The skin’s elasticity reduces as the person grows older.
Older skin gets more wrinkles and eventually becomes fragile over time.
Thus, the elderly deal with a lot of skin tears. Bruising and scrapes can be a huge problem for most of them.
Such conditions may be the least of younger people’s concerns. But for the elderly, it can be alarming and dangerous to their health.
What Are Skin Tears?
Skin tears are avulsions or wounds that appear as large cuts or scrapes. This usually affects thin and dry skin.
A skin tear can be characterized as partial thickness. This involves separating the skin’s top layer (epidermis) from the tissue underneath it (dermis).
Full thickness happens when both the epidermis and dermis are separated from the underlying tissue.
These acute wounds can happen by simply bumping on the edge of a table or scratching.
These wounds can heal on their own. However, it can get worse over time and become chronic wounds.
How Common Are Skin Tears in the Elderly?
Skin tears can happen anytime, especially among the elderly.
Age-related changes can cause their skin to lose thickness and elasticity.
Their old and dry skin tears easily compared to younger individuals.
Falling accidents and propelling in a wheelchair are largely associated with skin tears among older adults.
Furthermore, elderlies with previous skin tears and mobility issues showed an increased risk of getting the same health condition.
The forearm and legs are the most common locations of tears.
What Are the 3 Types of Skin Tears?
Health experts use these skin tear classification systems to distinguish the degree of tears:
- Payne-Martin Classification System
- Skin Tear Classification System (STAR)
- International Skin Tear Advisory Panel Instrument (ISTAP)
In this article, we will be discussing the ISTAP.
Leblanc K standardized skin tear classification by incorporating ISTAP. It’s a simplified classification system that 839 healthcare providers have validated.
This system categorizes a skin tear based on skin loss.
Type 1: No Skin Loss
Type 1 is categorized as a wound with no skin loss.
The skin flap can still be repositioned in these situations to conceal the wound bed.
Type 2: Partial Flap Loss
A wound can be considered a type 2 skin tear if there is partial skin flap loss.
Unlike in type 1, the skin flap can no longer be repositioned in these cases. And you can no longer use it to cover the wound bed.
Type 3: Total Flap Loss
Type 3 skin tear is characterized by total skin flap loss.
In cases like these, the skin flap is completely removed after an accident. Hence, the wound bed is blatantly exposed.
The Causes of Skin Tears in the Elderly
While other cases of skin tears have unidentified causes, common reasons why these happen include:
- Falling accidents
- Clothing and jewelry
- Doing day-to-day activities
- Equipment (such as rails, wheelchairs, and furniture)
- Forcefully hitting something or direct trauma (blunt force)
- Patient transfer (mostly characterized by friction and shear on the skin)
These causes can happen due to a mix of intrinsic and extrinsic factors.
Intrinsic
These risk factors are characterized by the age-related changes seen in older adults.
The epidermis gets thin, and collagen and elastin decrease. The sweat glands and sebaceous glands also have decreased activity. This consequently results in dry and fragile skin.
The elderly’s skin also has reduced abilities to regenerate.
These factors cause their fragile skin to easily tear, even with minor scrapes or trauma.
Extrinsic
Extrinsic factors are mostly concerned with the environment of the elderly.
These factors contribute equally to older adults’ increased risk of getting wounds.
Long fingernails and jewelry can easily scratch or scrape their skin.
They can also get a skin tear from bumping on furniture like shelves, bed rails, or wheelchairs.
How to Prevent Skin Tears in the Elderly
Skin tears are indeed common among the elderly. However, there are prevention measures that you can take to prevent skin tears.
Things that you might consider to prevent skin tears include:
- Maintain skin moisture
- Wear appropriate clothing
- Keep a healthy and balanced diet
- Avoid using adhesives
- Make the home a safe place
1. Maintain Skin Moisture
Dry skin tears easily! Hence, you might want to keep your skin moist.
You can apply lotion or any moisturizer twice daily to maintain your skin’s moisture.
Only use hypoallergenic products. And as much as possible, use pH-balanced cleansers instead of the usual soaps to prevent irritation and dryness.
If a certain area is drier than the other parts of your body, apply creams or seal it with a bandage.
2. Wear Appropriate Clothing
Wearing protective clothing, like long sleeves and long pants, can help guard the elderly’s skin against scratches and scrapes.
Also, jewelry should be avoided, including rings, necklaces, and bracelets. These might grab your skin and cause it to tear.
Clothes’ zippers, beads, and buttons might also result in similar issues.
3. Eat Right
Aside from using high-quality moisturizers, you can also keep your skin moist if you drink plenty of water.
Eating Vitamin C-rich fruits and vegetables also aids in keeping your skin strong. Foods such as these promote healing when you get skin tears.
When you eat high-protein food, you’ll be able to get sufficient nutrients to aid in collagen production. This helps in keeping skin elasticity to reduce its fragility.
4. Avoid Using Adhesives
Adhesives can extremely stick to one’s skin.
Removing adhesives would sometimes require blunt force. With the fragility of an older person’s skin, taking away adhesives can cause a tear.
In dressing wounds, you can opt to use non-adhesive like petroleum-based bandages.
5. Make the Home a Safe Place
The older person’s environment could also contribute to their increased risk of getting wounds.
To ensure a safe home for the elderly, you can remove clutter on the floor that would cause them to trip or fall.
Putting pads on furniture with sharp edges can also help avoid skin tears and trauma when getting bumped into.
If you are caring for an older adult, make sure to trim your nails. You can easily scratch or scrape their fragile skin with your long nails.
You should also handle them gently and carefully. When transporting an older adult with a wheelchair, ensure that their feet are in place to avoid hitting the wheelchair leg.
How to Treat Skin Tears for the Elderly
Prevention should always be the top priority. However, there will be cases where you can’t avoid accidents.
Hence, you must know how to treat wounds.
When an older adult gets a skin tear, they must get treated immediately.
Treatment is done to prevent infection, protect the surrounding skin, and keep the wound moist so it can heal faster.
Wound Care At Home
Keeping a first aid kit is handy, especially if you care for an older adult. If you have one, you can treat minor wounds at home.
Before treating skin tears, you must wash your hands with soap and water. Wear surgical-grade gloves if you have any.
If the wound area is bleeding, apply pressure using a clean cloth.
Once the bleeding stops, gently clean the wound using saline solution or sterile water. For smaller scrapes and scratches, washing with tap water and a mild soap works great.
If the skin flap is still intact, place it back to its original position without stretching the skin too much. Use a light dressing to conceal the wound.
Don’t use adhesive for the dressing. This might worsen the wound when it’s time to replace it.
Use petroleum-based gauze to fully cover the wound. Secure it with your usual dry gauze and medical tape afterward.
Visit Your Doctor
Going to your doctor is still necessary even if you treat the tear at home.
This is especially vital if there are signs of infection or the bleeding doesn’t stop.
Seeking professional medical advice, diagnosis or treatment, and care of a healthcare provider will ensure that the wound heals properly.
The doctor might use specific dressings that would aid the wound to heal.
In attaching the skin flap, they might use skin glue instead of stitching it back, given that the skin is fragile.
If there are signs of infection, a doctor can prescribe medication, like antibiotics, for treatment. They may also provide a vaccine shot for tetanus if necessary.
Signs of Infection
It would be best to look after several signs and symptoms that could signify an infection. These include:
- Increased pain
- Pus or foul-smelling secretion
- Fever and chills
- Redness or swelling near the wound
NOTE: To avoid infections from developing, always keep your wound clean and covered.
What Bandages to Use for Elderly Thin Skin?
Self-adherent bandages are best to use in treating an elderly’s delicate skin.
Unlike gauze, self-adherent bandages can stick to the skin without needing adhesives that would cause further damage.
This type of bandage is also an excellent replacement for elastic bandages. It doesn’t have metal clips that could potentially wound the elderly.
However, these bandages can only be applied to areas where they can be wrapped around, like the arms and legs.
What Is the Best Dressing to Put on a Skin Tear?
There are 2 types of dressings that you can use for wound care among the elderly:
- Transparent film dressing: This dressing lets you see the wound healing while still being covered.
- Petroleum-based dressing: This is a nonadherent type of dressing that keeps your wound bed moist. This aids in the wound to heal properly.
The Epidemiology of Skin Tears in the Elderly
Skin tears are identified to be common among older Americans. Such conditions deteriorate their health and quality of life.
The average age of the elderly getting skin tears is 83 years.
1.5 million adults in the US are inflicted with skin tears annually, specifically nursing home and care facility residents.
Literature also showed that over 16% of the population of a 120-bed capacity care facility in Australia were reported to have skin tears.
The prevalence of such incidents in a larger care facility (347-bed capacity) is higher at 41.5%.
From 2007 to 2009, an 8-11% prevalence rate was recorded in surveys among Washington hospitals.
Conclusion
Elderlies are prone to skin tears due to age-related changes in their body.
Hence, practicing prevention measures is important to protect your loved ones from harm.
In cases where accidents are not avoided, immediate wound treatment is necessary.
Despite treating the wound at home, getting the doctor’s advice, diagnosis, or treatment is essential to ensure proper healing.
