Preparing Healthcare Professionals for Administering Care to the Growing Elderly Patient Population

Author: Amanda Thornton, CIC, RN, MSN

For the first time in U.S. history, older adults are projected to outnumber children within the next 15 years, according to the U.S. Census Bureau.¹ The aging of America will also bring a significant increase in serious diseases, including Alzheimer’s disease and dementia-related diagnosis. Today there are an estimated 6.2 million Americans aged 65 and older living with Alzheimer’s dementia, and the annual number of new cases of Alzheimer’s and other dementias is projected to double by 2050.²

For those in the healthcare field, working with the frail elderly who have comorbidities such as Alzheimer’s disease or dementia can present challenges, especially when administering intravenous infusions or gaining vascular access. This specialized patient population is at a higher risk for complications and infections, such as line-related sepsis, cellulitis, and accidental line removal.

What can healthcare professionals do to be better prepared to work with this population when administering infusion activities and vascular access care?

First, it is important to understand that the aging process significantly affects the structures of the skin, including a decrease in tone, elasticity, and subcutaneous tissue.³ This thinning of the skin puts older patients at risk for skin bruising or tearing and potential infections. Veins may also be potentially unstable, causing them to “roll” or be difficult to access and lead to line-associated infections through peripheral intravenous (IV) or central lines.⁴

EMTs, ER nurses, and other health professionals should avoid the common method of “vigorously rubbing” the skin of elderly patients using an alcohol wipe to provide antisepsis and make the vein more visible, as it can cause microtears and breaks in the skin. These breaks can lead to infections as they promote the growth and harboring of bacteria under the dressing after insertion of the IV. Instead, the skin should be cleansed with gentle motions and the veins visualized through other methods, such as having patients drop their arm lower than their heart and ensuring the limb being used is warmed.

Additionally, the use of alcohol combined with Chlorhexidine gluconate (CHG) for skin antisepsis has been found to be superior to other methods to prevent surgical site and line-related infections.⁵ CHG provides persistent antimicrobial activity for up to seven days as it binds to the proteins within the skin and releases slowly over time, even working in the presence of blood or bodily fluids.⁶ Clinical evidence strongly supports the addition of CHG for cleansing the skin as well as disinfecting the hub of needleless connectors to prevent line-related infections with both peripheral IVs and central lines.⁷ Learn more about PDI Interventional Care solutions for skin antisepsis, device disinfection, and nasal decolonization to help protect even the most vulnerable patients.

As the population ages, the need for specialized training in caring for these patients with unique needs is increasingly important to improve outcomes and provide the highest quality care possible. More resources and articles on infection prevention can be found on PDI’s Clinical Resources center.