The Importance of Skin Integrity in Older Adults
Many people don’t think of their skin as a protective organ. But protection is one of the most important functions of your skin.
Your skin acts as a barrier and protects you from a variety of things like trauma, changes in outside temperature, and environmental chemicals, to name a few.
Not to mention, skin plays a vital role in one’s appearance, which may impact your self-image and quality of life.
Unfortunately, as we age, our skin health gradually starts to deteriorate due to several reasons, and it becomes less effective in its protective role.
This is often referred to as the loss of skin integrity.
In this article, we will cover the topic of skin integrity when it comes to older adults.
We will discuss what is skin integrity, the complications that can arise from losing it, and the various causes and risk factors for loss of skin health with aging.
We will also cover what you can do as a care provider to help your senior family member or client to maintain skin integrity, as well as to help in the skin healing process if necessary.
What is skin integrity?
Skin integrity refers to the health of your skin.
When in proper health, the skin performs various vital functions.
It helps maintain optimal core temperature in your body, helps absorb and process vitamin D from the sun, keeps you hydrated by supporting electrolyte balance, among many others.
But as we age, we start losing skin integrity due to a wide variety of factors, as we will discuss below.
If you lose skin integrity, that might mean that you’re more susceptible to damaged skin that is unable to heal after trauma or injury.
For seniors that you might be caring for, one of the biggest complications arising from loss of skin health is the greater risk of pressure wounds.
Skin integrity and pressure wounds
Pressure wounds, also known as bedsores or pressure ulcers, are injuries to the skin and the underlying tissue that occur as a result of the skin being under pressure for too long.
The bony areas of the body, such as shoulder blades, hip bones, ankles, etc., are typically at a higher risk of pressure wounds.
Symptoms of pressure wounds
Pressure wounds usually develop over time, but in some cases it can show up in a matter of hours.
If you’re caring for an older adult who falls under one or more of the higher risk categories listed below, you should check and inquire about their skin health regularly.
In general, keep an eye out for the following symptoms and warning signs for pressure wounds.
Warning signs and early symptoms for pressure wounds
Here are some of the early symptoms of pressure wounds, also known as stage 1 pressure ulcers.
● Discolored skin - Red patches (on pale skin) or purple or blue patches (on darker skin) can be an early symptom of pressure wounds.
● Warm, spongy, or hard skin patches - Watch out for these symptoms, especially if there is no explanation for them
● Pain or itchiness - There are many conditions that can cause the skin to get painful and itchy, including pressure sores.
Symptoms of later stages of pressure wounds
If the pressure sores progress beyond stage 1, one may experience the following symptoms.
● Category 2 pressure ulcer - A blister or an open wound on the skin.
● Category 3 pressure ulcer - A deeper wound that might reach the layers beneath the outer skin.
● Category 4 pressure ulcer - A very deep wound that might potentially reach the bones and muscles in the affected area.
Ideally, if there is a pressure wound forming, you can identify it early in the progression and get it treated so it never reaches the later stages.
Pressure wounds and mobility
Pressure wounds can happen to anyone, but older adults who spend prolonged periods sitting in a wheelchair or lying in bed can be more vulnerable.
If you’re caring for a senior that has an underlying condition that might make it difficult for them to change positions in bed frequently, then they could be at an added risk for pressure wounds.
In these situations, it might be best to assist them periodically and help them shift positions to avoid too much pressure on one part of the skin.
Most bedsores heal with treatment, but in some severe cases, there might not be a complete recovery.
Potential complications resulting from pressure wounds
Complications as a result of pressure wounds, depending on the severity and the patient’s overall health, can range from relatively mild to, in some rare cases, life-threatening.
Here are some of the possible conditions that can arise as a result of pressure ulcers.
Cellulitis - Cellulitis is an infection that affects the skin, and the soft tissue connected to the skin.
Symptoms may be redness, swelling, and pain. But unfortunately, those with impaired sensations due to nerve damage often don’t notice the symptoms.
Infections of the bones and joints - As we mentioned above, if pressure wounds progress beyond the early stages, it can reach and infect the bones and joints surrounding the affected area.
In severe cases, the bone infection can affect the cartilage and even impact the function of limbs and joints.
Cancer - If the wound doesn’t heal for a long time, it can develop into a type of cancer known as squamous cell carcinoma.
Sepsis - Also in severe and rare cases, a pressure wound might lead to sepsis.
As you can see, bedsores or pressure ulcers can potentially have some severe consequences, especially in those with underlying conditions and suppressed immunity.
The goal should be to always avoid pressure ulcers, and in the event they do develop, to identify and treat them immediately.
Below, we will discuss in detail what you can do as a caregiver to help maintain skin integrity to reduce the risk of pressure wounds, and to improve your senior client’s overall quality of life.
Why is skin integrity important?
As we just explained in detail in the previous section, pressure ulcers can develop into a serious medical condition.
And the best way to prevent pressure wounds is to maintain optimal skin health and integrity.
But skin integrity is important for reasons beyond preventing bedsores, like the following:
Protection - The skin is the largest organ and the outermost layer of the body, and it is responsible for protecting you from various factors like temperature changes, environmental chemicals, and more.
Maintaining skin integrity helps ensure that the skin can perform its protective function optimally.
Moisture - The skin plays a vital role in maintaining optimal moisture levels within the body to keep you adequately hydrated.
Sensory information - The skin provides necessary sensory input about any potential dangers in the environment. If you lose sensation due to damaged skin, you could be at a higher risk of injury or danger.
Quality of life - Unhealthy skin can become dry and flaky, and it can cause pain and itchiness. Itchy and painful skin can be very uncomfortable, and it could have a significant impact on one’s quality of life.
Self-image and mental health - The skin is directly tied to one’s appearance and therefore can affect self-image.
If an older adult has visibly damaged skin, he or she might be less willing to socialize with friends or take part in community activities. If they become isolated, it could also affect their mental health.
What causes poor skin integrity?
With aging, there are a variety of factors that can contribute to poor skin integrity. The aging process, both for the skin and in general, varies from person to person, and it can depend on the following factors, among others.
● Exposure to pollution and harmful chemicals
● Stress levels
Another one of the biggest contributors to poor skin integrity is sun exposure. The UV light from sunlight damages elastin, which is the elastic tissue that is responsible for the plump look in youthful skin.
When elastin breaks down, the skin can become saggy, wrinkled, and blotched.
Too much sun exposure can also lead to certain types of skin cancer.
The best way to help your care patient prevent damage due to sun exposure is to make sure they apply sunscreen before they go outside on a sunny day.
But be sure to only use sunscreens that are either approved or recommended by their dermatologist to avoid any unwanted skin reactions.
What are the risk factors of loss of skin integrity in the elderly?
We’ve covered some of the contributing factors for poor skin integrity as we age. But some older adults might be at a higher risk of skin damage depending on various risk factors.
If you’re caring for a senior who falls into one or more of the following risk categories, be sure to pay extra attention to their skin health and regularly check for pressure wounds.
It might also be a good idea to schedule a visit with a dermatologist to get a skin health evaluation.
Chemical skin irritants - Some people have skin that is sensitive to specific chemicals like certain detergents, soaps, dyes, adhesives, etc.
Older adults with lower skin integrity might be more susceptible to a reaction after exposure to chemicals.,
Dermatitis, pruritus, or itching - If the senior person you’re caring for has a history of itchy skin, dermatitis, or pruritis, they might be at a higher risk of age-related skin issues.
Extremes of age - After a certain age, skin moisture levels decrease, causing dry and flaky skin, as well as a higher risk of skin damage.
Edema - Edema is a condition that causes swelling due to too much fluid trapped in one part of the body, usually in the extremities like hands, feet, arms, ankles, etc.
If left untreated, the skin overlying edema can become stretched, increasing the risk of damage.
Fecal or urinary incontinence - Prolonged fecal or urinary incontinence can impact skin integrity, also known as incontinence-associated dermatitis (IAD).
Exposure to radiation - If the person you’re caring for has gone through radiation therapy, they could be at a higher risk of skin infection and damage.
Hyperthermia or hypothermia - Both hypothermia and hypothermia can leave your skin more vulnerable and susceptible to damage.
Imbalanced nutritional state - Nutrition has a direct impact on skin health. Lack of certain nutrients can make the skin more prone to breakouts, dryness, and damage.
We will discuss below how to include nutrients in the diet to promote healthy skin in older adults.
Immobility - Patients who suffer from mobility issues, whether due to a disability, obesity, or another underlying condition, are more likely to experience pressure wounds.
This is because their immobility might cause them to spend prolonged periods in one position, resulting in too much pressure on certain joints and the skin in that area.
Immunological deficit - If an older adult has a compromised immune system due to an underlying condition, exposure to radiation therapy, or simply old age, it might take them longer to recover from skin injuries or pressure wounds.
Impaired circulation - Optimal circulation delivers nutrients to the skin that keep it healthy and nourished. If circulation is impaired due to cardiovascular issues or lack of mobility, then skin health might suffer as a result.
Impaired sensation - Impaired sensation in the skin can cause your care patient to ignore skin discomfort or prolonged pressure, making them more vulnerable to the condition progressing further without treatment.
Long-term steroid use - Research has shown links between chronic steroid use and a higher risk of loss of skin integrity.
Mechanical factors - Mechanical stress on the skin, such as excess friction, pressure, and shear, might contribute to skin integrity issues.
Mechanical trauma - Mechanical trauma refers to events like skin tears and deep scratches. It could also be due to a medical procedure like a surgical incision.
If your care patient has had mechanical trauma to their skin, consult with a dermatologist to ensure proper and quick healing.
Lack of moisture - Lack of adequate moisture in the skin could cause it to become dry, flaky, and itchy, and overall skin health could suffer.
Obesity - Obesity is associated with a higher risk of other risk factors of skin health such as lack of mobility, poor circulation, immune deficit, and impaired nutrition, all of which could cause skin health issues.
How do you maintain skin integrity?
Here are some of the things that older adults and their caregivers can do to maintain and promote skin integrity.
See a dermatologist
The first thing you should do for your skin health is to consult with a dermatologist.
Every person is unique, and so is their skin. A dermatologist can evaluate the condition of your skin, the risk of severe infections like pressure wounds, and recommend a treatment or maintenance plan accordingly.
Proper skin maintenance routine
Regardless of whether you have damaged skin or not, you should maintain a proper skincare routine to promote skin integrity. This is true especially as you get older.
Here are some things you can do on a regular basis.
● Apply a natural dermatologist recommended moisturizer regularly, especially if you have dry skin
● Avoid showers in water that is too hot to prevent dry and cracked skin
● If you have vulnerable areas in your skin, be sure to apply ointments and dressings regularly
Depending on your level of mobility, try to get as much exercise or movement as possible.
It could be something as simple as going for a walk around the neighborhood. Or perhaps you can join exercise classes aimed at older adults at your local senior center.
Otherwise, you could simply do some stretchings in your home.
The point is to get as much movement as your health and fitness level allows. Movement promotes better circulation, which will help maintain skin integrity.
Eat a nutritious diet
What you eat on a regular basis might be one of the single biggest factors to influence your health, and that includes skin health.
Eating a diet full of beneficial vitamins and minerals will not only benefit your skin, but also your overall wellness.
Make sure to include plenty of high quality proteins and healthy fats in your diet. These macronutrients play a critical role in skin health.
Also, try to eat a wide variety of fresh fruits and vegetables to include a range of micronutrients. Specifically, vitamin K, C, A, and E are great for skin health, along with minerals like zinc, iron, and copper.
To keep it simple, just try to eat a mix of leafy greens like spinach, cruciferous vegetables like broccoli, roots like carrots, and fruits like berries. Also, garlic and ginger are great additions to any healthy diet.
Hydration is key for skin integrity and wound healing
Keeping the skin moisturized is important for skin health regardless of age. But it is especially critical for older adults who might be experiencing dry, flaky, or itchy skin.
Hydration is also vital in the wound healing process. Research has shown that a moist environment promotes better healing when compared to a dry environment.
To maintain proper hydration, drink plenty of water, and eat a lot of fruits and vegetables to get minerals like potassium, sodium, and magnesium.
Also, apply the right moisturizers and dressings to any wound on the skin to support the healing process.
How a CDPAP aide can help maintain skin integrity
If you’re not already familiar, CDPAP is a program through the New York State Medicaid that allows Medicaid beneficiaries to hire friends and family members (with specific exceptions) as care providers.
If you have an elderly family member or relative that needs care, you can provide caregiving services and get compensated through Medicaid.
When it comes to skin integrity,there are several things you can do to promote skin health and support the healing process.
What you should specifically do will vary depending on the current skin health of the person you’re caring for.
You might take the approach of helping them maintain good skin health, or in some cases, you might have to aid the healing process if their skin is already damaged.
Let’s take a look at a few of the things you might do as a CDPAP aide.
Regular inspection - Frequently inspect your senior relative’s skin for any warning signs of pressure wounds. Even if you can’t find anything, ask them and check if there is any discomfort or other symptoms.
Shift positions - If your relative or friend suffers from mobility issues and they spend a lot of time in bed or a wheelchair, you can help them shift positions periodically. Regular shifting will help avoid too much pressure on any one part of the skin.
Assist with skincare routine - Help your loved one or friend stick to their skincare routine. Apply moisturizers, ointments, and dressings as needed and recommended by the dermatologist.
Assist with movement - Help your relative get as much exercise as possible. That could mean helping them do some stretches on the bed, or it could be that you drive them to the park for a walk or jog.
Encourage and facilitate a healthy diet - We’ve discussed the importance of nutrition when it comes to skin health. Encourage your relative to stick to healthy food options to promote skin integrity. Offer to do their shopping, and if possible, to help with the meal preparation process.
Along with a healthy diet, you can make sure that your family member stays adequately hydrated.
Maintaining skin integrity is a vital aspect of the healthy aging process.
As we age, it is inevitable that we will all lose some of our youthful skin due to various factors like exposure to the sun, pollution, and other factors like stress and gravity.
But for the elderly, especially ones who fall in the risk categories mentioned in this article, the loss of skin health can cause serious conditions like pressure ulcers.
As a caregiver, you can play a critical role in helping your patient or family member promote skin integrity.
Try some of the tips mentioned in this article to prevent conditions like pressure wounds, and to help your senior family members enjoy their golden years with healthy and vibrant skin.