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.
Dr Tzun Hon Lau is a resident housecall doctor at CMY Medical with more than a decade of experience in home care in Singapore. He is a strong believer that comprehensive healthcare at home does not need to cost an arm and a leg.
Check out the housecall services of CMY Medical.
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