For an elderly (70+) person who has fractured his hip bone and cannot move even on the bed, what is the best?

Question

thing that can be done to prevent bedsores and general sweating of the clothes on his back and provide general well-being (under the circumstances)?

Any help and advice would be really welcome as my father has just fractured his hip bone yesterday morning and had to be carried by stretcher for an xray and back again as the hospital couldnt admit him immediately. He now goes into hospital after 4 days (cos of the hols), but in the meantime he is bedridden and connot move his position *at all*. I change his clothes and assist him with the basics and necessities that he has to do, but its difficult to do things like change the bedsheets, eating in an almost lying down position... I just wish I could do more to make him comfortable. He has a TV.

Answer 1

Prevention
Bedsores are easier to prevent than to treat, but that doesn't mean the process is easy or uncomplicated. Still, although wounds can develop in spite of the most scrupulous care, it's possible to prevent them in many cases.

The first step is to work with your nurses and doctor to develop a plan that you and your caregiver(s) can follow. The cornerstones of such a plan include position changes along with supportive devices, daily skin inspections and a maximally nutritious diet.

Position changes
Changing your position frequently and consistently is crucial to preventing bedsores. It takes just a few hours of immobility in a wheelchair or bed for a pressure sore to begin to form. For that reason, experts advise shifting position every 15 to 30 minutes that you're in a wheelchair and at least once every two hours, even during the night, if you spend most of your time in bed. If you can't move on your own, a family member or caregiver must be available to help you.

A physical therapist can advise you on the best ways to position yourself in bed, but here are some general guidelines:

Avoid lying directly on your hipbones. On your side, lie at a 30-degree angle.
Support your legs correctly. When lying on your back, place a foam pad or pillow — not a doughnut-shaped cushion — under your legs from the middle of your calf to your ankle. Avoid placing a support directly behind your knee — it can severely restrict blood flow.
Keep your knees and ankles from touching. Use small pillows or pads.
Avoid raising the head of the bed more than 30 degrees. A higher incline makes it more likely that you'll slide down, putting you at risk of friction and shearing injuries. If the bed needs to be higher when you eat, place pillows or foam wedges at your hips and shoulders to help maintain alignment.
Use a pressure-reducing mattress or bed. You have many options, including foam, air, gel or water mattresses. Because these can vary widely in price and effectiveness, talk to your doctor about the best choice for you. For some people, a low-air-loss mattress may provide enough support. But more expensive and technologically sophisticated beds may be needed for people who have recurring pressure sores or who are at very high risk.
Pressure-release wheelchairs, which tilt to redistribute pressure, make sitting for long periods easier and more comfortable. If you don't have a pressure-release chair, you or your caregiver will need to manually change your position every 15 to 30 minutes. If you have movement and enough strength in your upper body, you can do wheelchair pushups — raising your body off the seat by pushing on the arms of the chair.

All wheelchairs need cushions that reduce pressure and provide maximum support and comfort. Various cushions are available, including foam, gel, and water- or air-filled cushions. Although they may help relieve pressure, cushions and other devices don't prevent pressure sores from forming or replace the need to change your position as often as recommended.

Skin inspection
Daily skin inspections for pressure sores are an integral part of prevention. Inspect your skin thoroughly at least once a day, using a mirror if necessary. Some experts suggest examining your skin twice a day or with every repositioning. A family member or caregiver can help if you're not able to do it yourself.

If you're confined to bed, pay special attention to your hips, spine and lower back, shoulder blades, elbows and heels. When you're in a wheelchair, look especially for sores on your buttocks and tailbone, lower back, legs, heels and feet. If you see skin damage or any sign of infection such as drainage from a sore, a foul odor, and increased tenderness, redness and warmth in the surrounding skin, get medical help immediately.

Nutrition
A healthy diet is important in preventing skin breakdown and in aiding wound healing. Unfortunately, the people most likely to develop pressure sores are also often the most malnourished.

If you're ill, recovering from surgery or living with paralysis, you may have little appetite and eating may be physically difficult. Yet it's essential to get enough calories, protein, vitamins and minerals. A dietitian can help devise an eating plan that caters to your food preferences while supplying necessary nutrients. These measures also may help:

Try smaller meals. If you feel full after eating only a small amount, try eating small meals more frequently when you do get the urge to eat. If you never seem to feel hungry, it's often helpful to eat according to a schedule rather than to rely on appetite.
Take advantage of the times when you feel your best. Eat a larger meal when you're hungry. Many people have their best appetite in the morning, when they're rested.
Limit fluids during meals. Liquids can fill you up and prevent you from eating higher calorie foods. It may help to drink most of your liquids 30 to 60 minutes before or after you eat. Don't restrict your intake of water overall, however. It helps keep skin soft and supple.
Consider pureed or liquid meals. If swallowing is difficult, emphasize soups, pureed foods or nutritional supplement drinks, which provide protein and calories but require little or no preparation. It may be easier for you to drink rather than to eat something.
Consider protein alternatives. If meat isn't appealing to you, consider other high-protein foods such as cottage cheese, peanut butter, yogurt and custards. Beans and nuts also are good protein sources but may be hard to digest.
Find a comfortable position. Raise the head of your bed to a comfortable level while you eat.
Don't rush. Allow sufficient time for meals, and if you need assistance, don't let your caregiver rush you.
Lifestyle changes
Although you may need assistance with many aspects of your care, you can take control of some important preventive measures, including:

Quitting smoking. Ask your doctor about the most effective way to stop smoking. Tobacco use decreases oxygen to your skin, robs your body of vitamin C and slows wound healing.
Exercise. Daily exercise improves circulation, builds up vital muscle tissue, stimulates your appetite and strengthens your body overall. A physical therapist can recommend an exercise program tailored to your needs.
Support. Your physical and emotional well-being depend on having a strong support system. Don't be afraid to ask for help with daily tasks or for emotional support.

Answer 2

First of all, you have to reposition him, even if it's only slightly. The skin can breakdown in a VERY short period of time (think hours), and then that leads to all kinds of problems. Assess his skin daily for any areas of redness, espcially the heels, and sacrum (lower back). If there is an area of redness that doesn't go away within half the amount of time that he was laying on that spot, then the tissue has already been damaged. So, if he has been laying on his back for two hours, and his heels are red, reposition his heels to take the pressure off. If they are still red after 1 hour, there is damage. It will continue to break down, and trust me, pressure ulcers (bed sores are freakin' nasty little buggers, and create lots of additional problems for the patient) If he is physically able to be on his unaffected side, then he needs to do so every two hours. Keeping the skin clean is very important too. Make sure that the perineal area is kept clean after bowel movements and urination. Adequate nutrition is also important. Make sure he is getting lots of protein. Change clothes and sheets daily at minumum. If they become soiled with body fluids, like sweat or urine, you need to change them again. The easiest way to do this is to have him roll to one side, make the entire side of the bed, have him roll onto the other side, then make the other side.
That's about all I have to offer... That being said, I would be throwing a fit to his insurance company because he REALLY should have a home health nurse coming in... Good luck to you and your father!

Answer 3

Your dad should bless you for all that you do. You are doing your best, it seems to me. Once he gets access to a hospital bed, one thing they can do is rig a trapeze bar overhead such that he can reach up, grab it and help lift himself up for bed changes and bedpans and the like. That'll serve the purpose of letting him assist in his care and he'll feel much better about himself, and it'll also allow a measure of physical exercise so essential to his healthy recovery.
To help prevent bedsores, he needs to change position about once every twenty minutes while awake, and also to get a well-balanced diet: a great many older folks don't eat well and nutrition, we've learned, plays a very important role in preventing things like bedsores.
Frequent vigorous back rubs have been shown to be far less effective than has been believed because even a modest back rub creates shear forces that can actually cause internal tissue tearing which in turn contributes to the development of bed sores.
Getting up and walking as soon as the doctor clears him for it will also play a vital role in keeping him free of bed sores and getting him back to some semblance of self-sufficiency.

Answer 4

I broke my hip when I was 22, and they changed by bedding every day, rotating the mattress and pad to be sure I was not creating a rut. I stayed comfortable until I was able to walk again, or at least start in a wheelchair.