‘Aging Skin’ is a common problem among elderly people ( > 80 years ) living in nursing homes, geriatric wards in hospitals or at home.
Aging skin is a major but largely under estimated risk factor which is not treated properly today. In general, ointments and all kind of creams are prescribed with the intention tokeep the skin more healthy and flexible. Also, all kind of tools and devices are used in a artisan way . None of these solutions are giving the aimed effects ( proper support of the skin, diminishing the effect of shearing forces, … ); often these solutions even enhance the risk factor and should therefore be prohibited.
Aging skin ends – if not treated properly – as a skin tear or other skin lesion as a result of external factors which can be:
- Mechanical ( hurting skin against hard or sharp object )>> > skin tears
- Scratching when itching ( ex leg ulcers ) >>> scratch injury
- Moist/ humidity >>> intertrigo
- Shearing or friction ( external prosthesis user, wheelchair user,…)
During the aging process, a lot of histology changes happen. The number of collagen and elastin fibers diminish quite dramatic, the papillary layer between the dermis and the epidermis is thinning as well as the dermis and epidermis layer. Also, the volume of subcutaneous fat decreases.
Other changes are:
Vascular: arterial sclerosis in the small and larger blood vessels, thinning of the blood vessel wall and a less developed vascular network.
Cellular: diminishing number of sebaceous glands( gland that secretes sebum, which lubricates the skin and hair)and sweat glands ( gland that produces and secretes sweat).
The increased PH of the skin in combination with a increased loss of trans-epidermal water leads to a worsening of the skin hydration. The skin becomes thinner, dryer and fragile. As a consequence, the skin becomes less resistant to friction and shearing forces ; it’s only one step from the appearance of blistering, skin tears or abrasions after minor mechanical trauma.
Underlying causes of an aging skin:
- Diabetes Mellitus
- The usage of steroids and some topical agents
- Dry skin
- Sun exposure
- Use proper positioning, turning, lifting, and transferring techniques to prevent friction or shear. A lift sheet should be used to move and turn patients. If the patient is being cared for at home, make sure home health care assistants and her family caregivers understand these techniques.
- Provide a well-lit environment to minimize the risk of patients bumping into equipment or furniture.
- Make sure nursing assistants and home health care assistants know the importance of carefully handling elderly patients with frail skin. Any harsh movement or pulling can create a skin tear.
- Pad bed rails, wheelchair arm and leg supports, and any other equipment that may be used; this will protect the patient from accidentally bumping into a hard surface.
- Use pillows and blankets to protect and support arms and legs.
- Recommend that your patients wear long sleeves and pants to add a layer of protection.
- Use a soft silicone dressing with ReSkin technology on frail skin and remove it gently. Do not use dressings with too high adhesive; High adherent dressings stick too hard and will harm the fragile skin and new skin tears will occur.
- Mild cleansing agents should be used to minimize irritation and dryness; a mild cleanser should be non-alkaline to maintain the skin’s protective acid mantle. Force and friction applied to the skin during the cleansing process should be minimized.
- Apply a moisturizing agent to dry skin to keep it adequately hydrated. Creams are better than lotions.
Important note: Moisturizing agents (creams, lotions) compromises the adherence of the soft silicone dressing with ReSkin technology. It is important that the skin is 100% dry before applying the dressing.