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Unwrapping a big issue

Ann Rudowski outlines some simple strategies to reduce skin tears.

Skin tears have in the past received little attention with the apparent view that they are necessarily a consequence of ageing; clearly this is not the case. While ageing is a significant risk factor for the occurrence of skin tears, they are largely preventable.

The incidence and prevalence of skin tears are significant and have been reported to range anywhere from 27 per cent to 41.5 per cent among older people living in residential aged care facilities. A survey of 44 Victorian aged care facilities revealed skin tears to be the most common wound (54 per cent) when compared with pressure ulcers and leg ulcers.

Older people are at particular risk of incurring skin tears partly because of the normal ageing process and partly as a result of external mechanical forces applied to the skin.

Skin is exposed daily to the risk of irritants and substances in the environment, as well as to physical and mechanical injury. As we age the epidermis and dermis becomes thinner with a decrease in the number of elastin and collagen fibres giving it that paper-thin quality.

Thermoregulation, sensation and pain perception are altered making the skin much more vulnerable to mechanical trauma such as friction and shearing force injuries that subsequently result in a skin tear.

Preventing skin tears in older people is a challenge for all carers and clinicians as the most simple and routine movements involved in providing care to dependent older persons can pose a threat to their skin integrity.

Manual handling activities such as transferring, lifting, and positional changes can cause friction and shearing forces that damage the skin. Daily routine activities of bathing and dressing also pose a serious risk to older skin.

Older people who are independently mobile are also at risk of sustaining skin tears.

This coupled with a history of falls, peripheral neuropathy, a history of stroke, diabetes, sensory impairments such as visual deficits, reduced peripheral sensation and cognitive impairments increases the risk of sustaining skin tears particularly of the lower limbs.

Simple strategies can be used to reduce the risk of trauma to older skin. Education on manual handling and the use of assistive devices can help to reduce the impact of mechanical injury to the skin.

Factors that reduce direct contact with the skin can include the padding of wheelchairs, equipment and furniture. While some cite long sleeves, trousers or stockings as reducing the risk of injury; the evidence does not support a reduction.

However, adding another layer of protection such as using arm and leg protectors to reduce the impact of external forces on the skin will help to reduce the incidence of skin tears.

ActionWorks worked closely with aged care nurses to design and develop arm and leg protectors aimed at the prevention of skin tears, injury and discomfort. They not only protect the limbs, they also ensure that bony prominences are not in direct contact with each other.

The leg protectors have the added advantage of increasing blood circulation by keeping the legs warm day or night. While in bed, leg protectors reduce the need for the excessive use of pillows or other supports often used in an effort to reduce pressure.

Arm protectors are not only useful for protecting the skin against external forces but can also be used in older people who are receiving intravenous therapy (IV). By helping protect IV sites and cannulae from potential displacement, they also maintain a degree of warmth, facilitating improved circulation, particularly in frail clients.

The arm protectors are less intrusive than hard arm splints and bandages. They are lightweight, comformable and comfortable to wear and their ease of application and removal makes access to IV sites and cannulae much more readily available. Arm protectors can also be used to cover IV sites in older people who become distressed at the presence and sight of IV cannulae.

Interest and the application of the arm and leg protectors is becoming widespread, not only from facilities here and internationally, but also from individuals.

Feedback provided to ActionWorks by nurses and health care professionals and carers claim that the arm and leg protectors are making a significant and important contribution to the reduction and the prevention of skin tears and injury to the limbs.

Ann Rudowski is with ActionWorks. Go to actionworks.com.au.

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