Skin Problems in the Elderly

Immunity is the key for good health. The immune system of our body is responsible for fighting off infections. Different people have different levels of immunity. It is said that a strong immune system keeps away all types of illnesses.

Age has a profound effect on the immune system. Cancer, radiation treatments, certain drugs, organ transplant are some cases that can adversely affect the immune system. The immune system can be weakened even by stress and a common cold. A weak immune system is responsible for skin ailments such as shingles, senile purpura, xerosis and seborrheic dermatitis.

The skin of the elderly is different. It has been through a variety of age related changes, including -

• Flattening of rete pegs. Rete pegs are projections in the skin that increase the area of contact between the skin.
• Decreased dermal thickness, nerve ends, blood vessels, elastin fibres and collagen. This leads to reduced sensation, moisture retention and thermoregulation.
• Effects of exposure. The skin of the older adults has been exposed to drugs like corticosteroids and steroids, or the environment.

All these can cause what is called a ‘skin breakdown.’ Remember, this is not a disease but the symptom of disease.

Skin breakdown in the elderly could be due to a number of reasons, but the most common is diseases like renal failure, malignancy, hepatic failure, diabetes, venous disease and lymphedema.

1. Skin tear: Is often seen in most elderly people. There are over 1.5 million skin tears reported each year in health care facilities. Of these 25% are from wheelchair injuries, 25% due to accidentally bumping into objects, 18% due to transfers, and 12% due to falls.

Skin tears can be treated in time so that infection does not set in. Undue pain and suffering in the elderly can be avoided by recognizing patients at risk, preventing the skin injury, and using dressings.

They can also be prevented by -

• Careful positioning, turning, and transferring techniques
• Care to prevent friction or shear
• Educating the caregivers about appropriate skin handling techniques
• Avoiding harsh movements or pulling
• Padding the bed rails, arms and leg supports of the wheelchair arm
• Using pillows and blankets for protection and support of arms and legs
• Clothing with long sleeves and pants

2. Diabetic Foot Ulcers: An ulcer of the skin is a condition where an area has broken down and the underlying tissue is visible. Most ulcers of the skin occur on the lower legs or feet. In normal people, a skin ulcer can heals when the skin is cut off. However, in people with diabetes, the healing process is slow or sometime absent. Ulcers in diabetics usually occur after a mild injury.

Foot ulcers can be serious. However, they also respond well to treatment. Ulcers get worse and take a long time to heal in people with diabetes, as the disease can affect blood circulation. Serious problems such as gangrene can develop, but these are quite rare.

In addition, having diabetes means you are more likely to have infections and an infection in the ulcer can occur. Foot ulcers can be prevented by good foot care. This includes -

• Checking the feet carefully each day, including the area between the toes to detect any injury or tear.
• Feel your feet all over to check if you have sensation in your feet
• Consult your doctor immediately if you notice anything new, like a cut, bruise, blister, redness or blood.
• Avoid the DIY stuff with corns , calluses and verrucas

A little care of the skin goes a long way is keeping infections at bay.

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http://cawc.net/images/uploads//CAWC_Foot_Ulcer_Screen_Tool_3pg_101E.pdf
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http://www.grhosp.on.ca/uploads/Careers,%20volunteers%20and%20students/PDFs/20111101%20Skin%20Care%20in%20the%20Elderly%20Ten%20Top%20Tips.pdf