1
|
Yang S, Liang X, She J, Tian J, Wen Z, Tao Y, Wang H, Zhang X. Prevalence and incidence of skin tear in older adults:A systematic review and meta-analysis. J Tissue Viability 2024:S0965-206X(24)00085-8. [PMID: 38971682 DOI: 10.1016/j.jtv.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/27/2024] [Accepted: 06/21/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Skin tear (ST) is a public health problem in older adults; they substantially increase the risk of complications and cause serious adverse consequences and health care burden. AIM To estimate the pooled prevalence and incidence of ST among older adults. METHODS Ten databases were systematically searched from their inception to July 27, 2023. Two researchers performed a systematic review independently according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All inconsistencies were resolved by a principal researcher. The pooled prevalence and incidence of ST were estimated in R 4.3.1 program. RESULTS Thirteen studies were included in this review. The pooled prevalence of ST was 6.0 % (95 % confidence interval (CI): 3.0%-11.0 %, I2 = 98 %), and the pooled incidence was 11.0 % (95 % CI: 5.0%-19.0 %, I2 = 94 %). The prevalence of ST was 11.0 % (95 % CI: 5.0%-19.0 %, I2 = 95 %) in long-term care facilities, 5.0 % (95 % CI: 3.0%-9.0 %, I2 = 86 %) in Europe, and 7.0 % (95 % CI: 1.0%-16.0 %, I2 = 82 %) in the Skin Tear Audit Research classification system (STAR). It has stabilized at 6.0 % since 2021. The incidence of ST was 15.0 % (95 % CI: 11.0%-20.0 %, I2 = 66 %) in long-term care facilities in Japan and 4.0 % (95 % CI: 2.0%-6.0 %) in Canada. CONCLUSIONS Older adults are at a high risk for ST. Our findings emphasize the importance of epidemiologic studies and further exploring assessment tools for ST. Healthcare professionals should pay attention to ST, identify high-risk individuals and associated factors, and implement targeted prevention strategies for older adults.
Collapse
Affiliation(s)
- Shenbi Yang
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Xiaoli Liang
- Sichuan Nursing Vocational College, Chengdu, 610100, China
| | - Jian She
- Department of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Jing Tian
- West China Second University Hospital, Sichuan University,Chengdu, 610044, China
| | - Zhifei Wen
- Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu, 610032, China
| | - Yanmin Tao
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Hongyan Wang
- Sichuan Nursing Vocational College, Chengdu, 610100, China
| | - Xiangeng Zhang
- Sichuan Nursing Vocational College, Chengdu, 610100, China.
| |
Collapse
|
2
|
Holloway S, Prentice J, Samuriwo R. Preventing, assessing and treating skin tears. Nurs Stand 2023; 38:37-45. [PMID: 37661724 DOI: 10.7748/ns.2023.e12127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 09/05/2023]
Abstract
Skin tears are acute wounds caused by mechanical forces resulting in the separation of the skin's outer layers. Skin tears are more likely to occur in vulnerable people such as older people and people with neurodegenerative conditions. Rising life expectancy means that the number of patients with skin tears is expected to increase. This article describes the characteristics of skin tears, details the risk factors for skin tears and explains the importance of using a holistic, evidence-based and person-centred approach to skin tear prevention, assessment and treatment. The article outlines the crucial role of nurses as part of the multidisciplinary team in the management of skin tears.
Collapse
Affiliation(s)
- Samantha Holloway
- centre for medical education, College of Biomedical and Life Sciences, Cardiff University School of Medicine, Cardiff, Wales
| | - Jenny Prentice
- wound skin ostomy service, Hall & Prior Health & Aged Care Group, and director, Trojan Health, Perth, Australia
| | - Ray Samuriwo
- professional lead adult nursing and director of postgraduate research, School of Nursing and Healthcare Leadership, Faculty of Health Studies, University of Bradford, Bradford, England
| |
Collapse
|
3
|
Abstract
Significance: Healthy skin provides a barrier to contaminants. Breaches in skin integrity are often encountered in the patient health care journey, owing to intrinsic health issues or to various procedures and medical devices used. The time has come to move clinical practice beyond mere awareness of medical adhesive-related skin injury and toward improved care and outcomes. Recent Advances: Methods developed in research settings allow quantitative assessments of skin damage based on the measurement of baseline skin properties. These properties become altered by stress and over time. Assessment methods typically used by the cosmetic industry to compare product performance could offer new possibilities to improve clinical practice by providing better information on the status of patient skin. This review summarizes available skin assessment methods as well as specific patient risks for skin damage. Critical Issues: Patients in health care settings may be at risk for skin damage owing to predisposing medical conditions, health status, medications taken, and procedures or devices used in their treatment. Skin injuries come as an additional burden to these medical circumstances and could be prevented. Technology should be leveraged to improve care, help maintain patient skin health, and better characterize functional wound closure. Future Directions: Skin testing methods developed to evaluate cosmetic products or assess damage caused by occupational exposure can provide detailed, quantitative information on the integrity of skin. Such methods have the potential to guide prevention and treatment efforts to improve the care of patients suffering from skin integrity issues while in the health care system.
Collapse
Affiliation(s)
- Stéphanie F. Bernatchez
- 3M Health Care, St. Paul, Minnesota, USA.,Correspondence: 3M Health Care, St. Paul, MN 55144-1000, USA
| | | |
Collapse
|
4
|
Bandeira MA, Schmidt FMQ, Nogueira PC, Rosa T, Felizardo RDM, Villela de Castro DL, Woo K, Santos VLCG. The prevalence of skin tears and associated factors in hospitalised patients with cancer. J Wound Care 2022; 31:579-584. [PMID: 35797254 DOI: 10.12968/jowc.2022.31.7.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Oncology patients are vulnerable to skin breakdown. The primary purpose of this study was to estimate the prevalence of skin tears (STs) in hospitalised patients with cancer and to explore related sociodemographic and clinical factors. METHOD This was an observational, epidemiological, cross-sectional study conducted in an oncology hospital in the city of São Paulo. All STs were classified using the STAR Classification adapted and validated for Brazil. RESULTS Of the 341 patients evaluated, 22 had STs, equating to a prevalence of 6.5%. A higher number of STs were noted on the lower limbs (26.9%) than on other body areas. The main factors associated with STs were the use of anticoagulants, the presence of ecchymosis and the use of incontinence briefs. CONCLUSION This study contributed to a better understanding of the epidemiology of STs in hospitalised patients with cancer, as well as its associated factors. Results may inform nursing professionals with regard to the need to develop prevention strategies and early interventions.
Collapse
Affiliation(s)
| | | | - Paula C Nogueira
- Medical-Surgical Nursing Department University of São Paulo, School of Nursing, São Paulo, SP, Brazil
| | - Talita Rosa
- University of São Paulo, School of Nursing, São Paulo, SP, Brazil
| | | | | | - Kevin Woo
- School of Nursing, School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | | |
Collapse
|
5
|
Bandeira da Silva CV, da Costa Silva RS, Serna González CV, Hevia Campos HM, Woo K, Nogueira PC, Gouveia Santos VLCD. Epidemiología de los desgarros de piel: revisión bibliográfica. J Wound Care 2022; 31:7-18. [PMID: 36789899 DOI: 10.12968/jowc.2022.31.latam_sup_6.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Objetivo: Identificar y describir la epidemiología de los desgarros de piel (DP) en el contexto latinoamericano. Método: Revisión bibliográfica de estudios epidemiológicos publicados entre 1946 y mayo de 2021, en inglés, español y portugués, consultados en texto completo. Para la búsqueda, se utilizaron descriptores correspondientes a la estrategia PCC: Población (adultos), Concepto (epidemiología de los DP) y Contexto (hospitalario e institucional). Los estudios fueron recuperados de las bases de datos Scielo, Lilacs, Embase, Cinahl, Medline y BDEnf, y evaluados por dos revisores independientes. Los instrumentos STROBE y Newcastle-Ottawa fueron usados para evaluar la calidad de estudios de prevalencia e incidencia, respectivamente. Resultados: En total, 21 publicaciones fueron incluidas (siete de ellas, de origen latinoamericano). La prevalencia, reportada en 16 estudios, estuvo entre 0,97 y 28,7%. La incidencia, reportada en cinco estudios, varió entre 3,8 y 40%. Los factores de riesgo asociados al desarrollo de DP fueron: historia previa de la lesión, puntajes bajos en la escala de Braden, dependencia para actividades básicas de la vida diaria, y edad avanzada. En América latina, Brasil se destaca como el país con mayor número de publicaciones (n=5; 23,8%). Conclusión: La mayoría de los DP pueden ser considerados eventos adversos evitables, por lo tanto, los valores de incidencia y prevalencia encontrados son elevados. La caracterización de la situación epidemiológica de los DP posibilita la creación de protocolos y políticas públicas para su prevención y detección precoz. Conflicto de interés: Todos los autores son miembros del International Skin Tears Advisory Panel (ISTAP). CVBS es consultora técnica. CVSG es conferencista. KW es miembro del Canadian Pressure Injury Advisory Panel, consultor en centros de heridas en Canadá, y conferencista para varias empresas internacionales en la industria del cuidado de las heridas.
Collapse
Affiliation(s)
- Cinthia V Bandeira da Silva
- Programa de Posgrado en Enfermería en la Salud del Adulto (PROESA). Escuela de Enfermería, Universidad de San Pablo (Escola de Enfermagem da Universidade de São Paulo), San Pablo, Brasil.,Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Rayanne S da Costa Silva
- Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Carol V Serna González
- Programa de Posgrado en Enfermería en la Salud del Adulto (PROESA). Escuela de Enfermería, Universidad de San Pablo (Escola de Enfermagem da Universidade de São Paulo), San Pablo, Brasil.,Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Heidi M Hevia Campos
- Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil.,Escuela de Enfermería, Universidad Andres Bello, Viña del Mar, Chile
| | - Kevin Woo
- Escuela de Enfermería, Universidad de Queens (Queen's University), Kingston, Ontario, Canadá
| | - Paula C Nogueira
- Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil.,Departamento de Enfermería Médico-quirúrgica, Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Vera L Conceição de Gouveia Santos
- Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil.,Departamento de Enfermería Médico-quirúrgica, Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| |
Collapse
|
6
|
Bandeira da Silva CV, da Costa Silva RS, Serna González CV, Hevia Campos HM, Woo K, Nogueira PC, Gouveia Santos VLCD. Epidemiología de los desgarros de piel: revisión bibliográfica. J Wound Care 2022; 31:7-18. [PMID: 36787945 DOI: 10.12968/jowc.2022.31.latam_sup_6a.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Objetivo: Identificar y describir la epidemiología de los desgarros de piel (DP) en el contexto latinoamericano. Método: Revisión bibliográfica de estudios epidemiológicos publicados entre 1946 y mayo de 2021, en inglés, español y portugués, consultados en texto completo. Para la búsqueda, se utilizaron descriptores correspondientes a la estrategia PCC: Población (adultos), Concepto (epidemiología de los DP) y Contexto (hospitalario e institucional). Los estudios fueron recuperados de las bases de datos Scielo, Lilacs, Embase, Cinahl, Medline y BDEnf, y evaluados por dos revisores independientes. Los instrumentos STROBE y Newcastle-Ottawa fueron usados para evaluar la calidad de estudios de prevalencia e incidencia, respectivamente. Resultados: En total, 21 publicaciones fueron incluidas (siete de ellas, de origen latinoamericano). La prevalencia, reportada en 16 estudios, estuvo entre 0,97 y 28,7%. La incidencia, reportada en cinco estudios, varió entre 3,8 y 40%. Los factores de riesgo asociados al desarrollo de DP fueron: historia previa de la lesión, puntajes bajos en la escala de Braden, dependencia para actividades básicas de la vida diaria, y edad avanzada. En América latina, Brasil se destaca como el país con mayor número de publicaciones (n=5; 23,8%). Conclusión: La mayoría de los DP pueden ser considerados eventos adversos evitables, por lo tanto, los valores de incidencia y prevalencia encontrados son elevados. La caracterización de la situación epidemiológica de los DP posibilita la creación de protocolos y políticas públicas para su prevención y detección precoz. Conflicto de interés: Todos los autores son miembros del International Skin Tears Advisory Panel (ISTAP). CVBS es consultora técnica. CVSG es conferencista. KW es miembro del Canadian Pressure Injury Advisory Panel, consultor en centros de heridas en Canadá, y conferencista para varias empresas internacionales en la industria del cuidado de las heridas.
Collapse
Affiliation(s)
- Cinthia V Bandeira da Silva
- Programa de Posgrado en Enfermería en la Salud del Adulto (PROESA). Escuela de Enfermería, Universidad de San Pablo (Escola de Enfermagem da Universidade de São Paulo), San Pablo, Brasil.,Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Rayanne S da Costa Silva
- Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Carol V Serna González
- Programa de Posgrado en Enfermería en la Salud del Adulto (PROESA). Escuela de Enfermería, Universidad de San Pablo (Escola de Enfermagem da Universidade de São Paulo), San Pablo, Brasil.,Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Heidi M Hevia Campos
- Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil.,Escuela de Enfermería, Universidad Andres Bello, Viña del Mar, Chile
| | - Kevin Woo
- Escuela de Enfermería, Universidad de Queens (Queen's University), Kingston, Ontario, Canadá
| | - Paula C Nogueira
- Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil.,Departamento de Enfermería Médico-quirúrgica, Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Vera L Conceição de Gouveia Santos
- Grupo de Investigación en Estomaterapia. Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil.,Departamento de Enfermería Médico-quirúrgica, Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| |
Collapse
|
7
|
Peres GRP, Bandeira da Silva CV, Strazzieri-Pulido KC, de Gouveia Santos VLC. Skin tears in older adult residents of long-term care facilities: prevalence and associated factors. J Wound Care 2022; 31:468-478. [PMID: 35678790 DOI: 10.12968/jowc.2022.31.6.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the prevalence of skin tears, and demographic and clinical factors associated with their presence in older adult residents of long-term care facilities. METHOD This observational, quantitative, cross-sectional, epidemiological study was conducted with older adult residents of three long-term care facilities in São Paulo, Brazil. For data collection, four instruments were used: a questionnaire assessing sociodemographic and clinical characteristics of the residents; and the Brazilian-Portuguese versions of the Mini-Mental State Examination, Skin Tear Audit Research (STAR) Skin Tear Classification System, and the Katz Index of Independence in Activities of Daily Living. RESULTS A total of 69 residents took part in the study. The prevalence of skin tears was 11.6%. Skin tears were significantly associated with the presence of haematoma (odds ratio, OR=9.159; p=0.017) and actinic purpura (OR=6.265; p=0.033), which increased the odds of skin tear development nine-fold and six-fold, respectively. CONCLUSION The findings agree with the international literature. Considering that this was the first epidemiological study on skin tears carried out in long-term care facilities for older adults in Brazil, its contribution lies in the systematisation of data collection and making data available on a field that has not yet been studied in this country.
Collapse
|
8
|
Yüceler Kaçmaz H, Karadağ A, Kahraman H, Erat A, Ödek Ö, Akın S. The prevalence and factors associated with skin tears in hospitalized older adults: A point prevalence study. J Tissue Viability 2022; 31:387-394. [DOI: 10.1016/j.jtv.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/02/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
|
9
|
Souza LMD, Teixeira GDS, Silva DMD, Ruiz LDS, Coppola IDS, Meirelles LCDS. Prevalence of skin tears in hospitalized adults and older adults. Rev Esc Enferm USP 2021; 55:e03683. [PMID: 33886912 DOI: 10.1590/s1980-220x2019025103683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/22/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify the prevalence, related factors and to classify Skin Tears in hospitalized adults and older adults. METHOD Prevalence study with adults and older adults in inpatient and intensive care units of a hospital in the South Region of Brazil. The STAR Skin Tear Classification System was used to analyze the lesions. Data were collected by physical examination and consultation of medical records. The Poisson Regression Prevalence Ratio with robust variance was calculated. RESULTS The participants were 148 patients. There were 29 Skin Tears (mean 1.6 ± 0.7) in 18 individuals (prevalence of 12.2%). The variables age, friable skin, enteral feeding catheter, degree of dependence, use of antihypertensives, micronutrients, diuretics, antidepressants, and antifungals were associated with lesions in the bivariate analysis. In the final multivariate model, antihypertensives PR 2.42 (95%CI 1.01-5.77), antidepressants PR 2.72 (95%CI 1.1-6.33) and micronutrients PR 4.93 (95%CI 1.64-14.80) maintained a relationship. CONCLUSION The prevalence of injuries was 12.2%, showing they are present in the health care setting, especially in nursing care. Care protocols need to be developed for the prevention, identification and early treatment of ST.
Collapse
Affiliation(s)
- Luccas Melo de Souza
- Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Enfermagem, Porto Alegre, RS, Brazil
| | | | | | | | | | | |
Collapse
|
10
|
Risk scoring tool for forearm skin tears in Japanese older adults: A prospective cohort study. J Tissue Viability 2021; 30:155-160. [PMID: 33741206 DOI: 10.1016/j.jtv.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/09/2021] [Accepted: 02/24/2021] [Indexed: 11/21/2022]
Abstract
[Aim] Because painful skin tears frequently occur in older patients, the prevention of skin tears is fundamental to improve their quality of life. However, a risk assessment tool for skin tears has not been established yet in Japan. Therefore, we aimed to propose a risk scoring tool for skin tears in Japanese older adult. [Methods] We conducted a prospective cohort study with 6-month follow-up in two long-term care hospitals in Japan. A total of 257 inpatients were recruited. Patient and skin characteristics were collected at baseline, and the occurrence of forearm skin tears were examined during follow-up. To develop a risk scoring tool, we identified risk factors, and converted their coefficients estimated in the multiple logistic regression analysis into simplified scores. The predictive accuracy of the total score was evaluated. [Results] Of 244 participants, 29 developed forearm skin tears during the follow-up period, a cumulative incidence of 13.5%. Senile purpura, pseudoscar, contracture, and dry skin were identified as risk factors for skin tears. Their weighted scores were 6, 4, 5, and 6, respectively. The area under the receiver operating characteristic curve of the total score was 0.806. At a cut-off score of 12, the sensitivity was 0.86, and the specificity was 0.67. [Conclusion] Our forearm skin tear risk scoring tool showed high accuracy, whereas specificity was low. This tool can contribute to prevent forearm skin tears in Japanese older adults.
Collapse
|
11
|
Spin M, Vocci MC, Sardeli KM, Serafim CTR, Velozo BC, Popim RC, Castro MCNE. LESÃO POR FRICÇÃO EM IDOSOS. ESTIMA 2021. [DOI: 10.30886/estima.v19.1002_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivos:identificar na literatura científica o conhecimento produzido sobre lesões por fricção em idosos. Métodos: trata-se de uma revisão integrativa de literatura (2014-2019), realizada a partir de busca nas bases de dados/plataformas National Library of Medicine, Biomedical Answers e Biblioteca Virtual em Saúde, com descritores e os operadores booleanos “and” e “or”. Resultados: a partir da busca bibliográfica, seleção e análise, oito artigos compuseram a amostra. Para lesão por fricção em idosos emergiram quatro pilares do cuidado: manutenção da homeostase orgânica e tissular com foco na nutrição e hidratação apropriada; evitar traumas na pele senil, proporcionando um ambiente seguro com dispositivos adequados; e a sistematização da assistência e educação em saúde do cuidado com a pele do idoso. Conclusão: como mecanismos de prevenção, encontram-se a realização da prevenção primária por meio de um plano de cuidados singular e as atividades de educação em saúde, focadas nos fatores de risco e nas vulnerabilidades, minimizando danos e complicações
Collapse
Affiliation(s)
- Mayara Spin
- Universidade Estadual Paulista – Faculdade de Medicina de Botucatu − Botucatu (SP), Brasil
| | | | | | | | - Bruna Cristina Velozo
- Universidade Estadual Paulista – Faculdade de Medicina de Botucatu − Botucatu (SP), Brasil
| | - Regina Célia Popim
- Universidade Estadual Paulista – Faculdade de Medicina de Botucatu − Botucatu (SP), Brasil
| | | |
Collapse
|
12
|
Spin M, Vocci MC, Sardeli KM, Serafim CTR, Velozo BC, Popim RC, Castro MCNE. SKIN TEARS IN THE ELDERLY. ESTIMA 2021. [DOI: 10.30886/estima.v19.1002_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives: to identify in the scientific literature the knowledge produced about skin tears injuries in the elderly. Methods: it is an integrative literature review (2014-2019), carried out by searching the databases/platforms National Library of Medicine, Biomedical Answers and Biblioteca Virtual em Saúde, with descriptors and the Boolean operators “and” and “or ”. Results: from the bibliographic search, selection and analysis, eight articles made up the sample. For skin tears injuries in the elderly, four pillars of care emerged: maintenance of organic and tissue homeostasis with a focus on proper nutrition and hydration; avoid trauma to senile skin, providing a safe environment with suitable devices; and the systematization of health care and education for elderly skin care. Conclusion: as prevention mechanisms, primary prevention is achieved through a unique care plan and health education activities, focused on risk factors and vulnerabilities, minimizing damage and complications.
Collapse
Affiliation(s)
- Mayara Spin
- Universidade Estadual Paulista – Faculdade de Medicina de Botucatu − Botucatu (SP), Brasil
| | | | | | | | - Bruna Cristina Velozo
- Universidade Estadual Paulista – Faculdade de Medicina de Botucatu − Botucatu (SP), Brasil
| | - Regina Célia Popim
- Universidade Estadual Paulista – Faculdade de Medicina de Botucatu − Botucatu (SP), Brasil
| | | |
Collapse
|
13
|
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. Adv Skin Wound Care 2021; 33:186-191. [PMID: 32195722 PMCID: PMC7328867 DOI: 10.1097/01.asw.0000655492.40898.55] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
Collapse
|
14
|
LeBlanc K, Woo KY, VanDenKerkhof E, Woodbury MG. Skin tear prevalence and incidence in the long-term care population: a prospective study. J Wound Care 2020; 29:S16-S22. [DOI: 10.12968/jowc.2020.29.sup7.s16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: The World Health Organization estimates that between 2015 and 2050 the proportion of the world's population over 60 years old will nearly double from 12% to 22%. An often overlooked byproduct of ageing is the skin changes associated with it, which heighten the risk of developing skin tears. Despite this presumed increased risk, the true impact of skin tears across age groups and care settings is poorly understood. The purpose of the present study was to establish the prevalence and incidence of skin tears in the Ontario long-term care population. Method: A prospective study design was used to explore the prevalence and incidence of skin tears. Individuals from four long-term care facilities in Ontario were followed over four weeks. The participants were examined for skin tears at the beginning of the study and at week four to determine whether skin tears had occurred and to record the skin tear type and location. Results: A total of 380 individuals, aged 65 years and over, took part. The study found a skin tear prevalence of 20.8% and an incidence of 18.9% within four weeks. These results provide much needed data on the burden of skin tears in the long-term care population. Conclusion: The present study is an important first step towards developing a prevention programme targeting individuals at risk for skin tears in long-term care.
Collapse
Affiliation(s)
- Kimberly LeBlanc
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Kevin Y Woo
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | | | - M Gail Woodbury
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
15
|
Van Tiggelen H, LeBlanc K, Campbell K, Woo K, Baranoski S, Chang Y, Dunk A, Gloeckner M, Hevia H, Holloway S, Idensohn P, Karadağ A, Koren E, Kottner J, Langemo D, Ousey K, Pokorná A, Romanelli M, Santos V, Smet S, Tariq G, Van den Bussche K, Van Hecke A, Verhaeghe S, Vuagnat H, Williams A, Beeckman D. Standardizing the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory Panel Classification System in 44 countries. Br J Dermatol 2020; 183:146-154. [PMID: 31605618 PMCID: PMC7384145 DOI: 10.1111/bjd.18604] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Skin tears are acute wounds that are frequently misdiagnosed and under-reported. A standardized and globally adopted skin tear classification system with supporting evidence for diagnostic validity and reliability is required to allow assessment and reporting in a consistent way. OBJECTIVES To measure the validity and reliability of the International Skin Tear Advisory Panel (ISTAP) Classification System internationally. METHODS A multicountry study was set up to validate the content of the ISTAP Classification System through expert consultation in a two-round Delphi procedure involving 17 experts from 11 countries. An online survey including 24 skin tear photographs was conducted in a convenience sample of 1601 healthcare professionals from 44 countries to measure diagnostic accuracy, agreement, inter-rater reliability and intrarater reliability of the instrument. RESULTS A definition for the concept of a 'skin flap' in the area of skin tears was developed and added to the initial ISTAP Classification System consisting of three skin tear types. The overall agreement with the reference standard was 0·79 [95% confidence interval (CI) 0·79-0·80] and sensitivity ranged from 0·74 (95% CI 0·73-0·75) to 0·88 (95% CI 0·87-0·88). The inter-rater reliability was 0·57 (95% CI 0·57-0·57). The Cohen's Kappa measuring intrarater reliability was 0·74 (95% CI 0·73-0·75). CONCLUSIONS The ISTAP Classification System is supported by evidence for validity and reliability. The ISTAP Classification System should be used for systematic assessment and reporting of skin tears in clinical practice and research globally. What's already known about this topic? Skin tears are common acute wounds that are misdiagnosed and under-reported too often. A skin tear classification system is needed to standardize documentation and description for clinical practice, audit and research. What does this study add? The International Skin Tear Advisory Panel Classification System was psychometrically tested in 1601 healthcare professionals from 44 countries. Diagnostic accuracy was high when differentiating between type 1, 2 and 3 skin tears using a set of validated photographs.
Collapse
|
16
|
Rayner R, Carville K, Leslie G, Dhaliwal SS. Models for predicting skin tears: A comparison. Int Wound J 2020; 17:823-830. [PMID: 32173997 DOI: 10.1111/iwj.13340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/22/2020] [Accepted: 03/04/2020] [Indexed: 11/27/2022] Open
Abstract
A recently published model that predicted the risk of skin tears in older adults was compared with seven additional published models. Four models were excluded because of limitations in research design. Four models were compared for their relative predictive performance and accuracy using sensitivity, specificity, and the area under the curve (AUC), which involved using receiver-operating characteristic analysis. The predictive ability of the skin tear models differed with the AUC ranging between 0.673 and 0.854. Based on the predictive ability, the selection of models could lead to different clinical decisions and health outcomes. The model, which had been adjusted for potential confounders consisted of five variables (male gender, history of skin tears, history of falls, clinical skin manifestations of elastosis, and purpura), was found to be the most parsimonious for predicting skin tears in older adults (AUC 0.854; 81.7% sensitivity; 81.4% specificity). Effective models serve as important clinical tools for identifying older individuals at risk of skin tears and can better direct more timely and targeted prevention strategies that improve health outcomes and reduce health care expenditure.
Collapse
Affiliation(s)
- Robyn Rayner
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.,Silver Chain Group, Perth, Western Australia, Australia
| | - Keryln Carville
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.,Silver Chain Group, Perth, Western Australia, Australia
| | - Gavin Leslie
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | | |
Collapse
|
17
|
Soh Z, Wang W, Png GK, Hassan N, Wu VX. Risk of skin tears and its predictors among hospitalized older adults in Singapore. Int J Nurs Pract 2019; 25:e12790. [PMID: 31793134 DOI: 10.1111/ijn.12790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/31/2019] [Accepted: 09/07/2019] [Indexed: 11/29/2022]
Abstract
AIM To identify the characteristics that may be predictive of development of risk of skin tears among hospitalized older adults in Singapore. BACKGROUND Skin tears are wounds that are partial or full-thickness separation of skin layers, which are common in older adults. Skin tears can result from shearing, friction, and/or blunt force. Skin tears have correlated with prolonged hospitalization, raised health-care costs and poorer quality of life. METHODS This cross-sectional descriptive correlational study recruited a convenience sample of 140 patients aged 65 years or above from a Singapore acute hospital. A modified International Skin Tear Advisory Panel (ISTAP) Skin Tear Risk Assessment Pathway was used for data collection; this is a validated instrument to assess patients for risks of skin tears in clinical settings. RESULTS The results of the multiple linear regression analysis indicated that increasing age, being underweight, caregiver-dependence and dementia predicted higher levels of risk of skin tears among hospitalized older adults in Singapore. These factors accounted for 33.6% of the variance. CONCLUSION This study can aid health-care professionals assess patients' risk of skin tears and implement appropriate interventions to minimize risks of skin tears.
Collapse
Affiliation(s)
- Zann Soh
- Changi General Hospital, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
18
|
Validating the Italian Version of the International Skin Tear Advisory Panel Classification System. Adv Skin Wound Care 2019; 32:378-380. [PMID: 31299017 DOI: 10.1097/01.asw.0000569124.36663.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To validate the International Skin Tear Advisory Panel (ISTAP) Classification System in Italian. METHODS In collaboration with the ISTAP, the classification system was translated into Italian using a forward-back translation process. To validate the translated system, a convenience sample of 212 health professionals classified 30 photographs of skin tears originally used by ISTAP. The wound images were labeled type 1, 2, or 3 as described by the classification system. The resulting scores were compared with the ISTAP classification, and the reliability of agreement was calculated with Fleiss κ. RESULTS Complete data were obtained from 209 healthcare professionals. When the image classifications were compared with the original ISTAP indications, 72.5% of all classifications were correct. Data indicated a moderate level of agreement (Fleiss κ = 0.466, range = 0.41-0.60). Data analysis showed similar agreement levels between nurses (n = 197, Fleiss κ = 0.466) and nonnurses (n = 12, Fleiss κ = 0.46). CONCLUSIONS The study validates the Italian version of the ISTAP skin tear classification system. Further studies are necessary to confirm the system's usability in Italian research and clinical settings.
Collapse
|
19
|
The prevalence and associated factors of skin tears in Belgian nursing homes: A cross-sectional observational study. J Tissue Viability 2019; 28:100-106. [DOI: 10.1016/j.jtv.2019.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/29/2018] [Accepted: 01/31/2019] [Indexed: 11/17/2022]
|
20
|
Rayner RL, Carville KJ, Leslie GD, Dhaliwal SS. Clinical purpura and elastosis and their correlation with skin tears in an aged population. Arch Dermatol Res 2019; 311:231-247. [PMID: 30783769 DOI: 10.1007/s00403-019-01899-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 01/20/2023]
Abstract
The previous research reported the results of a prospect cohort study that used logistic regression analysis to construct a risk prediction model for skin tears in individuals aged over 65 years. The model identified three baseline individual characteristics (male gender, history of STs, and history of falls) and two baseline skin manifestations (purpura and elastosis) that predicted the risk of dorsal forearm skin tears. This paper outlines the relationships between baseline skin manifestations and the risk of skin tears. Univariable logistic regression analysis was conducted of all the baseline data collected from the same-study participants to identify variables that significantly predicted purpura and elastosis at baseline. Amongst the 173 participants, 71 (41%) developed one or more skin tears, and in these participants, 52 (73.2%) displayed purpura, 41 (57.8%) had elastosis, and 30 (42.3%) exhibited both manifestations of the dorsal forearm at baseline. Four individual characteristics (age, history of skin tears, history of falls, and antiplatelet therapy) and three skin properties (pH, subepidermal low echogenicity band of the forearms, and skin thickness) were found to predict the risk of purpura. Conversely, three individual variables (age, gender, and smoking), three clinical skin variables (uneven skin pigmentation, cutis rhomboidalis nuchae, and history of actinic keratosis) and one skin property variable (collagen type IV) predicted the risk of skin elastosis. Progressive changes to the skin's structural and mechanical properties from the underlying effects of chronological ageing, and environmental and lifestyle-related influences increased the risk of purpura and elastotic skin manifestations and concomitantly increased risk of skin tears amongst participants.
Collapse
Affiliation(s)
- R L Rayner
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent St, Bentley, WA, 6102, Australia. .,Silver Chain Group, 6 Sundercombe St, Osborne Park, WA, 6017, Australia. .,School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - K J Carville
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent St, Bentley, WA, 6102, Australia.,Silver Chain Group, 6 Sundercombe St, Osborne Park, WA, 6017, Australia
| | - G D Leslie
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - S S Dhaliwal
- School of Public Health, Curtin University, Kent St, Bentley, WA, 6102, Australia
| |
Collapse
|
21
|
Sari SP, Everink IH, Sari EA, Afriandi I, Amir Y, Lohrmann C, Halfens RJ, Schols JM. The prevalence of pressure ulcers in community-dwelling older adults: A study in an Indonesian city. Int Wound J 2019; 16:534-541. [PMID: 30768769 PMCID: PMC6850703 DOI: 10.1111/iwj.13081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/08/2019] [Indexed: 12/29/2022] Open
Abstract
The objectives of this study were to investigate the prevalence and the characteristics of pressure ulcers (PU) in community‐dwelling older adults in Indonesia, including specific characteristics of the PU patients and their use of formal and informal care. A cross‐sectional design was used for the study, with 325 participants aged 60 years or older, randomly chosen from the general community. The overall PU prevalence and the PU prevalence excluding category 1 were 10.8% (95% confidence interval [CI], 5.8‐15.8) and 5.2% (95% CI 0.2‐10.2), respectively. Category 1 PUs were mostly (34.3%) located on knees and toes, while category 2 and higher PUs were mostly (70.4%) located on the shoulder, sacrum, and hip. The main factors that contributed strongly to PUs among older adults in the community were the degree of physical activity, problems with sensory perception, and having a history of stroke. None of the participants with a PU received wound care or information about PUs from formal caregivers and only 11.4% received wound care from family caregivers. This study shows that pressure ulcers in community‐dwelling older adults in Indonesia are a relevant and largely unaddressed problem. Developing an intervention program to manage the PU problem in the community is recommended.
Collapse
Affiliation(s)
- Sheizi P Sari
- Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia.,Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Irma H Everink
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Eka A Sari
- Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
| | - Irvan Afriandi
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | | | - Christa Lohrmann
- Department of Nursing Science, Medical University of Graz, Graz, Austria
| | - Ruud J Halfens
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jos M Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
22
|
Rayner R, Carville K, Leslie G, Dhaliwal SS. A risk model for the prediction of skin tears in aged care residents: A prospective cohort study. Int Wound J 2018; 16:52-63. [PMID: 30175484 DOI: 10.1111/iwj.12985] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/31/2018] [Accepted: 08/12/2018] [Indexed: 12/01/2022] Open
Abstract
The objective of this study was to construct a predictive model to identify aged care residents at risk of future skin tears. Extensive data about individual characteristics, skin characteristics, and skin properties were gathered from 173 participants at baseline and at 6 months. A predictive model, developed using multivariable logistic regression, identified five variables that significantly predicted the risk of skin tear at 6 months. These included: a history of skin tears in the previous 12 months (OR 3.82 [1.64-8.90], P = 0.002), purpura ≤20 mm in size (OR 3.64 [1.42-9.35], P = 0.007), a history of falls in the previous 3 months (OR 3.37 [1.54-7.41], P = 0.002), clinical manifestations of elastosis (OR 3.19 [1.38-7.38], P = 0.007), and male gender (OR 3.08 [1.22-7.77], P = 0.017). The predictive model yielded an area under the receiver operating characteristic curve of 0.854 with an 81.7% sensitivity and an 81.4% specificity. This predictive model could inform a simple but promising bedside tool for identifying older individuals at risk of skin tears.
Collapse
Affiliation(s)
- Robyn Rayner
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.,Silver Chain Group, Perth, Western Australia, Australia
| | - Keryln Carville
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.,Silver Chain Group, Perth, Western Australia, Australia
| | - Gavin Leslie
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | | |
Collapse
|
23
|
Chaplain V, Labrecque C, Woo KY, LeBlanc K. French Canadian translation and the validity and inter-rater reliability of the ISTAP Skin Tear Classification System. J Wound Care 2018; 27:S15-S20. [DOI: 10.12968/jowc.2018.27.sup9.s15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Kevin, Y. Woo
- School of Nursing, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario
| | - Kimberly LeBlanc
- Chair, Wound Ostomy Continence Institute, Association of Nurses Specialised in Wound Ostomy Continence, Ottawa
| |
Collapse
|
24
|
Munro EL, Hickling DF, Williams DM, Bell JJ. Malnutrition is independently associated with skin tears in hospital inpatient setting-Findings of a 6-year point prevalence audit. Int Wound J 2018; 15:527-533. [PMID: 29797534 PMCID: PMC7949896 DOI: 10.1111/iwj.12893] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/11/2017] [Accepted: 12/31/2017] [Indexed: 12/14/2022] Open
Abstract
Skin tears cause pain, increased length of stay, increased costs, and reduced quality of life. Minimal research reports the association between skin tears, and malnutrition using robust measures of nutritional status. This study aimed to articulate the association between malnutrition and skin tears in hospital inpatients using a yearly point prevalence of inpatients included in the Queensland Patient Safety Bedside Audit, malnutrition audits and skin tear audits conducted at a metropolitan tertiary hospital between 2010 and 2015. Patients were excluded if admitted to mental health wards or were <18 years. A total of 2197 inpatients were included, with a median age of 71 years. The overall prevalence of skin tears was 8.1%. Malnutrition prevalence was 33.5%. Univariate analysis demonstrated associations between age (P ˂ .001), body mass index (BMI) (P < .001) and malnutrition (P ˂ .001) but not gender (P = .319). Binomial logistic regression analysis modelling demonstrated that malnutrition diagnosed using the Subjective Global Assessment was independently associated with skin tear incidence (odds ratio, OR: 1.63; 95% confidence interval, CI: 1.13-2.36) and multiple skin tears (OR 2.48 [95% CI 1.37-4.50]). BMI was not independently associated with skin tears or multiple skin tears. This study demonstrated independent associations between malnutrition and skin tear prevalence and multiple skin tears. It also demonstrated the limitations of BMI as a nutritional assessment measure.
Collapse
Affiliation(s)
- Emma L Munro
- School of Human Movement and Nutrition SciencesUniversity of QueenslandSt LuciaQLDAustralia
| | - Donna F Hickling
- Nutrition and Dietetics & Allied Health ServicesThe Prince Charles HospitalChermsideQLDAustralia
| | | | - Jack J Bell
- School of Human Movement and Nutrition SciencesUniversity of QueenslandSt LuciaQLDAustralia
- Nutrition and Dietetics & Allied Health ServicesThe Prince Charles HospitalChermsideQLDAustralia
| |
Collapse
|
25
|
Koyano Y, Nakagami G, Minematsu T, Sanada H. Reliability of the skin blotting method when used on the elderly. Int Wound J 2018; 15:807-813. [PMID: 29897658 DOI: 10.1111/iwj.12931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 03/19/2018] [Indexed: 12/01/2022] Open
Abstract
The aim of this study was to compare protein secretion on intact skin of extremities and verify the relationship between the marker proteins on abdominal skin and systemic factors using skin blotting. A cross-sectional study was conducted among elderly patients aged 65 years and older (N = 73) at a long-term medical facility in Japan. Skin blotting was performed on the right and left forearms, right and left lower legs, and abdomen. Pearson's correlations and Bland-Altman plots were utilised for comparing the protein secretion from the skin between the right or left forearms or lower legs. Multiple regression analysis was applied to determine the relationship between intensity levels of 3 proteins on the abdominal skin and the systemic factors. Bland-Altman plots demonstrated that there was no significant difference between right and left secretion levels on the forearms and lower legs among 3 proteins. Multiple regression analysis showed that age and antiplatelet use was positively associated with decreased collagen type IV and increased matrix metalloproteinase 2 levels, respectively. Our findings suggested that collecting samples from either the right or the left skin would be sufficient if skin properties between arms and legs are evaluated using skin blotting.
Collapse
Affiliation(s)
- Yuiko Koyano
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Minematsu
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
26
|
Bermark S, Wahlers B, Gerber AL, Philipsen PA, Skiveren J. Prevalence of skin tears in the extremities in inpatients at a hospital in Denmark. Int Wound J 2018; 15:212-217. [PMID: 29464916 PMCID: PMC7950313 DOI: 10.1111/iwj.12847] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/15/2017] [Accepted: 10/01/2017] [Indexed: 11/28/2022] Open
Abstract
The aims of the study were to determine the prevalence of skin tears in the extremities and to explore factors associated with development of skin tears in inpatients at a Danish hospital. The study was designed as a point prevalence survey and included 202 patients in the age range 19-99 (mean: 70·7, SD: 16·5). The patients were assessed for presence of skin tears, numbers, locations and previous skin tears. Data were collected using a data collection sheet developed for a previous study. The survey team consisted of four specialist nurses. Data were collected over a period of 24 hours spread over 3 days. Of the 202 patients, 23 had skin tears, yielding a prevalence of 11·4%. In total, 40 skin tears were observed. Multiple logistic regression analysis showed that previous skin tears (odds ratio (OR): 9·3, 95% confidence interval (CI): 2·6-33·4, P < 0·001), ecchymosis (OR: 5·6, CI: 1·4-23·2, P < 0·017) and risk of falling (OR: 3·8, CI: 1·2-12·0, P < 0·021) were significantly associated with development of skin tears. The prevalence of skin tears in this study (11·4%) matches other international observations. The following risk factors were recognised: previous skin tear, ecchymosis and risk of falling. These factors could be used to identify patients requiring prevention of skin tears.
Collapse
Affiliation(s)
- Susan Bermark
- Department of Dermatology and Copenhagen Wound Healing CentreBispebjerg University HospitalCopenhagenDenmark
| | - Britt Wahlers
- Department of Dermatology and Copenhagen Wound Healing CentreBispebjerg University HospitalCopenhagenDenmark
| | - Anne Liv Gerber
- Department of Dermatology and Copenhagen Wound Healing CentreBispebjerg University HospitalCopenhagenDenmark
| | - Peter Alshede Philipsen
- Department of Dermatology and Copenhagen Wound Healing CentreBispebjerg University HospitalCopenhagenDenmark
| | - Jette Skiveren
- Department of Dermatology and Copenhagen Wound Healing CentreBispebjerg University HospitalCopenhagenDenmark
| |
Collapse
|
27
|
Hahnel E, Blume-Peytavi U, Trojahn C, Kottner J. Associations between skin barrier characteristics, skin conditions and health of aged nursing home residents: a multi-center prevalence and correlational study. BMC Geriatr 2017; 17:263. [PMID: 29132305 PMCID: PMC5683462 DOI: 10.1186/s12877-017-0655-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/01/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Geriatric patients are affected by a range of skin conditions and dermatological diseases, functional limitations and chronic diseases. Skin problems are highly prevalent in elderly populations. Aim of this study was to investigate possible associations between health, functional and cutaneous variables in aged long-term care residents. METHODS This observational, cross-sectional, descriptive prevalence study was conducted in a random sample of 10 institutional long-term care facilities in Berlin. In total, n = 223 residents were included. Demographic and functional characteristics, xerosis cutis, incontinence associated dermatitis, pressure ulcers and skin tears were assessed. Stratum corneum hydration, transepidermal water loss, skin surface pH and skin temperature were measured. Data analysis was descriptive and explorative. To explore possible bivariate associations, a correlation matrix was created. The correlation matrix was also used to detect possible collinearity in the subsequent regression analyses. RESULTS Mean age (n = 223) was 83.6 years, 67.7% were female. Most residents were affected by xerosis cutis (99.1%; 95% CI: 97.7% - 100.0%). The prevalence of pressure ulcers was 9.0% (95% CI: 5.0% - 13.0%), of incontinence associated dermatitis 35.4% (95% CI: 29.9% - 42.2%) and of skin tears 6.3% (95% CI: 3.2% - 9.5%). Biophysical skin parameters were not associated with overall care dependency, but with age and skin dryness. In general, skin dryness and measured skin barrier parameters were associated between arms and legs indicating similar overall skin characteristics of the residents. CONCLUSION Prevalence of xerosis cutis, pressure ulcers and skin tears were high, indicating the load of these adverse skin conditions in this population. Only few associations of demographic characteristics, skin barrier impairments and the occurrence of dry skin, pressure ulcers, skin tears and incontinence-associated dermatitis have been detected, that might limit the diagnostic value of skin barrier parameters in this population. Overall, the measured skin barrier parameters seem to have limited diagnostic value for the reported skin conditions except xerosis cutis. TRIAL REGISTRATION This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526 . Registration date: 8th November 2014.
Collapse
Affiliation(s)
- Elisabeth Hahnel
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Carina Trojahn
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| |
Collapse
|
28
|
Koyano Y, Nakagami G, Iizaka S, Sugama J, Sanada H. Skin property can predict the development of skin tears among elderly patients: a prospective cohort study. Int Wound J 2016; 14:691-697. [PMID: 27758078 DOI: 10.1111/iwj.12675] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/19/2016] [Accepted: 08/26/2016] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to identify skin properties that may be used to predict the development of a skin tear (ST) among elderly patients. A prospective cohort study was conducted among elderly patients aged 65 and older (N = 149) at a long-term medical facility in Japan over an 8-month period. Skin properties at baseline were measured on the forearm using a 20-MHz ultrasound scanner, which measured the thickness of the dermis layer and low-echogenic pixels, and skin blotting method, which evaluated the levels of collagen type IV, matrix metalloproteinase-2 and tumour necrosis factor-alpha. Adjusted hazard ratios (HRs) for the main confounders were obtained using the Cox proportional hazard model. A total of 52 STs were recorded among the 21 patients, resulting in an incidence rate of 1·13/1000 person-days. The predictor of STs was dermis thickness (HR = 0·52; 95% confidence interval = 0·33-0·81; P-value = 0·004). The cut-off point for dermis thickness was 0·80 mm (area under the curve = 0·77; 95% confidence interval = 0·66-0·88; P-value = 0·006). Our results suggest that measuring the dermis thickness at baseline is an easy and accurate way to identify a high-risk patient.
Collapse
Affiliation(s)
- Yuiko Koyano
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinji Iizaka
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Sugama
- Wellness Promotion Science Center, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|