In our latest post, Dr Anna Galazka shares some of the findings of her PhD research where She focused on the emancipatory potential of clinician-patient partnerships for dealing with the social stigma of wounds and the ‘dirty work’ stigma of wound healing.
Thanks to developments in healthcare we now live longer. However, medicine has not yet found ways of curing many of the chronic diseases that sometimes show themselves as hard-to-heal wounds on already fragile, ageing skin.
Wounds are often a hidden debilitating condition that can reduce the quality of social life for elderly people.
Death of a spouse, declining mobility or embarrassment caused by the wound smell mean that elderly people suffering from chronic ulcers are likely to experience social isolation. Loneliness and its negative effects on physical and mental health in older people has been recognised as a modern epidemic (Salman, 2017; BBC Sounds, 2018; Coughlan, 2018) but for people with wounds that go on and on with no end in sight, this issue can be particularly upsetting.
Wounds can have a social stigma with serious relational repercussions for the elderly. One patient mentioned that her daughter and granddaughter would not visit her at home as often as they had used to because they could not stand the smell from her wound.
Another elderly patient described feeling self-conscious on a bus journey to a wound clinic when a boy stared at him throughout the journey.
“I don’t think I will go on the bus again”, he said.
The distressing sense of isolation can be heightened because wound healing is still dubbed as a Cinderella service (Sandoz, 2016; Young, 2016) that attracts relatively little interest in the medical profession.
Lindsay Leg Club
For some elderly patients with wounds, visits from district nurses can provide a sense of relational continuity they might seek to maintain – sometimes at a dangerous cost to their physical health.
“As district nurses we used to go to people’s homes and we knew that sometimes they would use something like a knitting needle […] and poke it in there to make the wounds […] because otherwise if we weren’t going to visit them anymore because they’d healed, they might not see many people”, said a lead of one Lindsay Leg Club.
Lindsay Leg Club is a charity based on a social-medical model of care provision run by district and practice nurses off the NHS premises, that offers wound care support for many elderly people in the community, including after their wounds heal.
Social infrastructure has a huge potential to improve physical and mental outcomes for elderly patients with wounds.
‘No man is an island’ may be a cliché (Beer, 1997) but Lindsay Leg Clubs have a transformative potential to bring people together to heal better by making friends, learning from one another and being motivated by peer pressure in the company of nurses interested in leg ulcer care. As one patient-turned-secretary of a Leg Club said, it is, first and foremost, a social occasion to share a cup of tea, play bingo, or have their toenails cut.
“If a patient’s head is okay, the rest heals as well”, the Leg Club lead added.
Healing and management
There are many success stories from Leg Clubs across the country.
One is of a patient who had had weeping leg ulcers that kept her indoors for four years before she was persuaded to come to her local Leg Club.
“I didn’t realise other people had the same problem as me”, she reportedly said.
After three months, her life was changed. She started going out with her daughter and getting her own groceries. She would go to every Leg Club outing. After one year, her legs were healed.
“Not because we did anything different but just because she was happy, and she was more mobile”, the Leg Club lead said.
The patient did not develop a single ulcer until she passed away eight years later.
Social support is important in the healing and management of chronic wounds in elderly people, so it is important to make them aware of the presence of such social infrastructure in their locality.
Established in 1995 and operating across Great Britain, Lindsay Leg Clubs offer social-medical assistance for people with wounds as well as ongoing support for people whose wounds have healed, and all providers of care to elderly patients should make them aware of their local club.
For more information on Leg Club locations and the possibility of getting involved as a volunteer, visit their website.
Dr Anna Galazka is an Early Career Researcher and University Teacher at Cardiff Business School.
She completed her PhD in organisation studies in the Cardiff Business School earlier this year and continues to focus her research on understanding the possibilities and power of social innovation in the context of managing chronic conditions, such as wounds.
This article originally appeared in a wound care special issue of Innov-age Magazine.
- BBC Sounds (2018). The Anatomy of Loneliness – Episode 1. [Accessed: 28 October 2018].
- Beer G (1997). The making of a Cliché: ‘No man is an Island’. European Journal of English Studies, 1(1), pp. 33–47.
- Coughlan S (2018). Loneliness threatens young as well as old. BBC News, 9 October. [Accessed: 28 October 2018].
- Salman S (2017). The battle against loneliness among older people. The Guardian, 10 May. [Accessed: 28 October 2018].
- Sandoz H (2016). Under pressure: why it’s time to heal these wounds. [Accessed: 9 January 2018].
- Young T (2016). Introducing the Welsh Wound Innovation Centre. Dermatological Nursing, 15(1), p. 6.