It's easy to get lost in the whirlwind of lotions and potions in a world flooded with the latest skin-care trends and anti-aging remedies.

But the undeniable truth remains that while we can delay some of the effects, we really cannot prevent the aging of our skin. And whilst pursuing eternal youth is an appealing idea, the real wisdom lies in caring for and embracing our skin's journey as it matures.

Our skin layer is the first defence, the guardian of our bodies. As the largest organ, our skin protects us from external threats like temperature fluctuations and the sun's unforgiving rays.

Older person applying moisturiser to their skin with the words "9 tips for maintaining skin integrity."

Australia, with its diverse landscapes and sunny climate, has fostered a unique lifestyle that revolves around outdoor activities. With an average of over 200 sunny days per year, it's no wonder we have the highest rate of skin cancer globally. Approximately two in three Australians are diagnosed with skin cancer during their lifetime. The current generations of traditionalists, veterans, and baby boomers have spent an enormous amount of time in the sun, either fighting for our country, working outside, or seeking to build a suntan whilst on holiday.

As well as UV-damaged skin, our skin undergoes various changes as it ages, making it more vulnerable to damage and health issues that need monitoring. As we age, our skin becomes thinner, reducing protection, becoming drier, and losing elasticity, making it more susceptible to damage. Wounds Australia notes that older blood vessels are more prone to bruising and breaking. Along with chemical changes in our skin, this leads to increased chances of infection.

Dehydration, medications, soaps, perfumes and lotions, and the lived environment, as well as a more sedentary lifestyle all impact the skin integrity of older people.

This means we see many of our seniors living with seriously damaged or frail skin and at increased risk of skin cancers, tears and other skin trauma.

With this in mind, we need to ensure staff are trained in noting changes to a person's skin and practices that minimise causing damage.

Following are nine practices that support good skin care and help to prevent skin tears and other skin damage in an older person receiving personal care services. But before we get started on those, we need to set the standard.

Establish a baseline

Before commencing any personal care services with an older person it is essential to establish a baseline. Generally, this is done within 8 hours of admission to residential care or on the first home care visit where personal care services are to be provided.

During the first personal care service, a staff member should carry out a general skin inspection noting any signs of skin changes and skin trauma. This initial assessment will be added to over time, building up an overall picture of the person’s skin integrity. All findings need to be documented in the skin assessment chart (where used), the care plan assessment and in progress notes.

Support the maintenance of good skin integrity

Now that you have a baseline in place, you want to ensure you do everything possible to maintain or improve the person’s skin integrity.

Firstly, nourish from the inside. You can do that through:

1. Hydration

As people mature, they tend to drink less, especially if they are sensitive to continence issues, or they may be on a fluid restriction due to a health issue such as renal dialysis.

It’s important that staff are observant. In a residential setting, you may notice that the water level in a glass doesn’t appear to change, or a person may prefer to drink tea or coffee. Unfortunately, caffeine can also act as a diuretic. Both these scenarios can lead to a person becoming dehydrated.

Keep an eye out for common signs of dehydration such as dry mouth, lips and tongue. You may also observe sunken eyes and dry papery skin.

Encourage adequate water intake. This will benefit not only the skin but other body systems.

2. Nutrition

Along with hydration, good nutrition contributes to good skin integrity. Poor nutrition impacts wound healing as well as tissue recovery leading to an increased chance of incurring chronic wounds.

Prevention is the most effective way to work against skin aging. Eating a balanced nutritional diet, rich in antioxidants, vitamins and minerals is an important key to promoting healthy skin.

Vitamins A, B2, B3, B6, C, D, E, zinc and selenium are important for optimal skin health and function. Whilst most people can get these nutrients by eating a healthy and balanced diet, many older people may have a smaller appetite or suffer from malabsorption of nutrients and are simply not getting all they need. Care staff can help by encouraging older people to eat nutrient-dense meals rather than simply exist on ‘tea and toast.’ Their skin (and their bones!) will thank them for it.

Now let’s look at how to support skin integrity from the outside.

3. Soaps

The wrong type of cleanser can exacerbate dry skin. Many soaps, shower gels and bubble bath liquids can strip the skin of natural oils. Instead of soap, consider using a pH-balanced cleanser. With so many mild, pH-balanced cleansers on the market, finding something that works for the person shouldn’t be too difficult.

Moisturising shower gels can also be used, however with caution as some products can make the shower cubicle slippery.

4. Frequency of washing

The frequency of showering or bathing plays a part in maintaining good skin integrity. Too frequent showering can dry the skin, stripping away the body's natural oils and protection.

Instead, the person may choose to access more sponge baths, balancing cleanliness and over-washing.

5. Drying properly

Assisting a person to dry off after a shower or bath provides a great opportunity for the care worker to monitor the person’s skin integrity and note any issues.

It is important to ensure the person is assisted to dry off thoroughly, leaving no damp patches under skin folds. The care worker should take time to check between and under skin folds for any raw or irritated lesions, over bony prominences for reddened areas and in between a person’s toes. We don’t want any of that ‘toe jam’… ew yuck!

6. Moisturising

Applying moisturiser after showering or bathing will help maintain skin hydration and minimise the chances of skin trauma. Many older people experience dry, itchy skin. The regular use of moisturisers can help address this.

Moisturiser should be dabbed onto the skin and smoothed on following the direction of hair growth. Care should be taken to avoid areas where there are healing wounds.

Twice-daily skin moisturising is ideal, so where possible a second application by the staff or the older person should be carried out. The bonus is it provides another opportunity to inspect a person's skin integrity.

And while we’re on the topic of moisturising, I know a lot of older people love using talcum powder but avoid using it if possible as it does absorb the skin's natural oils, drying it out. It's also a slip hazard on the floor.

7. Continence management

Prolonged exposure to urine or faeces can lead to skin breakdown and infections such as incontinence-associated dermatitis (IAD). It is therefore important to follow the person’s established routine for changing continence aids or toileting intervals, and to complete urine and bowel records where in place.

Note: we will be covering Incontinence Associated Dermatitis later in this series of articles on skin integrity.

8. Environment

Older people, particularly those living in residential care, spend large amounts of time indoors. This means they are exposed to the drying effects of air-conditioners and heating units. Additionally, when they do leave the house, their sensitive skin can be less tolerant of the sun’s UV rays.

Care staff should be aware of the impact of the environment on the skin of older people. In the indoor setting, humidifiers may be required, and when venturing outdoors, even for short periods, hats and sunscreen may be advisable.

9. Activity

Now obviously not all older people can be active, especially if they are incapacitated in some way. However, where possible older people should be encouraged and facilitated to move around or to change position to prevent pressure injuries from occurring.

For more on preventing pressure injuries, why not add your name to our email list so you don’t miss out on the next in this series of articles covering skin care in seniors? It's free and you can unsubscribe at any time.

Monitoring skin integrity

While we try to ensure that a person receives care and support that promotes good skin health, we should never simply accept that as the ‘job done’. Whenever care staff support a client’s personal hygiene, they should be monitoring the person’s skin integrity. Take the time to really look at your client’s / resident’s skin, check existing lesions to ensure they are improving, or at least not worsening, and keep an eye out for new problems.

Managing and monitoring skin integrity is an important aspect of care that often goes overlooked but plays a significant role in a person's well-being. Using these tips can help to maintain the skin integrity of those clients or residents you care for. Keep your eye out for our next article covering foot care.

If you can think of someone else who might benefit from this article, send them a link. We’d appreciate it! And if you’re looking for more helpful resources, why not check out our Total Quality Package resource hub? We have culturally appropriate, tailored resources that are designed to make your job simpler and help you provide quality care to your clients. Click here to find out more.

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