The influence of incontinence on the characteristic properties of the skin in bedridden elderly subjects

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.

Nurses' perspectives and preferences on MoliCare Premium Elastic products for incontinence management

BACKGROUND

With the wide range of absorbent incontinence products available, it is crucial to select the most suitable product for individuals with incontinence, ensuring that their expectations are met and their quality of life is not compromised.

AIM

This study aimed to assess the key features of the newly introduced MoliCare Premium Elastic product by nurses working with residents with incontinence in nursing homes and compare the product characteristics with those of the previous design.

METHODS

Forty-three nurses from five nursing homes in Germany were asked to complete a questionnaire focusing on key product performance aspects to elicit their views on the use of MoliCare Premium Elastic products.

FINDINGS

All performance features of the new product design received positive ratings from most nurses: 84% considered the overall acceptance of the new design as 'Good', and 52% preferred the new MoliCare Premium Elastic.

CONCLUSIONS

The new MoliCare SkinGuard absorbent core technology performed well on each performance characteristic, demonstrating the high quality of the product and its ability to meet the needs of people with incontinence.

The Effects of Incontinence Pad Application on Loaded Skin With Reference to Biophysical and Biochemical Parameters: An Exploratory Cohort Study Using a Repeated-Measures Design

PURPOSE

The purpose of this study was to evaluate temporal changes in skin responses following exposure to moisture alone or moisture in combination with mechanical loading.

DESIGN

Comparison cohort with a repeated-measures design.

SUBJECTS AND SETTINGS

The sample comprised 12 healthy volunteers. Participants were purposely sampled from 2 different age groups; half were 32 to 39 years old and half were 50 to 62 years old. Participants identified as White, Black, or mixed; 83% (n = 10) identified as White; 8 (67%) were female.

METHODS

Four sites at the sacrum were challenged with the application of specimens taken from 2 absorbent products; the pad specimens were applied dry or saturated with synthetic urine (SU; pH = 8); a further site from the sacral skin was also selected and used as a control. Skin assessments were performed at different points in time: (1) 60 minutes after exposure to dry or SU-saturated pad specimens; (2) 60 minutes after exposure to pads and mechanical loading (application of pressure in the form of 45°C high sitting); and (3) 30 minutes after removal of all pads (recovery period). Outcome measures were transepidermal water loss (TEWL), stratum corneum (SC) hydration, erythema, pH, and skin inflammatory biomarkers measured at each of the time points described earlier.

RESULTS

The control site and those exposed to dry pads showed minimal time-dependent changes irrespective of the parameter investigated. In contrast, significant increases in TEWL (P = .0000007) and SC hydration responses (P = .0000007) were detected at the sites under absorbent pad specimens after saturation with SU (exposure to moisture). In some participants, TEWL and SC hydration parameters were significantly higher during pressure application. Skin pH remained in the mildly acidic range throughout the test session, and no consistent trends were observed with erythema. Skin inflammatory biomarkers also exhibited considerable variability across participants; none changed significantly over time. Significant differences (P = .02) were also detected following the exposure of moisture in combination with pressure.

CONCLUSION

We evaluated an array of parameters to identify changes following skin exposure to 2 absorbent pads in the presence and absence of SU and mechanical loading. Analysis revealed changes in skin barrier properties in the presence of moisture and/or pressure. This observation suggests a need for frequent pad changing as well as periods of skin off-loading to protect the skin health of individuals with incontinence.

Spatial and temporal changes in biophysical skin parameters over a category I pressure ulcer

In acute care facilities, the detection of pressure ulcers (PUs) relies on visual and manual examination of the patient's skin, which has been reported to be inconsistent and may lead to misdiagnosis. In skin and wound research, various biophysical parameters have been extensively employed to monitor changes in skin health. Nonetheless, the transition of these measures into care settings as part of a routine clinical assessment has been limited. This study was designed to examine the spatial and temporal changes in skin biophysical parameters over the site of a category I PU, in a cohort of hospitalised patients. Thirty patients, each presenting with a category I PU, were enrolled in the study. Skin integrity was assessed at the PU-compromised site and two adjacent areas (5 and 10 cm away). Data was collected over three sessions to examine both temporal differences and longitudinal changes. Skin integrity was assessed using two biophysical parameters, namely, transepidermal water loss (TEWL) and stratum corneum (SC) hydration. In addition, the influence of intrinsic factors, namely, incontinence and mobility status, on the parameters was evaluated. TEWL values at the sites compromised by PU were statistically significantly greater (P < .001) than corresponding values at the adjacent control sites at 5 and 10 cm, which were consistent with a normative range (<20 g/h/m2 ). By contrast, SC hydration values did not reveal clear distinctions between the three sites, with high inter-patient variation detected at the sites. Nevertheless, individual profiles were consistent across the three sessions, and the PU site was observed to be either abnormally dry or overhydrated in different individuals. No consistent temporal trend in either parameter was evident. However, intrinsic factors were shown to influence the parameters, with females, bedridden and incontinent patients presenting significantly higher TEWL and SC hydration values (P < .05). TEWL was able to identify differences in skin responses at skin sites compromised with a category I PU when compared to healthy adjacent skin sites. Accordingly, this parameter could be included in the clinical assessment for the identification of PU risk. Further studies are required to elucidate the role of hydration and skin barrier function in the development of PUs and their ability to monitor temporal changes in skin integrity.

The Influence of Absorbent Products on Skin Integrity: A Scoping Review

PURPOSE

Absorbent products are commonly used to absorb urine and fecal matter and to mitigate potential skin complications such as incontinence-associated dermatitis (IAD). Evidence concerning the effect these products have on skin integrity is limited. This scoping review aimed to explore the evidence/literature on the effect of absorbent containment products on skin integrity.

METHOD

A scoping literature review.

SEARCH STRATEGY

The electronic databases CINAHL, Embase, MEDLINE, and Scopus were searched for published articles between 2014 and 2019. Inclusion criteria were studies that focused on urinary and/or fecal incontinence, use of incontinent absorbent containment products, impact on skin integrity, and published in English. The search identified a total of 441 articles that were identified for the title and abstract review.

FINDINGS

Twelve studies met inclusion criteria and were included in the review. Variability in the study designs did not allow firm conclusions regarding which absorbent products contributed to or prevented IAD. Specifically, we found variations in assessment of IAD, study settings, and types of products used.

IMPLICATIONS

There is insufficient evidence to support the effectiveness of one product category over another for maintaining skin integrity in persons with urinary or fecal incontinence. This paucity of evidence illustrates the need for standardized terminology, a widely used instrument for assessment of IAD, and identification of a standard absorbent product. Additional research using both in vitro and in vivo models, along with real-world clinical studies, is needed to enhance current knowledge and evidence of the impact of absorbent products on skin integrity.

Investigating the release of inflammatory cytokines in a human model of incontinence-associated dermatitis

Incontinence-associated dermatitis (IAD) is a painful complication in elderly patients, leading to reduced quality of life. Despite recent attention, its underlying inflammatory mechanisms remain poorly understood. This study was designed to quantify the release of inflammatory cytokines in a human model of IAD. The left volar forearm of ten healthy volunteers was exposed to synthetic urine and synthetic faeces for 2 h, simulating the effects of urinary and faecal incontinence, respectively, and the subsequent cytokine response compared to that of an untreated control site. Inflammatory cytokines were collected using both the Sebutape® absorption method and dermal microdialysis and quantified using immunoassays. Results from the former demonstrated an upregulation in IL-1α, IL-1RA and TNF-α. Synthetic urine caused a higher median increase in IL-1α from baseline compared to synthetic faeces, whereas synthetic faeces were associated with significantly higher median TNF-α levels compared to synthetic urine (p = 0.01). An increase in IL-1α/IL-1RA ratio was also observed with significant differences evident following exposure to synthetic urine (p = 0.047). Additionally, microdialysis revealed a time-dependent increase in IL-1β and IL-8 following exposure of up to 120 min to synthetic urine and synthetic faeces, respectively. This study demonstrated the suitability of both sampling approaches to recover quantifiable cytokine levels in biofluids for the assessment of skin status following exposure to synthetic fluids associated with incontinence. Findings suggest some differences in the inflammatory mechanisms of IAD, depending on moisture source, and the potential of the cytokines, IL-1α and TNF-α, as responsive markers of early skin damage caused by incontinence.

Prevalence and management status of urologic diseases in geriatric hospitals in South Korea: A field research

PURPOSE

We aimed to investigate the current management status of urologic diseases in geriatric hospitals in South Korea.

MATERIALS AND METHODS

Questionnaire surveys and in-depth person-to-person interviews were conducted at 13 hospitals within the Seoul and Incheon areas.

RESULTS

The study was carried out from July to December 2014; 75.6% of patients (1,858/2,458) and 77.5% (779/1,031) of medical personnel responded to our survey. All surveys and interviews were performed by urology specialists, fellows, residents, or nurses. The hospitals included in the study had an average of 215.2 beds (range, 110-367), 189.1 patients (range, 90-345), and 40.2 nurses (range, 10-83). The average number of physicians was 6.2 (range, 3-11), but none of these were certified urologists. Only 4 hospitals provided consultation services for urological disorders. In total, 64% of patients had urological disorders, although only 20.7% of patients were receiving medication. Most patients were being treated using urological interventions; diapers (49.7%), indwelling catheters (19.5%), clean intermittent catheters (12.2%), and external collection urinary drainage (7.9%). However, most interventions were inadequately implemented, and only 17% of the patients had been examined by a certified urologist. Urological complications were found in 20.2% of patients, and secondary complications occurred in 18.8%. Excluding redundant cases, the total prevalence of urological complications was 39.0%.

CONCLUSIONS

Urologic diseases are poorly managed, and no certified urologists work in geriatric hospitals. Therefore, more designated urologists are needed in geriatric hospitals.