Aging Process - skin
Script
NB this script may vary to the recording
Slide 1 & 2
As you age there are many changes that happen to your body so today we are going to talk about the
changes that happen to skin with age.
You will all know how different your skin is now to when you were a child or even a teenager. This change
process continues throughout your lifespan as you can see in this picture, the facial changes of a person with
age.
So in order to understand and look after your clients better you need to know how the skin changes and what
you need to do to compensate for these changes. This of course will help you understand how your own skin
will change as you get older too.
Slide 3 The skin
The skin is the largest organ in the body. If you look at this diagram on this slide you will see there is a
difference between the skin layers of an older person and a younger person.
Taking good care of a person’s skin can save the person in your care a great deal of discomfort. When skin
breaks downs through injury or trauma it is very painful and I know you do not want to inflict unwanted pain on
the people in your care.
Slide 4 Main function of the skin
The main function of the skin is to protect the body and vital organs from injury and damage from the harsh
UV rays of the sun and also to help keep you warm. We will talk more about this in later slides but first let’s
talk about the composition of skin.
Slide 5 Composition of the skin
There are 3 layers to the skin. The outer layer which is called the epidermis. This is the layer that you see.
Next is the dermis. The second layer. There are a lot of major changes that occur in this layer as you get
older. Lastly is the subcutaneous layer and under this is muscle. So let’s have a more in-depth look at the
layers of skin and why it is important to take good care of a client’s skin, and your own.
Slide 6 The Epidermis
As you can see on the slide on the left of the picture, your skin is actually very scaly. You can’t see this with
the naked eye, but under a microscope this is what it looks like. The area is constantly renewing itself which is
why you see so much dry skin in your bed and the bed of your clients. The skin sheds the old skin and
replaces it with new layers and this is happens every 6-8 weeks. So dry and flakey skin is normal and
because of this renewal process the skin needs constant moisturizing which is why you should never use
harsh soaps on an older persons skin and you should apply moisturizing skin lotions. This helps protect the
skin as well.
As I said the outer skin or the epidermis covers the whole body but it has various thicknesses. For instance,
the thinnest part is on the eyelids while the thickest part is on the palms of the hands. So you can see,
depending on the job the skin is required to do, your body has been provided with different thicknesses of skin
depending on how your body is going to be used.
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The new skin is formed at the base of the epidermis and gradually moves to the top layer of the skin over a 68 week period. Then the top layer of dead skin is shed. It is a constant process of renewal. So apart from
protection and sensory functions the epidermis is also acts as a barrier to preserve moisture, vitamins,
minerals and proteins.
It also contains a substance called keratin which keeps the skin water proof.
As you age, the epidermis gets thinner although the number of cells don’t actually reduce. This gives the skin
the appearance of looking paler, clearer or more translucent and of course appears much thinner. Large
spots may appear on the skin too. These are commonly called aged spots and are usually the result of sun
damage. Skin tags or warts are also common and some of them look really nasty but in actual fact they do
not cause any harm. They just look a bit unsightly.
Slide 7 Dermis
The next layer is called the dermis which consists of bundles of tough fibers. The dermis is made up of a 2
proteins. One is called collagen and is what holds the skin together and the other is called elastin which is
what allows the skin to spring back. It is these fibers that gives your skin its elasticity, makes it firm and
strong.
Within the dermis are glands and nerves. This is where your sweat glands, hair follicles, hot and cold nerve
receptors and blood vessels are found.
The nerve endings are very close to the surface of the skin which explains why you feel pain when you are
injured but in an older person the nerve receptors reduce which makes them more at risk of sensory damage
making it more likely for them receive and injury and not even know about it.
Your temperature is also regulated through the heat and cold receptors which is why your body can adjust to
the environment and tell you if you are hot or cold however in an older person these receptors are less
efficient and they may not be able to adjust to temperate as well so you may have to think for them and make
sure they have suitable clothes on for the climate. Just remember an older person may spend more time
sitting and are more prone to getting cold so don’t judge on you’re the way you are feeling. You are moving
around being busy and like to fell a lot warmer than your client.
The dermal layer also has a vast supply of tiny blood vessels that provides your skin with the nourishment it
needs. This is where much of your fluid is stored. It also has lymph glands which help you to fight infections.
One of the major problems for skin as you age is the little projections that hold the dermis and the epidermis
together. They become flat and the layers are not able to stick together which makes the older person more
prone to injury as the top layer (epidermis) rolls over the second layer (dermis). This is why they are more
likely to sustain a skin tear.
There is also less collagen so they layers don’t stick together so well and elastin that allows the skin to spring
back so the skin is less able to repair itself. This means that any injury a person sustains may take longer to
heal because elastin and collagen are proteins and for any wound to heal there must be protein present. Also
with reduced protein that is elastin and collagen the thickness of the dermal layer reduces especially on the
palms, soles of fee and shins. Consequently there is also a corresponding reduction in the amount of oil the
skin produces which is why the skin becomes drier as a person ages.
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There is a slight difference between the amount of oil men and women produce too. Women’s skin begins to
become dryer from menopause while men their skin really doesn’t start to become dry till around 80. However
it is important to monitor a person skin and make sure it is well moisturized as I mentioned earlier. This makes
their skin feel comfortable and prevents the risk of skin breakdown and rashes.
This skin also gets damage by the sun which causes the blood vessels in your dermis to thicken. As you age
these begin to dilate (get bigger) which is what causes the spidery web of tiny red threads you sometimes see
on older people’s skin.
Slide 8 Subcutaneous layer
Subcutaneous Layer. This is the fat layer of the skin. You can see on this slide all the little yellow globules of
fat at the bottom of the picture. This provides a cushion of protection for your organs. It also helps to insulate
the body and keep you warm.
As people age there is less fat on their body which makes the body more vulnerable to injury because there is
not much fat to cushion the organs including the epidermis and is another reason older people notice the cold.
They don’t have the insulation to keep them warm.
Slide 9 How the skin functions
Overall the function for the skin is
 To keep the internal body temperature constant independent of the environment. This means your
body temperature should remain around 37C. This is called homeostasis which is the state of balance
or internal equilibrium. However it is not uncommon for older people to have a thyroid disease which
can affect the body’s temperature and affect homeostasis or the state of balance.
 Sweating releases a small amount of toxins that develop in the body but older people don’t often sweat.
 Sweating also helps to maintain hydration of the epidermis and keep it moist, this is the horny outer
layer of the skin
 The glands in the skin secretes oil to help keep the skin moist but as I said, women have a reduction in
oil secretion from menopause
 Protects the organs of the body but as we all know the skin can suffer damage from the elements like
sun in sunburn and extreme cold as in frost bite.
Slide 10 What affects aging skin – external factors
So what are some of the external factors that influence skin?
Firstly there is the
 Sun and its ultraviolet rays. Sun damage is a major problem for the skin so it is essential not to get
sunburnt. Older people are very susceptible to sun burn so it is important that they have sunscreen on
when they are outside in the sun and to also wear a hat.
 Medications can have a severe effect on your skin. The more medications a person is on the greater
the risk to the skin. Check with your registered nurse the medications a person is one to see if one of
the problems is skin irritation or rashes.
 Smoking cigarettes or marijuana makes the skin very wrinkly and also affects the color of the skin
giving it a yellowish tinge. Any of these drugs are harmful to your skin as well as other parts of your
body.
 A person’s health status will have an effect on their skin too. For example, in diabetes people develop
nerve damage in their legs with affects the feeling in their feet so their feet are at risk of injury with out
them feeling the pain. Also the circulation of blood is affected so the blood can’t reach the lower legs
and feet. This means that any injuries will take longer to heal and in fact some don’t heal at all.
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Reduced ability for self-care. If a person becomes unwell and cannot look after themselves their skin
will suffer for example if a person cannot reach their lower legs and feet they are at risk of skin
infections like tinea. Drying between and under toes is really important.
Mental health issues: Apart from a person’s ability to self-care being impaired, they could also be on
many drugs like anti-depressants which are known to have an affect a person skin
Nutrition – diet plays a major part in healthy skin. If a person doesn’t have a balanced diet, then it will
show in their skin so it is important that you make sure a person eats well and if they are not eating all
their meal then you need to report this to your Registered Nurse as a supplement may be needed.
Slide 11 Effects of skin changes in older people
Now you understand the structure and function of the skin and the changes that go on in your skin it is easy
for you to understand why as you get older you
 Get cold more easily. This is because you don’t have as much fat (subcutaneous tissue), have
decreased blood supply and lean muscle mass and all of these lead to an inability to keep warm.
 More susceptible to injury including skin tears and bruises because of the reduced collagen or elastin
that “fill out” the skin. This means the epidermis and dermis separate very easily or slides off each
other. This is also why the skin becomes saggy with age.
 Skin gets dryer so it needs more moisturizing. This is because the oil and sweat glands don’t work as
well so the moisturizer needs to be replaced from the outer layer of the skin.
 Have limited range of joint movement. This is because there isn’t enough elastin to enable free
movement of your joints
 Skin becomes less sensitive. This is due to the reduction in nerve receptors on the skin so the risk of
mechanical and loss of sensation injuries increase.
 Wounds take longer to heal. Through the changes to the dermal layer and with the lack of proteins
(that is collagen and elastin) the process of healing slows down.
Have Age Spots. These commonly develop in people from 40 years of age onwards as the skin is less
able to regenerate or recover from the sun damage that has occurred over the years. Age spots are
mostly harmless but occasionally they mask an underlying skin cancer. These age spots range in color
from brown, red, to black and the color does not necessarily indicate malignancy.
 Skin tags form. This is usually in people who are overweight. Commonly they occur under the arms,
base of the neck and under breasts of full breasted women. These are benign so they are not
malignant. They don’t usually cause any problems but it they do cause any problems like rubbing on a
bra strap, then they can be removed. These do not fall off on their own.
 Senile warts or Seborrhoeic Keratosis as it is also known. These occur where there is an increase in
keratin which flows onto the skin. Keratin is a “hard” protein that helps form skin, hair and nails so
when there is an excess being produced the layers flow on to the skin, forms a layer and becomes
hard. It is a benign condition that is very common. It is not know why this happens.
So when caring for older people, you need to make sure that their skin in protected, that they are kept warm,
you apply moisturizer frequently and make sure they enough clothes on to keep them warm in the winter or
cool in the summer.
You see, as I mentioned earlier, in your normal day you are walking around keeping busy, keeping the
circulation in your body flowing, so you don’t notice the cold as much. Older people who are sitting all day
notice the cold so make sure they have sufficient clothes on to keep them warm but not too many that they
cook.
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Don’t sit them next to a draft as this will make them cold. Be aware of your surroundings and make sure the
person in your care if comfortable for not all people are able to express that they are cold or hot however it
could show in their behavior.
Remember people who can’t tell you what they are feeling or experiencing my display behaviors that you
consider unacceptable or challenging when in fact they are trying to tell you something. Just think how you
might communicate if you were not able to tell someone what you need?
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