the challenge of maintaining skin integrity on the older person - an achievable goal rosie callaghan...
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The challenge of maintaining skin integrity on the older person - an achievable goal
Rosie Callaghan Tissue Viability Nurse for Nursing Homes Worcestershire Primary Care [email protected]
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