1. 5/30/05 draft Aging & the Integumentary System Support for this project provided to School of Nursing, University of Washington by the John A. Hartford Foundation, Geriatric Nursing Education Grant and Nursing School Geriatric Investment Program Grant. Content for this module provided by The John A. Hartford Foundation, Institute for Geriatric Nursing, Online Gerontological Nursing Certification Review Course http://www.nyu.edu/education/nursing/hartford.institute/course/

2. 5/30/05 draft Aging & Integumentary Changes Skin  epidermal & dermal thickening & contact area Flattening of epidermal/dermal junction  subcutaneous fat  connective tissue  elasticity (thinning, loose skin, wrinkles)  # of melanocytes

3. 5/30/05 draft Aging & Integumentary Changes Skin  hair follicle density  sebaceous & sweat gland activity  melanin  immune cells  vascularity,  nerve endings

4. 5/30/05 draft Aging & Integumentary Changes Nails Alternating hyperplasia (nail thickening) and hypoplasia  growth rate Longitudinal ridges Thinner, more brittle Dermatology Image Atlas http://dermis.multimedica.de/doia

5. 5/30/05 draft Aging & Integumentary Changes Physiological changes Loss of body hair Loss of skin pigment (  melanin)  sweating Dry skin Puritis of skin (itching) Graying & thinning hair

6. 5/30/05 draft Aging & Integumentary Changes  susceptibility to: skin tears bruising shearing pressure damage blunt trauma  risk of heat stroke & hypothermia Slower healing  barrier protection Delayed absorption of medications  UV protection  vulnerability of pressure points Functional implications

7. 5/30/05 draft Aging & Integumentary Changes Dermis Paler skin color, uneven pigmentation age spots (‘liver spots’) Skin tags, xerosis (  moisture), actinic & seborrheic keratosis  wrinkling  loose/slack skin, due to loss of connective tissue Fragile skin that looks ‘paper-thin’ Photo provided by the Administration on Aging at http://www.aoa.gov/press/multimed/photos/2002/01_Jan/images_aging/photo_images_aging.asp

8. 5/30/05 draft Aging & Integumentary Changes Nursing assessment Medical & surgical hx Co-morbid illness/intrinsic factors (i.e. anemia, hypoxia, peripheral vascular disease, low albumin) Risk assessment – Braden scale Nutritional status – Nutrition scale Hydration status Functional status – Katz scale Environment

9. 5/30/05 draft Aging & Integumentary Changes Nursing considerations Potential for altered topical medication absorption Prevention: 1st-line strategy for pressure ulcer care  incidence of benign & malignant growths Hydration, moisturizing, sun protection Keep dressing tape to a minimum

10. 5/30/05 draft