My 99 year old mother sleeps about 19-20 hours a day. How do I prevent her from getting bed sores?

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At 99 Mom has earned the right to sleep as long as she wants. just be thankful she is comfortable and not agitated.
Stop doing things that are good for her like eating, drinking, getting out of bed getting dressed. because that's what you do in the day time and you will feel better washed and dressed. if she is sleeping all the time that is what she will do. Her head will be twisted in her wheelchair. the newspaper will fall from her hands. Her head will be on her chest in front of the TV. Visitors will notice her drop off in five minutes. If you take her on a nice drive in the country to "Get some fresh air" she won't make it past the end of the driveway. the nice dinner you cook will remain untouched, well that's not quite true because her face will fall into the plate. Then there are the dr visits. Help her shuffle into the office and into one of those nice hard plastic chairs. I don't know how many times you will have to haul her up before she hits the floor.
All of that being said leave her alone. but and this is a big but she does need consistent and regular care. bathing is very important and keeping the skin well hydrated. Washing the genital area after every void or BM.. changing diapers when you change position every two hours. if possible get her out of bed at each position change during the day. If she can manage a few shuffles it really helps keep the blood moving. if not massage her legs with lotion stroking upwards to encourage blood flow towards the heart. I am not up to date with the very latest products used for bedsores but there is a patch called Duoderm that is applied over a sore and not changed for seven days. it works by sloughing off the dead tissue. Hospice or a wound center will have the latest products. heels hips and elbows can be protected with foam and there are special boots for the feet. Foam and air matresses are also helpful and a hospital or craftmatic bed. hospice will supply a bed or your Dr can prescribe. The absolute finest thing you can use is sheep skin but it must be the real thing
Of course it is not washable which is major but small pieces can be used on area that won't be soiled. Caregivers must get their sleep so it may not be possible to change positions every two hours. maybe you can do it at ten and someone else do the 2 AM then you take over again about 5AM. just do the best you can. An overnight hire is ideal but expensive. perhaps you can have help during the day so you can nap or maybe you go to bed really early and the family takes over in the evening. The most vulnerable are the obese so make sure you get into all those skin folds. keep the mouth moist if the patient can't or wont drink. Give ice chips and lubricate the lips well. I can't think of anything else but I expect others will
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By the way, for almost two years my frail 92 year old father used my product to reposition himself independently for comfort in his comfortable home bed and never had a bedsore. He had been a 230# "turtle on his back" and couldn't roll over or move an inch once he landed in bed. My 88 year old mother with back problems had been getting up from her bed multiple times a night to help him roll over or get up for the bathroom. Getting up from a dead sleep all night and rolling 230# of dead weight around had disaster written all over it. Don't know if this applies to readers but don't wait for bedsores or serious injuries to occur- please be pro-active to check out mattresses and other things that will help.
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My father at 92 was probably sleeping 18-20 hours a day- like a house cat it was only a matter of where- sleep in bed, eat, sleep in recliner, sleep in bed, eat, sleep in recliner, etc. Dementia was starting in but it was his body's natural progression, not depression. After a serious infection he ended up in a SNF for almost 3 years so sleeping is not always hospice linked. Back to original question- repositioning (by the caregiver or the person themselves if they can do it) or special mattresses, etc are key to "pressure sores" reduction.
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My mom had serious OA pain in both shoulders as well as drug-induced dementia. The beginning of the end for her was when the darvocet they switched her to (after she had hallucinations from vicodin) contributed to her new onset heart problem, atrial flutter, very much like atrial fibrillation. When hospitalized, we learned from her nephrologist that she only had 25 percent kidney function. In and of itself, that is going to be terminal. We brought her back home and things were pretty much the same for about 6 months. Then she had a heart attack early one Monday morning and went back to the hospital for a few days. Although she had always preferred to be up and about, when she came home this time, she was now so fatigued that the most I could get her to do, or should I say the most she was willing to do on her own, was to get up and go to the bathroom, then go back to bed. In the hospital, they had finally scoped her throat overall a complaint of sticky swallowing and found an unhealed ulcer that had been there over 6 months (b/c I had taken her to the ENT due to it but it wasn't discovered, therefore not treated). The ENT at the hospital said food particles were getting stuck in the ulcer and causing intermittent infection. He Rx'd a pureed diet. My moms only enjoyment was eating so this did not make her happy. Between her fatigue and her diet, I believe she was letting go of the will to live. This was OK at 94-1/2. She was also experiencing what I call "visitations from the other side", conversations departed folks we're having WITH HER. In about 2 weeks, too much bed rest lead to pneumonia which landed her back in the hospital. In spite of aggressive treatment, the pneumonia could not be halted. This time, we felt hospice was in order and she was evaluated as appropriate. Eventho no one really wanted to admit it, as soon as the morphine started being increased, it was pretty easy to guess the outcome. She lived about another week but that was it.

The moral of my story, I suppose, is that sleeping 19 to 20 hours a day is a symptom of its own and may indicate end stage coming on. You can't always get them up and going at those times because it's not about what you want, it's about what's going on with them. Only you as a 24 /7 caregiver can really address that issue but as I've heard before and have said myself many times, none of us are getting out of this alive. If your mom is in or nearing end stage, comfort should be your main consideration. Get hospice involved to help you. You will need either her personal doctor or the hospice doctor to certify that, in their medical opinion, she has 6 months or less to live. Then you can get some help with her. If that's not the case, you can always fall back to more aggressive intervention. But too much intervention isn't appropriate when it's time for comfort care.
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First of all, she should not be sleeping this long per day. Get her up and active. If she is depressed, then sleeping is a coping mechanism. Get her on an anti-depressant and re-regulate her wake/sleep cycle. This is not normal unless you are in a coma. She will have eons to sleep when she dies, but not now!
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Baby ointment all over her body and keep all her skin covered with a thin layer so she slides on the sheets. The idea is to protect her skin from dragging on the sheet, her clothing or anything that might snag her delicate skin. You will also need to move her every hour to distribute her weight to different parts of her skin and body. (this is hard at night). I also used lambskin wool between my mom's knees and under her hips. Look up pressure ulcers on the internet. It is easier to prevent them than care for them. If you see a small red bump on her skin, treat it immediately by gently cleaning, applying baby ointment and covering with a protective bandage designed to not tear the skin. Do not allow any weigh to rest on the spot. I have books on this if you need more info. Also talk to a hospice nurse or hospice doctor, they give the best advice for bedsores and you don't have have your mom under their care to talk to them.
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My obese mother-in-law had bedsores on her buttocks, could not lie down (her weight tended to suppress her lung function) so sat 24 hours a day. I cared for her from age 90-100, so saw a lot of degeneration in bedsores. Consulting with a visiting nurse, I had success with using baby ointment, powder and some very expensive surgical bandages. The bandages were about $5 apiece, and had to be changed twice daily. I am sorry I don't remember the brand name, but the nurse supplied a small amount, covered by Medicare. We paid out-of-pocket for most of them. Keeping the broken down area extremely clean was very important. It was very difficult because I worked full time, but she was very cooperative. I used one of those disposable cleansing clothes with aloe (do not rub, but dab because rubbing breaks down tissue). Dried with hair dryer on low setting. Ointment then powder, then bandage. The sores came and went, but at least didn't get infected. The air mattress is a good idea as CarolLynn suggested, but I had no experience with one and bedsores. If you have a Wound Care Center nearby, they can also help you treat them. Good luck, sometimes just seeing inprovement (rather than complete cure), is everything.
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Where are the bed sores? Heels, hips, what? Are you able to get her to turn often? She can't be allowed to lay in the same position hour after hour, day after day. A pneumatic air mattress ought to be very helpful and probably covered by Medicare if she already has some good store activity...

Vikki, Veronica ... ??
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