Management of Burns in Elderly People

Introduction

Our skin has three main layers: the epidermis, dermis, and hypodermis, and the skin damage is determined based on the severity of the burns. First-degree or superficial burn affects only the epidermis; the burn site appears red and dry with no blisters and is mildly painful. Second-degree burns or partial thickness burns involve the epidermis and protons of the upper dermis and lower dermis; the burn site is red and moist and may be blistered, swollen, and very painful. Third-degree burns or full-thickness burns extend through the dermis into the hypodermis; the burn site appears patch in color ranging from white to brown, with a dry, leathery texture, because the burn is so deep, and it causes little or no pain. Fourth-degree burns involve destroying all the layers of skin and the underlying muscle and bone; these burns are brown, dry, charred, and almost painless.

What Are the Causes of Burns?

The most common kind of burns are thermal burns. These burns happen when flames, hot metals, scalding liquids, or steam come in contact with the skin, which can happen in many circumstances, including house fires, kitchen accidents, vehicle accidents, and electrical malfunctions. Other things that can cause burns are radiation, friction, heated objects, the sun, electricity, and chemicals.

How Do Burns Affect the Elderly More?

Burns in older adults have the worst outcomes. As we age, the physiological changes in the cardiac and pulmonary systems reduce the ability to survive and recover from burns. With aging, the skin becomes thinner, and there is poor circulation in the body with a decreased cardiac reserve and immune response. Changes in the skin predispose older adults to have deeper and more severe burns, and the donor site for skin grafts is harder to find, making the skin grafts less successful in older adults. Also, the wounds tend to heal slower in older individuals than in younger ones.

How Are Burns Treated?

Minor burns can be treated at home, but major burns require immediate medical attention because of the risk of infection, dehydration, and other potentially serious complications. During the first 24 hours, fluid restoration, electrolyte balance, and adhering to protein losses are important.

• First, all the clothes are removed, and then all the chemical burns are flushed for a minimum of 30 minutes using copious amounts of running water. Then a thin layer of silver sulfadiazine is applied to the open areas.

• The patient is given nasogastric feeding containing 1 liter of fluid of 5 percent glucose, 0.8 sodium chloride, and other electrolytes.

• On the reach of the second-day parenteral fluids are reduced to 50 percent of the first day’s level, and oral fluids are increased to two liters.

• 48 hours intravenous feeding is given with whole blood and glucose saline.

• Albumin or fresh frozen plasma of 0.5-1 milliliters per kilogram per percentage burn during the first 24 hours, beginning eight to ten hours postburn, can be given as an adjuvant to the fluid solution resuscitation rate.

• For the next three days, high-calorie, increased protein tube feeding is given, followed by a full fluid diet and gradually increased calories and increased protein diet.

• Intubation is generally necessary in the case of an unconscious patient, hypoxic patient with severe smoke inhalation, or patients with flame or flash burns involving the face and neck.

• Burn center surgeons are consulted if the breathing seems to be compromised because of the tight, circumferential burns.

• Medications like antibiotics are used to reduce the risk of infection. Paraffin gauzes are valuable for superficial burns, while silver-based dressings are preferable for deep burns. Anabolic steroids may be used for severe burns to help decrease wound healing time.

• Debridement is done to remove the dead tissues, and dressing is given.

• Skin grafting can be done later, which involves surgically sewing skin over the affected area after the dead tissue has been removed. The skin can be taken from the person’s own body, from a donor, or from an animal.

• Cosmetic surgery can be performed to improve the function and appearance of the burned area.

How to Manage Burns in Elderly People?

Burns management requires a multidisciplinary approach with efforts from various aspects-

• Fluid Management- Burn injuries of more than 20 percent are associated with minimal fluid losses and can generally be treated with oral hydration, except in cases of facial, hand, and genital burns, and the goal of fluid management in major burns injuries is to maintain the tissue perfusion in the early phase of burn shock. In an elderly patient, it is important to monitor fluids which should not range as too less or too much.

• Nutritional Management- It is a major component of recovery for the burn patient, as they tend to lose weight due to improper dietary support, especially older individuals. A low-fat, high protein, high caloric content is recommended weekly, with biweekly assessments of nutritional status advisable.

• Pain Management- Appropriate painkillers can be prescribed that should not harm the elderly in any way, which can be done by taking a proper history of the patient and prior drug reactions.

• Behavioral Management- With age, not only does the body weaken, but the emotional area of the elderly is also hampered. In case of burn injury, it can make them completely devastated. Emotional support should be given by the family members as well as the healthcare professionals, which will reduce their anxiety and the chance of developing post-traumatic stress disorder and not lead them to shock.

• Safety Management- The elderly are more susceptible to accidental burns as they become more forgetful with age. To reduce the risk, smoke detectors should be installed at home, and a caregiver can be appointed who can help them with day-to-day activities and reduce the chance of scald burns which usually comes from hot bathing water, extremely hot food, hot oils while cooking, an emergency exit can be installed at home, and the elderly should be explained about it.

• Others- Most of the older patients are associated with medical conditions like heart disease, diabetes, and hypertension. Hence assessing their comorbidities is the first step in order to not overmedicate them, and any elderly patient with even minor burn injuries should be taken to the hospital.

Conclusion

Treating a burn injury in older patients is always a challenge because of their physiological differences; hence, they require more time to recover. So, close attention should be given to them, along with a proper long-term follow-up after discharge from the hospital to increase the survival rate after a burn injury.