Prevention and Treatment of Skin Tears in the Elderly Population

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elderly patient skin tear prevention

Holly M. Hovan MSN, APRN, ACNS-BC, CWON-AP

I'm sure you're all familiar with the terms "prednisone skin," "thin skin," "fragile skin," or "easily bruises." One or all of these phrases are commonly used to describe our geriatric population's aging skin. As we age, so does our skin. Skin loses elasticity and often gains wrinkles. Skin conditions that were maybe never present throughout life can crop up with aging. Keep in mind that the environment and different exposures (to sunlight, smoking, and stress) can cause our skin to age differently. Additionally, certain drugs, obesity, diet/lifestyle, habits, exercise, repetitive movements, and family history can also influence how our skin ages. Exposure to radiation (for cancer treatment) can also cause skin changes several years after treatment is complete. Regardless of the reason, as we age, our skin composition changes, and undoubtedly the risk for skin tears increases.

How Skin Tears Occur

You may notice that your elderly patient bruises just by bumping into the bed rail, or that the tape used to secure gauze after a blood draw seems to tear their skin; these problems are not uncommon. Though prevalent, skin tears are usually easily treatable and, in some cases, preventable.

Skin tears usually occur as the result of an accident (bumping into something, a door knob, wheelchair pedal/leg, or other object). Sometimes skin tears can occur as a result of direct trauma, such as removing tape or dressing. Prevention is always best, just like with pressure injuries. However, if we're unable to prevent, then we must treat and heal. Usually, when left undisturbed and protected with a dressing, skin tears resolve quickly - but they can be recurrent.

Treatment and Prevention Strategies for Skin Tears

When a skin tear is first noticed, it is important to attempt to replace the "skin flap" or piece of skin that was torn. With a large skin tear, sometimes steri-strips can be helpful with this, but with small skin tears, they're often not needed. A non-adherent layer, along with bordered foam dressing, usually does the trick to cover. Dressing changes depends on the amount of drainage; some wound dressings can be left in place for a week, while others are changed MWF or biweekly. It is helpful to mark the direction with arrows on the secondary dressing, so that when it is removed, the skin flap is left in place and not torn in the opposite direction.

Alginates or more absorptive dressings are also handy if there is a lot of drainage, a weepy leg, etc. Also, dressings impregnated with silver can be used as needed for infection. It is important to note that the antimicrobial properties of silver, just like antibiotics, should not be overused. When using silver or other antimicrobial dressings, it is important to re-evaluate wounds frequently to determine continued need.

In terms of prevention, protective arm sleeves are helpful. The use of paper or gentle release tapes is also a better alternative to nylon tape, when it comes to sensitive or aging skin. In addition, it is important to routinely moisturize dry skin with an appropriate moisturize barrier. As we age, hydrating dry skin helps to replenish missing skin and keep skin healthy and intact. Oral hydration is important as well. I am sure we've all heard the saying, "a dry cell is a dead cell!"

Prevention and treatment of skin tears is something that can sometimes seem like a small task, however means so much to our patients' comfort and well-being. Though small, skin tears are painful. And, as we know, if skin is open, we have a route for possible infection. So, prevent as able, treat with care, and monitor for changes!

About the Author
Holly Hovan is a WOC nurse at the Cleveland Veterans Affairs Medical Center in long-term care/geriatrics. She has been practicing as a WOC nurse since 2013. Ms. Hovan has a passion for education, our veteran population, and empowering others to learn and succeed.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

Comments

This is such an important topic. There are many things that can be done to prevent skin tears, such as improving nutrition, altering medications, and increasing hydration. However, the underlying problem in the elderly is a shortening of the rete ridges that keep the layers of the skin from sliding in relation to one another, and there is no cure for that.

When skin tears do occur, the most evidence-based solution is to follow the treatment protocol developed by Dasie Wilson, a WOC nurse who consulted for many years for LTC facilities in the Chicago area. A complete, heavily footnoted Skin Tear Prevention and Management Clinical Education booklet which includes Wilson's strategies and more is available as a free download at: www.polymem.com/mkl/MKL252.pdf

Linda Benskin, PhD, RN, SRN (Ghana), CWCN
Independent Nurse Researcher, and Clinical Research and
Education Liaison, & Charity Liaison for Ferris Mfg. Corp.

Thank you for writing about skin tears and their prevention Holly. As you mention, it's vital to moisturize skin prone to skin tears (especially with a moisturizer that provides skin-strengthening nutrition). It's also a very good idea to use a nourishing, moisturizing and gentle cleanser that doesn't irritate skin. Even though skin tears are a frequent occurrence in the elderly due to the biology of skin aging, there are still steps that can be taken to help prevent them and that is important to remember as you have highlighted.

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