Stotts Nancy A, Hopf Harriet W
School of Nursing, University of California San Francisco, 2 Koret Way, No. 631, San Francisco, CA 94143, USA.
Nurs Clin North Am. 2005 Jun;40(2):267-79. doi: 10.1016/j.cnur.2004.09.005.
Older people with wounds are not the same as younger people with wounds. Older people experience biologic differences in wound healing that result in delayed healing, increased wound infection, and a greater incidence of dehiscence. Clinicians need to assess the risk of dehiscence in the older population, looking for serous drainage from the incision line and the absence of a palpable healing ridge. It is critical to recognize that older persons' presentation of wound infection is atypical. More subtle signs such as alteration in cognitive status and changes in function may indicate the presence of infection. The clinician who cares for older persons must be an exquisite detective when such changes occur to identify the source of the problem. As part of the normal trajectory of aging, older persons experience sensory loss and so may require accommodation when explanations are given to them about their wound and their wound care choices. Health care providers must consider hearing and vision changes that occur in older adults and tailor their explanations and teaching so that the message reaches the older adult and is successfully processed. Older persons have a higher incidence of cognitive changes and functional decline than do their younger counterparts, and these changes need to be assessed before a plan of care is developed to care for the older person with a wound. Limited data are available to help the clinician know the cognitive and functional level that is critical for older persons to understand their wound care choices, perform their own wound care, and to make choices about who will provide the care if they are unable to perform self-care. These seemingly basic issues raise questions for clinicians as we strive to provide evidence-based care to this ever-increasing population of older Americans.
伤口愈合的老年人与伤口愈合的年轻人不同。老年人在伤口愈合方面存在生物学差异，这会导致愈合延迟、伤口感染增加以及裂开发生率更高。临床医生需要评估老年人群中伤口裂开的风险，留意切口处有无浆液性渗出以及是否可触及愈合嵴。至关重要的是要认识到老年人伤口感染的表现不典型。诸如认知状态改变和功能变化等更细微的迹象可能表明存在感染。当出现此类变化时，照顾老年人的临床医生必须像敏锐的侦探一样，找出问题根源。作为衰老正常过程的一部分，老年人会出现感觉丧失，因此在向他们解释伤口情况及其伤口护理选择时可能需要做出调整。医疗保健提供者必须考虑到老年人发生的听力和视力变化，并调整他们的解释和教导，以便信息能够传达给老年人并被成功理解。老年人比年轻人更容易出现认知变化和功能衰退，在制定护理计划来照顾伤口愈合的老年人之前，需要对这些变化进行评估。目前可用于帮助临床医生了解老年人理解伤口护理选择、自行进行伤口护理以及在无法自理时选择谁来提供护理所需的关键认知和功能水平的数据有限。在我们努力为不断增加的美国老年人群提供循证护理时，这些看似基本的问题给临床医生带来了疑问。
