physical effect of wounds in hospice patients, we cannot overlook the psychosocial impact. Wounds that are malodorous or leaking can lead to a negative body image and feelings of shame that can cause depression or a desire to avoid friends and family.

Hospice social workers work alongside hospice nurses and aides to ensure both the physical and psychosocial needs of the patients are met.

While complete healing of a wound may not be possible in terminally ill patients, the hospice team works together to manage wound care with a focus on the patient’s overall comfort.

Crossroads Hospice & Palliative Care provides support to patients facing serious and terminal illness. To learn more about our services, please call 1-888-564-3405.

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