The challenge of maintaining
skin integrity on the older person
- an achievable goal
Rosie Callaghan Tissue Viability Nurse for Nursing
Homes Worcestershire Primary Care Trust
rosiecallaghan@nhs.net
07717543046
skin
layers
Thermoregulation
Excretory
Function
sensation
metabolism
Protection
Non-verbal
communication
Changes in ageing skin
Pigmentation
Texture
Thickness
Ageing
Turgor
Moisture
Reduced number
of sweat glands
Lac of tensile
strength in healed
wounds
Reduction in the
number of
langerhans cells
Poor nutrition and
hydration
Poorer absorption
through the skin
Presence of
Chronic conditions
Reduced vitamin D
synthesis's
Use of multiple
medication
Poor oxygenation
Impaired function
of respiratory and
immune systems
Reduction in ability
to detect pressure
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
Reduced sebum
production
Less effective barrier
Fewer langerhans cells
Dry, itchy skin
Fewer mast cells
infection
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
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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
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Benbow M (2009) skin tears British journal of Community Nursing 23 (1) 1418
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
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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