Frailty and body mass index are associated with biophysical properties of the skin in community-dwelling older adults

Risk factors of skin barrier dysfunction in older adults: A systematic review

AIM

Skin barrier dysfunction can trigger various skin disorders in older adults. Skin barrier assessment is essential for nurses and caregivers to prevent skin disorders; however, the evidence available for clinical assessment is limited. This systematic review aimed to clarify the risk factors of skin barrier dysfunction in older adults.

METHODS

This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The four databases were searched using multiple terms related to "aged" and "skin barrier." The search was initially run on April 19, 2023, and rerun on October 12, 2023. Peer-reviewed quantitative studies in English were included, with no publication time limit being set. Two reviewers assessed the risk of bias in a blinded and independent manner using JBI tools. Owing to the heterogeneity of the results, a narrative synthesis was performed.

RESULTS

Among the database-identified 4833 studies, 20 studies were included. The extracted factors were categorized as demographic characteristics, functional characteristics, chronic diseases, nutritional status, skin condition, and environmental factors. However, owing to high risk of bias and inconsistent results across studies, only chronic kidney disease and dry skin were considered risk factors for skin barrier dysfunction in older adults.

CONCLUSIONS

Assessment of chronic kidney disease and dry skin in daily skin care may guide the development of personalized skincare programs to maintain skin integrity in older adults. Furthermore, cohort studies that consider confounding factors and the reliability of measurements are needed for an in-depth investigation into skin barrier dysfunction and more risk factors.

Facial Physiological Characteristics and Skin Microbiomes Changes are Associated with Body Mass Index (BMI)

Background

Overweight and obesity have become public health problems worldwide. An increasing number of research works are focusing on skin physiology and the manifestations of obesity-associated skin diseases, but little is known about the correlations between body mass index (BMI), facial skin physiological parameters, and the facial skin microbiome in healthy women.

Objective

To investigate the correlations between BMI, facial skin physiological parameters and facial bacteria and fungi in 198 women aged 18 to 35 years in Shanghai.

Methods

According to the international BMI standard and Chinese reference standard, subjects were divided into three groups, "lean" B1, "normal" B2 and "overweight" B3, and the physiological parameters of facial skin were measured by non-invasive instrumental methods, and the skin microbiota was analyzed by 16S rRNA and ITS high-throughput sequencing.

Results

Compared with the skin physiological parameters of the normal group, those of the overweight group exhibited a significant increase in trans-epidermal water loss (TEWL), which indicated that the skin barrier was impaired. The skin haemoglobin content was significantly increased, and skin surface pH was significant decreased in those with a high BMI. Furthermore, α-diversity, analysed using the Shannon, Chao, Sobs, and Ace indexes, was increased in the overweight group, suggesting that the diversity and species abundance of facial bacterial and fungal microbiota were also increased. Moreover, the overweight group had higher abundances of Streptococcus, Corynebacterium, Malassezia, and Candida. Notably, skin surface pH was significantly and negatively correlated with the relative abundances of Malassezia, Candida, and Cladosporium. Besides, the abundance of Malassezia was positively associated with the abundances of Staphylococcus and Corynebacterium.

Conclusion

These results indicate that BMI is associated with differences in the biophysical properties and microbiome of the facial skin. A high BMI affects the integrity of skin barrier and changes the skin flora diversity and species composition.

Association of Epidermal Biophysical Properties with Obesity and Its Implications

BACKGROUND

Obesity is a condition defined by an excess amount of body fat, with body mass index (BMI) of 30 and higher. It is associated with a number of other medical conditions, including insulin resistance, diabetes mellitus, and cardiovascular diseases, as well as dyslipidemia, and it is also associated with several cutaneous disorders such as atopic dermatitis, psoriasis, intertriginous dermatitis, acanthosis nigricans and skin infections.

SUMMARY

Evidence suggests a link between obesity and epidermal dysfunction. Generally, individuals with obesity display higher transepidermal water loss rate and lower stratum corneum hydration levels, although no association of obesity with epidermal dysfunction has been documented. Results of skin surface pH are controversial. But study demonstrated a positive correlation of BMI with skin surface pH on both the forearm and the shin in males, suggesting that the changes in epidermal function vary with gender in individuals with obesity.

KEY MESSAGES

This review summarizes the association between obesity and epidermal function, and discusses possible underlying mechanisms. Individuals with obesity exhibit poor epidermal permeability barrier and lower stratum corneum hydration levels. Because of the pathogenic role of compromised epidermal function in inflammation, which is also linked to obesity, improvement in epidermal function could benefit individuals with obesity, particularly those with abnormalities in epidermal function.

The Length of Incision in Unicondylar Knee Arthroplasty Is More Affected by the Patient's Height Than Their Weight

Objective Obesity leads to osteoarthritis due to increased loading forces on joint cartilage and inflammatory agents released from adipose tissue. In patients with a high body mass index (BMI), during hip and total knee arthroplasty, surgical technical challenges such as longer incisions and wider exposure are encountered, resulting in increased postoperative complications (wound healing problems and infection, venous thromboembolism (VTE)- pulmonary embolism (PE), dislocation, early implant failure) and ultimately decreased patient satisfaction and implant survival. This study investigates whether BMI, height, weight, and patient age are associated with longer incisions in patients undergoing unicondylar knee prosthesis (UKP) placement. Method Between January 2017 and December 2018, 30 patients (29 females and 1 male) who underwent UKP surgery due to medial gonarthrosis were included in the study. The UKP used in the procedures was the Oxford Knee Phase III by Biomet Ltd., UK. The study comprised 43 knees, 13 being bilateral cases, 8 on the right, and 9 on the left. Data regarding the patient's height, weight, BMI, age, and the operated side were collected and compiled. The relationships between these variables and the surgical incision length were statistically analyzed. Results The average age of the patients was 66.3 years, with an average weight and height of 77.6 kg (ranging from 62 to 98 kg) and 167 cm (ranging from 150 to 184 cm), respectively. The lengths of the surgical incisions ranged from 70 mm to 160 mm, with an average length of 124.5 mm. When comparing the incision lengths between the right and left sides, it was observed that the incisions on the left side were longer. The average incision length on the right side was 122.09 mm, while on the left, it was 126.86 mm. Moreover, in the 13 patients who underwent bilateral surgery, this difference in incision length was even more pronounced. The average incision length on the right side was 117.15 mm, whereas on the left, it was 124.23 mm. Bivariate correlation analyses were performed to examine the relationship between the length of the incision and BMI and age. However, no significant relationship was found between the incision length and BMI or age. On the other hand, there was a correlation between the patient's weight values and the incision length (p < 0.05, correlation 0.335). Furthermore, a higher correlation was observed between the patient's height and the incision length (p < 0.01, correlation 0.595). Conclusion The latest advances in surgical techniques and instrumentation have enabled surgeons to perform the procedure using a reliable mini-incision approach. Mid-term evaluation of UKP with mini-incision shows faster recovery and lower morbidity. The findings show that in UKP, the length of the surgical incision is more strongly related to the patient's height than their weight.

Factors Related to the Skin Thickness of Cardiovascular Implantable Electronic Device Pockets

BACKGROUND

The skin overlying cardiovascular implantable electronic devices (CIEDs) sometimes becomes very thin after implantations, which could cause a device erosion. The factors related to the skin thickness of device pockets have not been elucidated.

OBJECTIVE

This study aimed to evaluate the skin thickness of CIED pockets and search for the factors associated with the thickness.

METHODS

Seventeen skin thickness points around the CIED pocket were measured through ultrasonography in each patient.

RESULTS

A total of 101 patients (76±11 years, 26 female) was enrolled. The median duration from the implantation to the examination was 95 months (quartile: 52.5~147.5). The median skin thickness overlying the device was 4.1 mm (3.3~5.9). Patients with heart failure and malignancy had thinner skin overlying the CIED than those without. A significant correlation existed between skin thickness and body mass index (BMI), hemoglobin, serum creatinine, estimated glomerular filtration rate (eGFR), and left ventricular ejection fraction. In contrast, the age, gender, and device size did not exhibit a significant correlation with the skin thickness. A multivariate logistic regression analysis revealed that chronic heart failure and a decrease in the eGFR and BMI were independent predictive factors of "very thin (≦3.3 mm)" skin of the CIED pocket late after an implantation.

CONCLUSION

Aside from a low BMI, the comorbidities (low hemoglobin, heart failure, and renal dysfunction) had a stronger impact on the skin thickness overlying the device than the device size. A careful observation of the device pocket should be performed in patients with those risk factors. This article is protected by copyright. All rights reserved.

Mapping instruments for assessing and stratifying frailty among community-dwelling older people: a scoping review

OBJECTIVE

To map in the current literature instruments for the assessment and stratification of frailty in community-dwelling older people, as well as to analyse them from the perspective of the Brazilian context.

DESIGN

Scoping review.

STUDY SELECTION

The selection of studies took place between March and April 2020. Includes electronic databases: Medline, Latin American and Caribbean Literature in Health Sciences, Scopus, Web of Science and Cumulative Index of Nursing and Literature Health Alliance, in addition to searching grey literature.

DATA EXTRACTION

A data extraction spreadsheet was created to collect the main information from the studies involved, from the title to the type of assessment and stratification of frailty.

RESULTS

In summary, 17 frailty assessment and stratification instruments applicable to community-dwelling older people were identified. Among these, the frailty phenotype of Fried et al was the instrument most present in the studies (45.5%). The physical domain was present in all the instruments analysed, while the social, psychological and environmental domains were present in only 10 instruments.

CONCLUSIONS

This review serves as a guideline for primary healthcare professionals, showing 17 instruments applicable to the context of the community-dwelling older people, pointing out advantages and disadvantages that influence the decision of the instrument to be used. Furthermore, this scoping review was a guide for further studies carried out by the same authors, which aim to compare instruments.

Effect of an Oral Nutrition Supplement Containing Collagen Peptides on Stratum Corneum Hydration and Skin Elasticity in Hospitalized Older Adults: A Multicenter Open-label Randomized Controlled Study

OBJECTIVE

The purpose of this randomized open-label study was to investigate the effect of an oral nutrition supplement containing collagen peptides on stratum corneum hydration and skin elasticity.

METHODS

The study protocol was registered at the UMIN Clinical Trials Registry (UMIN 000027347). Once-a-day oral administration of a nutrition supplement containing collagen peptides (10.0 g) was instituted in 39 inpatients 65 years or older who were assigned to either the intervention or the control group using a block-randomization design. Stratum corneum hydration and skin elasticity were measured at baseline and at 2, 4, 6, and 8 weeks after the start of the intervention.

RESULTS

Mean stratum corneum hydration was significantly increased from 43.7 at baseline to 51.7 at postintervention week 8 in the intervention group (P = .001). Differences in skin elasticity from baseline were significant at postintervention week 6 (P = .026) and week 8 (P = .049).

CONCLUSIONS

Oral nutrition supplements containing collagen peptides may reduce skin vulnerability in older adults and thus prevent conditions such as skin tears.

Risk factor analysis of the decrease in gait speed among Japanese older outpatients with polypharmacy

Background

Both polypharmacy and frailty are critical issues faced by the elderly. The decrease in gait speed is an index of frailty, and it is generally associated with falls and fractures, which are risk factors requiring the need for support or long-term patient care. In this study, we assess the risk factors responsible for the decrease in gait speed in older outpatients with polypharmacy.

Methods

Thirty-one persons (13 men, 18 women) aged 65 years or above and regularly taking 5 or more internal medications participated in this study.

Results

Propensity score-adjusted multivariate logistic analysis showed that only number of medications was associated with the risk of decreasing gait speed (odds ratio: 16.00, 95% confidence interval:1.72–149.00, p value = 0.0149). A negative correlation was found between the number of medications and gait speed. In addition, the gait speed of the calcium channel blocker medication group was significantly slower than that of the non-medication group.

Conclusion

These results suggest that not only the number of medications but also the prescription contents is a risk factor for decrease in gait speed and may serve as indexes to identify patients at high risk of requiring support or long-term care.