Skin changes with age. But the fundamentals of keeping aging skin clean and healthy aren’t very different from those of caring for young skin.

Normal skin changes in aging include:

• The outer layer of skin begins to thin making it more sensitive and easier to damage.
• The normal fat layer under the skin begins to disappear. This makes it easier for an elderly person to develop pressure sores as well as feel colder more quickly.
• Oil glands do not function as well and this makes the skin dryer. The skin begins to sag and wrinkle and it is easily bruised; bumps and scrapes tend to tear it. Dry skin is also more sensitive to chemical irritants, soap, infection and poor hygiene.
• Liver or age spots appear on the face, arms and back of hands.
• Sweat glands decrease in activity and this makes it harder for an elderly person to lower their body temperature in hot weather.
• Blood flow to the skin decreases and this makes it harder to heal skin injuries.

        The skin is a major body system. Its most vital body function is to provide protection. Keeping the skin intact, with no open areas, is an important task. Decubitus ulcers, or pressure sores, are areas where the skin and tissues are broken down due to lack of blood flow. They are caused by the loss of circulation, caused in turn by pressure on a part of the body. Other factors that contribute to the decubitus ulcers are dry skin and irritation by urine and feces. Care recipients who are unable to move or to change positions are more likely to develop decubitus ulcers. Bony areas of the body are also called pressure points. These points bear the weight of the body. Decubitus ulcers usually occur over these bony areas. Common areas include ears, elbows, under breast, backbone, shoulder blades, knees, ankles, heels, and toes. In obese (overweight) elders, decubitus can develop where the skin is in contact with skin, such as between the legs and the folds of abdominal skin. The first sign of a decubitus ulcer is either sore skin or a reddened area. The care recipient may complain of tingling, burning, or pain in an area. If not treated, the skin may blister, open, and a deep sore may develop, increasing the risk of infection. To prevent decubitus, maintain good skincare and cleanliness. It is much easier to prevent pressure sores than it is to heal them. The following guidelines should be observed to prevent skin breakdown:

• Change the care recipient’s position at least every two hours. The care recipient should be lifted or moved slowly to prevent burns from the sheets.
• Be careful when using bedpans. They can cause pressure and friction. Avoid spilling urine on the skin.
• Keep linens wrinkle-free and dry.
• Remove any hard objects from the bed, such as hairpins, food crumbs, etc. ” Use powder where skin comes together to form creases.
• Wash and dry care recipient’s skin with mild soap to remove urine or feces.
• If the care recipient shows signs of a pressure sore, gently rub around the area with non-drying lotion every two hours. Do NOT rub directly on the reddened area as too much rubbing can cause further skin breakdown. Figure out why the area is reddened and try to correct the problem.
• Always pat the skin dry (not rub) after bathing and apply lotion to dry areas.
• Provide a back rub when the care recipient is repositioned. It stimulates the circulation of blood.
• Use pillows, etc. to prevent skin from contact with skin.
• Report any observations of skin breakdown or decubitus to the care recipient’s physician.

Important facts to remember:

• The skin is the body ‘s first defense against disease. It needs to be protected from injury and irritation.
• Skin that is poorly nourished and dry has less ability to protect the body and is more vulnerable to injury.
• Bathing may be limited for those whose skin is extremely dry.
• Lotions or creams are often applied after personal care has been given.
• Very elderly clients may have paper-thin, “parchment” like skin that tears easily. Be gentle.
• Moisture in contact with the skin for a period of time can result in irritation and increased bacterial growth.
• It is very important to pat the skin dry after bathing, paying particular attention to creases and skin folds. Cornstarch or talcum powder may be applied in certain areas to absorb moisture.
• Incontinent clients need immediate cleaning to prevent irritation. During the bathing process, the skin should be washed with long, firm strokes, taking care to avoid harsh rubbing.
• Extremities (arms and legs) are washed from the farthest point (feet, hands) toward the trunk. This stimulates blood flow back to the heart from the distant portions of the body.

Infection Control Considerations with Skin Care

        Any time you contact body fluids during personal care or homemaking, when you discover open weeping areas, or when you help with cleaning a client after toileting, you need to wear disposable gloves. It is not necessary to wear gloves for general bathing, except for when cleaning the genitals. New areas of broken or reddened skin must be reported immediately to the supervisor.

        Always be sure that you protect your own skin from injury and irritation. If you have dry, cracked in on your hands, you should wear gloves. This protects you from picking up any infections and protects the client from your body fluids.

        Frequent hand washing during your workday can cause your skin to become dry and cracked. Use plenty of lotion after hand washing and at other times throughout the day. Well-lubricated skin provides a stronger defense for you, too.

BackRub

        Back rubs are refreshing and relaxing for everyone. To the care recipient who is in bed and/or unable to get up and move around, a back rub is even more important as it stimulates circulation. Procedure: Back Rub

1. Assemble equipment:

             a)      Towels;

             b)      Lotion;

             c)      Basin of warm water

1. Wash your hands.
2. Explain to the care recipient what you are going to do.
3. Warm the lotion by placing it in a basin of warm water.
4. Ask the care recipient to turn on his/her side or abdomen. If unable to, you can assist the care recipient over to the side.
5. Uncover the care recipient’s back and buttocks. Do not over-expose them.
6. Put a small amount of lotion in the palm of your hand. Rub your hands together.
7. Apply the lotion to the care recipient’s back, using long strokes. Remember to use proper body mechanics yourself.
8. Use a circular motion on the bony areas of the back. Continue rubbing for one to three minutes.
9. Dry the care recipient’s back and help to redress.
10. Make the care recipient comfortable.
11. Wash your hands and return equipment.