Skin Tears in the Elderly:
Causes, Prevention, and Treatment

Skin tears in the elderly are extremely wounds. A skin tear involves the full or partial separation of the skin’s layers. They mainly occur on frail and fragile skin.[1]

They are acute wounds that are caused by mechanical trauma. This includes blunt force, a fall, damage from equipment or the removal of a strong adhesive dressing. They typically occur on the extremities of the body such as the hands, arms, and lower limbs, as the skin on these areas is not only thinner, but also more prone to external injury.[2]

Skin tears can have a detrimental impact on the quality of an elderly person’s life as they can cause unnecessary pain, discomfort, and distress.

Despite being common in older people, they are often misidentified and underreported, which means that they are frequently mismanaged. Without proper management, the risk of physical distress and infection increases significantly, whilst the effectiveness of treatment is limited.[3]

Skin Tears in the Elderly: Causes, Prevention, and Treatment

Why are elderly people more at risk of skin tears?

The skin is the largest organ in the body. It is made up of two main layers, known as the dermis and epidermis, which serve as the initial line of defence against external dangers that can harm internal organs and tissues.[4]

The structural and functional changes that the skin undergoes as we age affects its elasticity, strength, and appearance:

• Loss of collagen and elastin
• Blood vessel walls become thinner
• Reduced blood supply to the extremities
• The top layer of the skin (epidermis) thins and flattens
• Contraction of the dermis
• Sweat and sebaceous glands become less efficient causing dry skin
• Photoaging caused by prolonged sun exposure, specifically UVA and UVB rays [5]

In addition to the effects of natural ageing on the skin, various other factors can compromise the skin’s integrity and increase the intrinsic risk of skin tears:

• Taking certain medications that can thin the skin (e.g. corticosteroids)
• Comorbid conditions (e.g. cancer and diabetes)
• Undergoing certain medical treatments (e.g. chemotherapy)[6]

The risk of mechanical trauma is even higher in elderly people with impaired mobility that may require assistance with daily activities such as washing, dressing, and walking. The use of equipment, particularly wheelchairs, can increase the risk of skin tears due to handling and blunt trauma.[7]

How to prevent skin tears in the elderly?

An important part of prevention is identifying elderly people at risk of skin tears, as well as making environmental changes to minimise environmental risk factors.

A physical assessment should be conducted to identify elderly people that are vulnerable to skin-related trauma. There are multiple factors that that should be included in this assessment to determine risk:

• Skin problems (incl. a history of skin tears)
• Underlying diseases
• Mobility
• Visual impairment
• Cognitive impairment
• Gender (more common in females)
• Poor nutrition and hydration
• Medications [8]

Skin Tears in the Elderly: Causes, Prevention, and Treatment

Although these physical factors mean that skin tears in the elderly are not entirely preventable, steps can be taken to maintain skin integrity and stop the skin from becoming more susceptible in the future:

Improve nutrition. As people age, they can sometimes develop food sensitivities and conditions that affect digestion, as well as experience a loss of appetite. It is important to tailor an elderly person’s diet to fit their needs and ensure it contains enough proteins and nutrients that are vital in maintaining skin health.
Encourage hydration. Providing additional fluids between meals and avoiding highly caffeinated beverages will help the skin stay hydrated, which will lower the risk of tearing.
Limit excess bathing. Bathing can remove the skin’s natural oils, which can worsen dryness caused by ageing. Using a pH-balanced and soapless cleanser will reduce the oil-stripping effects of bathing.
Apply moisturiser. Using moisturiser twice a day, particularly on the hands and legs, can help to hydrate dry, ageing skin.[9]

Small environmental changes are important in creating a safe environment that reduces the risk of skin tears:
• Adopt good equipment handling techniques.
• Pad sharp furniture edges to minimise impact.
• Avoid long nails and jewellery that can lead to scratches and pinches.
• Wear long sleeves and trousers to protect the arms and legs from skin damage.
• Move small rugs and other trip hazards.
• Improve lighting to prevent people bumping into furniture and objects.
Skin Tears in the Elderly: Causes, Prevention, and Treatment

How to manage skin tears in the elderly?

1) When possible, gently unfold the skin flap and bring the edges as close together as possible.
2) Cleaning the skin tear with either sterile water or a saline solution.
3) Select the appropriate dressing and apply it in the direction of the flap. The dressing should not have a strong adhesive that could rip the tear further upon removal. It is preferable that the dressing be a transparent gauze that can stay in place for several days. This will ensure that a skin tear can be monitored and cleaned without disturbing the wound bed, especially if a secondary dressing is applied to manage any exudate and bleeding.
Whilst it is possible to treat small skin tears at home, it is recommended that people visit a healthcare professional to prevent it from worsening and reducing the chance of infection.
References:
  1. Klapper, Andrew, Moradian. A Novel Way to Treat Skin Tears. International Wound Journal 2015; 12(2): 283
  2. Ewart, June. Caring for People with Skin Tears. Wound Essentials 2016; 11(1): 3
  3. LeBlanc, Kimberly, et al. Best Practice Recommendations for the Prevention and Management of Skin Tears in Aged Skin. Wounds International 2008; (1): 8
  4. Ewart, June. Caring for People with Skin Tears. Wound Essentials 2016; 11(1): 3
  5. LeBlanc, Kimberly, et al. Best Practice Recommendations for the Prevention and Management of Skin Tears in Aged Skin. Wounds International 2008; (1): 4
  6. Holmes, Regina F., et al. Skin Tears: Care and Management of the Older at Home 2013. Home Healthcare Nurse 2013; 31 (2): 90-101
  7. LeBlanc, Kimberly, et al. Best Practice Recommendations for the Prevention and Management of Skin Tears in Aged Skin. Wounds International 2008; (1): 5
  8. Holmes, Regina F., et al. Skin Tears: Care and Management of the Older at Home 2013. Home Healthcare Nurse 2013; 31 (2): 90-101
  9. Ibid: 90-101

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