1. The challenge of maintaining skin integrity on the older person - an achievable goal Rosie Callaghan Tissue Viability Nurse for Nursing Homes Worcestershire Primary Care Trust rosiecallaghan@nhs.net 07717543046

2. skin

3. layers

4. Thermoregulation Excretory Function metabolism Non-verbal communication Protectionsensation

6. Changes in ageing skin Ageing PigmentationThicknessMoistureTurgorTexture

8. Reduced number of sweat glands Reduction in the number of langerhans cells Poorer absorption through the skin Reduced vitamin D synthesis's Poor oxygenation Reduction in ability to detect pressure Impaired function of respiratory and immune systems Use of multiple medication Presence of Chronic conditions Poor nutrition and hydration Lac of tensile strength in healed wounds

10. Results in Are more likely to suffer pressure and thermal damage to the skin due to diminished sensation Risk hyper/hypothermia due to decreased subcutaneous tissue Have fewer sweat glands and therefore produce less sweat which hinders thermoregulation and increases the risk of hyperthermia Slower to exhibit a sensitization response redness heat discomfort due to reduction in langerhans cells this can result in overuse of topical medications and more severe allergic reactions Risk of overdose of transdermal medications poor absorption can prompt them to reapply too often Much higher incidence of shear and tear injuries due to compromised skin adhesion and less flexible collagen

11. Reduced vascularisation Prone to oedema around wounds Bruise easier Decreased sensation Not notice discomfort from Remaining in one position Bony areas have less subcutaneous cushioning Higher incidence of ischemia

12. Thinner skinLess effective barrierFewer langerhans cellsFewer mast cellsinfection Reduced sebum production Dry, itchy skin Puritis, dermatitis, venous leg ulcer

13. Pigment changes There is an increase in brown spots which resemble freckles. senile purpura are more often associated with the arms.

15. Extrinsic Factors Smoking Environmental pollutants Ultra violet light Decreased mobility Drug induced disorders Chronic illness

20. Correct manual handling techniques‘ good nutrition and hydration Good skin care including emollients and use of non perfumed soap The removal of potential hazards

22. references Benbow M (2009) skin tears British journal of Community Nursing 23 (1) 14- 18 Bianchi J, Cameron J (2008) Assessment of skin integrity in the elderly British journal of Community Nursing 13 (3) s23-32 Davies A Management of dry skin conditions in older people British journal of Community Nursing 13(6) 250-257 Finch M (2003) Assessment of skin in older people Nursing Older People 15 (2) 29-30 Hodgkinson B, Nay R, Wilson J (2006) A systematic review of topical skin care in aged facilities Journal of Clinical Nursing 16 129-136 Lawton S addressing the skin care needs of the older person British journal of Community Nursing 12(5) 203-210 British journal of Community Nursing 13 (7) 302-308 Nazarko L Understanding and treating a common dermal problem: pruritus Timmons J (2006) skin function and wound healing physiology Wound Essentials 1 8-17

23. Web sites www,skincarecampaign.org www.bdng.org.uk www.britishskinfoundation.org.uk http://www.woundcare.com/ http;//www.smtl.co.uk/World-Wide Wounds/www.smtl.co.uk/World-Wide Wounds/ http://www.ewma.org/ www.cochrane.org www.dressings.org