All of us will find our skin changes as we age.
We have subjected it to many environmental factors over the years that can age it more quickly, such as sun, weather and even potions we use in hopes of looking younger.
Skin does change on its own as well. We can see it naturally thin and become loose, virtually before our eyes.
Looking at our senior loved ones, we can see how their skin has changed and continues to change with each passing year.
It isn’t about beauty or vanity that we worry about our senior’s skin. We also know that the more fragile their skin becomes, the greater the risk for getting what is known as skin tears.
Skin tears are annoying and very painful areas where there skin essentially peels back after they bump it or move certain ways, even from the chair to the bed.
There are things we can do to help prevent skin tears and the pain associated with them. But first, let’s talk about our aging skin.
The skin of many older adults begins to look like tissue paper as they age. It becomes very thin and fragile, such that we can see each blood vessel coursing through their bodies.
This thinning skin is a result of changes in the layers of the skin as we age and as a result of other factors as well.
The skin has essentially three layers:
- The outer layer, or covering, of skin is known as the epidermis.
- The second layer, below the epidermis, is the dermis. Our hair follicles, sweat glands and nerves live in this layer.
- Below these two layers is a fat layer called subcutaneous tissue. This layer provides us with protection and padding from trauma.
The epidermis and dermis are linked through a series of grooves naturally jointed that hold the two layers together making them strong and resilient.
As we age, this juncture flattens out, resulting in the two layers acting separately. The dermis layer can thin by 20% through the years. They can shift leading to fragile skin that tears when bumped.
We also lose the fat tissue in the subcutaneous layer as we get older, especially in key areas of our bodies, so that the protection isn’t what it once was.
Many seniors have bruises that seem to pop up overnight and tears that are unexplained. 80% of skin tears occur on our senior’s hands and arms. If they get a skin tear where the skin is flapping but still holding firm, clean the wound and then replace the skin over the open area before covering it. Avoid pulling it open again when changing the dressing. This loose skin will heal better if not removed.
Once the skin is damaged, it takes an older person longer to heal, too, which can lead to pain and potential infection of the affected site of the wound.
Risk Factors for Skin Tears
The layers of our skin tend to flatten out after age 60. As a result, even the smallest bump can lead to a skin tear.
There are factors that put our seniors at even greater risk of injury from normal, everyday movements.
- Inadequate nutrition especially adequate vitamins and protein intake
- Poor hydration
- Previous skin tears
- Impaired mobility
- Medications that further cause thin skin such as corticosteroids
- Decreased pain sensation (may keep reinjuring self)
- Uncontrolled pain causing erratic movements or thrashing
- Impaired circulation not providing nutrients to get to the skin to nourish it sufficiently
- Xerosis or dry skin
Ways Seniors Get Skin Tears
Getting a skin tear on fragile skin really only seems like it happens out of nowhere but in actuality there was a cause for the breakdown in their skin.
There are many ways that seniors can get a skin tear, including bumping on something when they walk in the home or outside, hitting a wheelchair, transferring from one place to another, and falls. Friction and shearing on fragile skin can also lead to skin tears.
The fear for family caregivers when frequent skin tears occur in their senior loved ones is the amount of pain seniors can have from skin tears. There is also the potential for scarring when healed and continued skin tears since once they have had one, they are at higher risk of repeating the behavior that caused it in the beginning.
There is also the potential for the skin tears to become infected, although this is not as common as one would imagine.
Trying to identify the reason for the skin tear and how it occurred, which is often not as easy as we would like, will help to prevent future occurrences. If the skin tear happened by bumping on the table, fixing the edge of the table or pushing a chair out further before getting up will prevent future wounds.
If there is a problem, it is best to find it and fix it.
Skin Tear Prevention Strategies
Some skin tears in our senior loved ones are not going to be preventable but many can be prevented or at least we can lessen their severity when they do occur.
There are some things that can help our senior’s skin withstand bumps and bangs.
- Wear long sleeves and long pants to protect them when they bump
- Be careful removing any adhesives, like band-aids or tapes, from their skin
- When they’re sitting in their favorite chair, pad them with pillows
- Upholster any sharp edges in the home (some child safety interventions can work in this application as well)
- Moisturize their skin daily with emollient lotions; especially helpful are those that contain nourishing ingredients such as vitamins, fatty acids like omega 3s, and antioxidants
- Drinking plenty of fluids
- Observe for and control pain (especially if they can’t express it)
- When moving or transferring, handle them carefully
- Cleanse skin with pH balanced soaps but don’t scrub or use hot water; use only lukewarm water on tender skin
- Unclutter the living environment to prevent bumping
- Ensure adequate lighting so they don’t hit something they can’t see
- Use elastic sleeves, called geri-sleeves or tubi-grips, that give more protection; cover wrists including thumb hole
- Reposition so that they are not putting pressure on sensitive areas
- Use heel or elbow protectors
- Wear proper foot covering in house too
- Use skin sealants instead of tapes that could enlarge skin tear when changed
Skin tears can be scary to both you and your senior loved one.
The fewer they get the better. You can make a difference in their frequency and severity when you ensure they are living in the safest environment possible!