the challenge of maintaining skin integrity on the older person - an achievable goal

The challenge of maintaining skin integrity on the older person - an achievable goal

Rosie Callaghan Tissue Viability Nurse for Nursing Homes Worcestershire Primary Care Trustrosiecallaghan@nhs.net07717543046

skin

layers

Thermoregulation

Excretory Function

metabolism

Non-verbalcommunica

tion

Protection

sensation

Changes in ageing skin

Ageing

Reduced number of sweat glandsReduction in the

number of langerhans cells

Poorer absorption through the skin

Reduced vitamin D synthesis's

Poor oxygenation

Reduction in ability to detect pressure

Impaired function of respiratory and immune systems

Use of multiple medication

Presence of Chronic conditions

Poor nutrition and hydration

Lac of tensile strength in healed

wounds

Results in • Are more likely to suffer

pressure and thermal damage to the skin due to diminished sensation

• Risk hyper/hypothermia due to decreased subcutaneous tissue

• Have fewer sweat glands and therefore produce less sweat which hinders thermoregulation and increases the risk of hyperthermia

• Slower to exhibit a sensitization response redness heat discomfort due to reduction in langerhans cells this can result in overuse of topical medications and more severe allergic reactions

• Risk of overdose of transdermal medications poor absorption can prompt them to reapply too often

• Much higher incidence of shear and tear injuries due to compromised skin adhesion and less flexible collagen

Reduced vascularisation

Prone to oedema around wounds

Bruise easier

Decreased sensation

Not notice discomfort from Remaining in one position

Bony areas have less subcutaneous cushioning

Higher incidence of ischemia

Thinner skin

Less effective barrier

Fewer langerhans cells

Fewer mast cells

infection

Reduced sebum production

Dry, itchy skin

Puritis, dermatitis, venous leg ulcer

Pigment changes

• There is an increase in brown spots which resemble freckles.

• senile purpura are more often associated with the arms.

Extrinsic Factors

• Smoking• Environmental pollutants• Ultra violet light• Decreased mobility• Drug induced disorders• Chronic illness

• Correct manual handling techniques‘• good nutrition and hydration• Good skin care including emollients and use of

non perfumed soap• The removal of potential hazards

references• Benbow M (2009) skin tears British journal of Community Nursing 23 (1) 14-

18• Bianchi J, Cameron J (2008) Assessment of skin integrity in the elderly

British journal of Community Nursing 13 (3) s23-32• Davies A Management of dry skin conditions in older people British journal of

Community Nursing 13(6) 250-257• Finch M (2003) Assessment of skin in older people Nursing Older People

15 (2) 29-30• Hodgkinson B, Nay R, Wilson J (2006) A systematic review of topical skin

care in aged facilities Journal of Clinical Nursing 16 129-136• Lawton S addressing the skin care needs of the older person British journal

of Community Nursing 12(5) 203-210 British journal of Community Nursing 13 (7) 302-308

• Nazarko L Understanding and treating a common dermal problem: pruritus • Timmons J (2006) skin function and wound healing physiology Wound

Essentials 1 8-17

Web sites

• www,skincarecampaign.org• www.bdng.org.uk• www.britishskinfoundation.org.uk• http://www.woundcare.com/• http;//www.smtl.co.uk/World-Wide Wounds/• http://www.ewma.org/• www.cochrane.org• www.dressings.org