AGEING SKIN

Ageing Skin

(A Simple guide for carers)

Pressure ulcers, Cellulitis, MRSA, Staphylococcus aureus and
Bed sores (pressure ulcers)*
Cellulitis*
Staphylococcus aureus
Methicillin Resistant Staphylococcus Aureus*
Pressure Ulcers (Bed Sores

What is a pressure ulcer?

A pressure ulcer is a lesion caused by unrelieved pressure, friction or force on the skin
Pressure ulcers are commonly referred to as:
Pressure sores
Bedsores

Decubitus ulcers

Why do people get pressure ulcers?

In many cases pressure ulcers can be prevented.

Immobility is a major cause of pressure ulcers in frail older people, they usually develop on certain
pressure points on the body, for example:

The sacrum, heels, elbows, back and ears

How can risks be minimized?

Pressure ulcers can develop very quickly, so we should inspect the skin daily for pressure areas
Take measures to relieve pressure on the skin.
This will help to minimize the risk of a pressure ulcer developing

It is important to closely monitor a pressure area to prevent a pressure ulcer from developing

What do they look like?

Pressure ulcers can start off as very small reddened areas that do not go away when the area is relieved of pressure

What should I be aware of?

Redness on unbroken skin that remains after 15-30 seconds (skin may appear bluish, red or purple on people with dark skin)

Excess moisture (any open area on the skin can deteriorate into a larger pressure ulcer if it is exposed to excess moisture and pressure)

Blisters can quickly develop into a larger pressure ulcer, never underestimate the first sign of a pressure ulcer. Damage can extend from the skin to underlying tissue and bone. They can be slow to heal and difficult to treat

If a client is restricted to bed, what should I do?


if the client is in bed they should be repositioned every 2 hours

They may require special bedding . For example, an air mattress or special medical overlay

If the person is in a wheelchair, what should I do?

If the client is in a wheelchair they should be encouraged to shift their weight regularly (every 15 minutes)
If they are unable to do so then moving and handling procedures should be followed

They may require a special cushion or medical pressure relieving wheelchair pad

If a resident has a pressure ulcer what should happen?

Skin should be washed with soap and warm water to:
Ensure that no urine and faeces is left on the client
The skin should be patted dry (never rubbed),the area should never be massaged
If you are the first person to notice the pressure ulcer you must not ignore it:
Alert a nurse, doctor or senior member of staff (depending on the type of care setting you are working in)and follow the policy and procedures

Are there any other risk factors?

Ageing people are at increased risk of pressure ulcers (especially if they are immobile and not just if they are immobile)

The risk is increased if they are recovering from serious illness and infection or have diabetes,

Immobility, Spending long periods sitting or lying in the same position increase the risk of pressure ulcers.

Prolonged pressure on a pressure point can cut off the blood supply and delivery of oxygen and nutrients to the skin causing the skin to break down

Skin integrity

Excessive exposure to moisture through urine or perspiration can lead to skin breaking down particularly in areas such as the sacrum.

Skin that becomes too dry can crack and tear

Friction

Fragile delicate skin can tear easily with friction
Pulling clothes over bony prominences such as elbows can cause friction

Moving a person in bed or a chair by dragging on the skin can easily cause skin to tear and break down.

Repeated irritation from poorly fitted shoes can also cause pressure areas


Poor nutrition
To repair itself the skin needs nutrients
Inadequate nutrition can slow healing

Ageing people who are ill often have poor appetite and are at risk of malnutrition

Cellulitis

What is cellulitis?

Cellulitis is a common infection of the skin caused by bacteria

Usually staphylococcus aureus (Staph) or Group A beta haemolytic streptococcus

What causes cellulitis?

Cellulitis is caused by bacteria which enter the body via broken skin

The infection damages the delicate tissue under the skin causing inflammation and pain

Why are older people at risk?

Older people are at risk of cellulitis as with age the skin becomes frail and prone to damage

Poor circulation, diabetes and pressure ulcers are also common risk factors for cellulitis

How can the infection enter the body?

Via:
Burns, bites, cuts and grazes
Surgical wounds
Pressure ulcers
Dry skin patches, eczema, scabies or boils

Foreign object in the skin

What are the symptoms of cellulitis?

Cellulitis commonly occurs on the lower legs, arms and hands (although the infection can spread to other parts of the body)

An infected wound will be painful, hot to touch and have a shiny waxy appearance
The area of skin affected can grow as the infection spreads
In some cases infection can spread to the bloodstream and make a person feel very ill

If this happens urgent medical treatment and hospital admission is necessary

Symptoms of cellulitis include:

Redness
Skin that is warm/hot to touch
Skin appears tight and glossy
Discomfort or pain at the affected site
Leaking of fluid or pus
Sweating
Fever

Feeling unwell

How is cellulitis treated?

A wound swab will be needed to determine the cause of the infection
Treatment of cellulitis includes a course of oral antibiotics
Inflammation of the skin should start to ease once antibiotics have been started
In some cases the bacteria can be resistant to antibiotics or the infection can spread

Treatment of severe cellulitis could involve intravenous antibiotics (via a drip directly into the vein) in a setting or at the hospital

If someone has cellulitis, what other care is required?

When managing cellulitis it is important to avoid further infection
Skin to skin contact should be avoided to stop the spread of the infection
The affected part should be closely monitored
Most people respond to antibiotics within a few days
If there is any cause for concern a follow up with a doctor will be required
Urgent medical attention should be sought if the person:
Has a fever (greater than 38.5ºC in adults)
Is shaking (chills)
Is vomiting
When caring for someone with cellulitis they should be encouraged to rest
The affected body part should be elevated higher than the heart (to help relieve any swelling and encourage drainage)
The full course of antibiotics should be taken
Painkillers as prescribed by a doctor
Covering of the wound
Avoidance of touch to the wound and surrounding skin
Hand washing as per infection control procedures
A daily shower
Disinfectant cleansing of surfaces as per procedures

Linen, towels and clothing washed in isolation of other laundry

Staphylococcus aureus

What is staphylococcus aureus?

A normal bacteria commonly found in the nose and skin of otherwise healthy people

What causes a staphylococcus infection?

Staphylococcus infections frequently enter the body through broken skin

People who have had recent surgery, have an open wound or dermatitis are at risk of a staph infection

A staphylococcus aureus or staph infection can cause minor skin infections such as a boil or pimple
In some cases it can lead to serious complications such as blood poisoning and lung infection

Methicillin Resistant Staphylococcus Aureus (MRSA)

What is Methicillin Resistant Staphylococcus Aureus ?

Commonly known as MRSA

A strain of bacteria called Staphylococcus aureus (staph) that is resistant to methicillin (a type of antibiotic)

It is also becoming increasingly resistant to many other antibiotics

Who gets an MRSA infection?

MRSA is commonly found in in hospitals and nursing homes but recently has also been found in the community

Many people carry MRSA in the lining of their nose (mainly medical staff) but are otherwise healthy
MRSA appears similar to a staph infection
It is usually acquired in hospital after surgery
People with an open wound or tubes going into their body are at risk of MRSA

An MRSA infection can prove hard to heal and manage

Who is at risk from an MRSA infection?

Older people and people with suppressed immune systems are at risk of MRSA

In many cases it can make them seriously ill

How is an MRSA infection transmitted?

MRSA can be found on the skin, in the nose, blood, urine or in wounds

MRSA infection is passed on from person to person by direct contact, poor hand washing and hygiene practices or the use of unclean equipment

How is MRSA treated?

Managing a MRSA infection can take time
Treatment will involve using antibiotics that are sensitive to the bacteria
As the bacteria are resistant to many antibiotics it can be difficult to treat
In order to detect MRSA a wound swab must be taken
If an MRSA infection is in a wound it will need to be kept clean and covered
Treatment may involve specialised dressings

There are specific infection control procedures

How can MRSA be prevented?

Proper hand washing is one of the most effective techniques to reduce the risk of transmission of MRSA in hospitals and nursing homes

Some people are isolated within the care setting environment to help stop the spread of MRSA

If someone has MRSA what is required?

Visitors as well as staff must follow infection control procedures

Anyone with a wound infected with MRSA should keep it covered and wash their hands before and after coming in contact with the wound

Disposable gloves and the proper cleaning of equipment can help stop the spread of MRSA

What should happen if MRSA is suspected?

Any wounds that are taking a long time to heal should be seen by a doctor
A wound swab should be taken if MRSA or is suspected

Ageing Skin Awareness and Common Problems

The skin changes as a person ages

Most people associate old age with wrinkles

Care workers need an awareness of what happens to the skin as it ages as there are associated care needs for the client

General changes

Wrinkles
Age spots
Dryness
The skin also becomes thinner and loses fat, making it less plump and smooth

It also takes longer to heal

Skin integrity

Excessive exposure to moisture through urine or perspiration can lead to skin breaking down (particularly in areas such as the sacrum)

Skin that becomes too dry can crack and tear

Friction

Fragile delicate skin can tear easily with friction
Pulling clothes over bony prominences such as elbows can cause friction

Moving a person in bed or a chair by dragging on the skin can easily cause skin to tear and break down

Repeated irritation from poorly fitted shoes can also cause pressure areas

Poor nutrition

To repair itself the skin needs nutrients
Inadequate nutrition can slow healing

Ageing people who are ill often have a poor appetite and are at risk of malnutrition

Skin care routine

Ageing skin can be very fragile
A small knock to the skin can cause a skin tear taking a long time to heal

Ageing skin can be kept relatively healthy and protected from injury with a good skin care routine

Common problems – bruising

As the skin ages it becomes thin and more prone to bruising
The blood vessels can be easily damaged and rupture

The loss of the protective fatty layer increases the risk of injury and an older person can bruise from a relatively minor bump

Bruising and medication

Bruising can be minor or widespread

An older person may also be taking medications that thin the blood and interfere with the clotting mechanism of the body

Some medications cause the skin to become thin and papery

Bruising and moving and handling

Bruising frequently occurs on the legs and arms
Mobility or lifting aids can often cause injury to the skin when transferring
Placing extra padding on supports can help protect the limbs from damage
Bruising and unknown reasons
increased bruising should never be ignored

Referral for GP advice will be needed if it is not known how the bruising occurred or bruising becomes painful

In some cases bruising of the skin can be an indication of abuse

How can the skin be protected from bruising?

Clothing that covers the limbs
Protection of the shins and arms with arm and leg protectors
Cushioning of wheelchair leg supports
Cushioning of forearm support frames with padding
Removal or protection on furniture with sharp corners
Ensuring that all areas have no trip hazards
Avoiding prolonged exposure to the sun to protect against damaged skin

Common problems – excoriation

Excoriation and skin breakdown often occurs in the skin folds of older people
Moisture becomes trapped in areas such as the abdominal folds, under breasts, groins and toes

Excessive moisture causes the skin to become very red and sensitive

Excoriation and medical problems

Sometimes a person can have trouble drying particular areas of the body
They may be frequently incontinent, sit for long periods or wear inappropriate clothing

Someone with contracted limbs (stiff and immobile joints) is susceptible to excoriation in hard to dry areas

Carers can also have difficulty drying under arms or behind the knees if the limbs cannot be moved freely

After a stroke excoriation can occur on the affected side or in contracted hands and fingers

Excoriation and incontinence

Incontinence increases the risk of skin breakdown
Excess moisture in the skin also increases the likelihood of infection

Excoriated skin can become itchy, sore and in some cases infected

Excoriation and barrier creams

A suitable barrier or topical skin cream should be used
If excoriation persists then referral to the GP will be needed

Protecting skin from excoriation

Skin folds should be kept clean and dry (especially under the arms and breasts, the groin area and toes)

After an episode of incontinence the skin should be cleaned and dried thoroughly and a barrier ointment applied

Incontinence pads should be changed regularly

Clothes made from natural fabrics will reduce sweating
Ensure you wash your hands before and after coming into contact with the skin, wear gloves

For excoriation due to incontinence there are incontinence pads and underwear that can help

Common problems – fungal infections

Areas of the skin that are moist and prone to excoriation will often be at risk of developing infection caused by the yeast like fungus candida albicans

Areas commonly affected are the skin folds under the breasts, groin and area around the genitals

It appears as bright, reddened moist areas of skin with small papules that are itchy

Factors associated with fungal infections

Use of antibiotics
Diabetes
use of steroids

Incontinence

Treatment of fungal infections

Thorough cleaning and drying of affected areas
Keep skin folds free of moisture
Wearing clothes that allow skin to breathe
Ensuring correct hygiene practices
A suitable anti-fungal (as per medical advice)

Use of a barrier cream to protect skin after infection has healed

Common problems – dry skin

Ageing skin has less sebaceous (oil secreting glands) and sweat glands, causing the skin to be depleted of moisture

Dry skin can be an uncomfortable and persistent problem for older people

The skin appears rough, scaly, cracked and dry

Factors associated with dry skin

Cold dry weather
Daily use of soaps
Frequent bathing
Nutritional deficiency
Underlying health conditions such as kidney disease

Medications

Prevention of dry skin

Avoiding excessive bathing and harsh soap
Trying special no-rinse cleansers instead of soap
Using warm water (not too hot)
Using emollients such as bath oils (take care with slippery baths)
Patting skin dry
Application of moisturiser to damp skin directly after bathing

Increasing fluid intake

Common problems – skin tears

A skin tear results from friction, shearing or injury to the skin

A skin tear occurs when the epidermis (top layer) of the skin becomes separated from the underlying layer (dermis)

Skin can become very fragile with age - even the simplest movement, bump or knock can cause damage

Skin tears often occur in people who are dependent on others for showering, dressing, and transferring

The use of lifting equipment and assistive devices increases the risk of skin tears

People with confusion, poor vision and problems wandering can often bump into furniture or not recognise hazardous objects

Skin tears will often be sustained on the arms, lower legs or hands

Complications from skin tears include infection

Prevention of skin tears

Keep skin hydrated by moisturising daily after a shower or bath
Patting skin dry (not rubbing)
Increasing fluid intake
Wearing clothing that covers the limbs
Using arm and leg protectors
Supporting dependent legs or arms with pillows
Cushioning sharp furniture corners
Avoiding grabbing a person by the arms
Avoiding pulling clothing over elbows or lower calves
Using padding on wheelchair arms and legs
Placing bed protectors over bedrails to avoid limbs getting caught between rails
Ensuring that the environment is well lit
Using non-adherent (non-stick) dressings and removing them in water
Following correct moving and handling procedures (never drag the person)
Skin tears – protecting the skin from damage
Arm and leg protectors provide protection against injury
They relieve pressure between bony prominences and keep limbs warm
Arm and leg protectors can be worn under clothes, in bed and wheelchairs or over dressings

They must never constrict a limb

Dressing a skin tear

Follow infection control procedures for:
Cleansing the wound and application of a sterile non-stick dressing
Securing the dressing and protecting the wound with a bandage

The wound should be observed regularly for signs of infection including swelling, pain, ooze and redness