Skin property can predict the development of skin tears among elderly patients: a prospective cohort study

Skin tears in older patients in intensive care units: A multicentre point prevalence study

BACKGROUND

With the ageing of the global population, it is predicted that the population of older adult patients in hospitals and intensive care units (ICUs) will increase. Because of health conditions, care practices and ageing-related skin changes, older adult ICU patients are prone to skin integrity problems, including skin tears (STs).

AIM

To determine the prevalence of STs and associated factors in older patients hospitalized in ICUs.

STUDY DESIGN

The study is a regional, multicentre, point prevalence study conducted in five centres in the five largest cities in terms of population in the Central Anatolia Region of Türkiye. Data were collected simultaneously in each centre on the same day. The list of patients hospitalized in the ICUs on the day of data collection was drawn up, and 200 patients who were 65 years of age or older, were hospitalized in ICUs and agreed to participate in the research were included. The researchers formed an "ST chart" to record patient demographic characteristics, clinical variables and skin assessment.

RESULTS

STs were detected in 14.5% of patients in ICUs, with 72.5% of them having stage 1 ST. A significant relationship was found between individuals' average body mass index (BMI) (p = .043), age (p = .014), length of stay in the ICU (p = .004) and having ST. There was also a statistically significant relationship between skin temperature (p = .002), skin turgor (p = .001) and ST. More STs were observed in patients with cold skin and low turgor. The prevalence of ST was higher in individuals with a history of ST. Additionally, there was a statistically significant relationship between consciousness (p = .014), incontinence (p = .006), the Braden score (p = .004), the Itaki fall risk score (p = .006) and ST.

CONCLUSIONS

In this multicentre point prevalence study, the prevalence of ST in older patients in ICUs was 14.5%, and many factors associated with ST have been identified.

RELEVANCE TO CLINICAL PRACTICE

Given the insufficient information and attention to STs in older adults, the study emphasizes the importance of addressing STs. The impact of STs includes increased treatment costs, length of stay and risk of complications. Therefore, understanding the global extent of STs in ICUs and developing effective interventions for prevention and management are crucial.

Prevalence and incidence of skin tear in older adults：A systematic review and meta-analysis

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.

The Science of Skin: Measuring Damage and Assessing Risk

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.

The prevalence of skin tears and associated factors in hospitalised patients with cancer

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.

Epidemiología de los desgarros de piel: revisión bibliográfica

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.

Epidemiología de los desgarros de piel: revisión bibliográfica

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.

Skin tears in older adult residents of long-term care facilities: prevalence and associated factors

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.

Sampling the skin surface chemistry for diagnosis and prognosis

Skin and wound blotting are non‐invasive techniques used to sample the skin and wound surface chemistry, whereby a nitrocellulose membrane is applied to an intact or broken cutaneous surface to detect biomarkers. However, there has been no comprehensive review of the evidence for the techniques used and data obtained to date. The primary aim of this study was to review the utilities of surface blotting for the diagnosis and prognosis of physiological, pre‐disease, and pathological states. The secondary aim was to summarise the procedural steps. A systematic literature search was conducted on 9 July 2021 using Medline, Embase, and Google Scholar databases. Investigators used McMaster's Critical Review Form for Quantitative Studies to assess quality, then performed a narrative synthesis reporting according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Twenty‐five studies were reviewed. Eighteen studies were of good quality, and seven were of moderate quality. These studies conducted skin and wound blotting on 176 animals and 1546 humans. Studies reported physiological and pathological states for diagnosis and prediction of conditions, including skin tears, wound healing, biofilm detection, and skin barrier function. The four steps for blotting are surface preparation, blot preparation, application and removal of blot, and analysis. This review demonstrates that blotting can determine the skin and wound surface chemistry using a versatile and reproducible technique. However, future research is needed to validate the technique and skin biomarkers identified.

Reliability and validity of the Japanese version of the overall dry skin score in older patients

BACKGROUND

Dry skin is the most common skin problem, especially in the elderly. However, there is no effective instrument to assess dry skin in Japan. This study aimed to evaluate the reliability and validity of the Japanese version of the overall dry skin score (ODS-J), the gold standard for dry skin assessment.

MATERIALS AND METHODS

A cross-sectional study was conducted on 47 patients aged > 65 years. Images of skin on their limbs were captured using a digital camera; both upper and lower limbs were assessed (n = 4/patient). One dermatologist; two wound, ostomy, and continence nurses; and three nursing researchers independently evaluated the images using the ODS-J to assess the intraclass correlation coefficient (ICC) for inter-rater reliability. Stratum corneum hydration (SCH) and transepidermal water loss (TEWL) were the external criteria used to verify concurrent and known-groups validity.

RESULTS

In total, 182 sites at which the SCH and TEWL could be measured were evaluated for the ODS-J. The ICC for inter-rater reliability of the six raters was 0.939 (p < 0.001). A higher ODS-J was associated with lower SCH (ρ = -0.374; p < 0.001) and lower TEWL (ρ = -0.287; p < 0.001) values. The ODS-J for the lower legs was significantly higher than that of the forearms (p < 0.001).

CONCLUSIONS

The ODS-J showed good inter-rater reliability, concurrent validity, and known-groups validity. It can be used by clinical nurses in Japan to observe patients' skin and is an effective indicator for the evaluation of skin care.

Risk scoring tool for forearm skin tears in Japanese older adults: A prospective cohort study

[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.

LESÃO POR FRICÇÃO EM IDOSOS

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

SKIN TEARS IN THE ELDERLY

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.

Development of educational material for the prevention and treatment of friction injuries

Objective: to develop and validate an educational booklet to help health professionals to prevent and treat friction injuries. Method: methodological study. An integrative review of the literature of journals published between 2009 and 2019 was carried out in the main databases of Health Sciences. The evaluation of the educational booklet was conducted with 32 nurses, using the Delphi technique. The statistical analysis used was the Content Validity Index. Results: the judges considered the content of the educational booklet between the concepts “inadequate” and “adequate”, in the first assessment; after the corrections requested by the judges, the booklet was forwarded to the evaluators and the content of the educational booklet was rated between “adequate” and “totally adequate”. The overall Content Validity Index was 0.8118 in the first assessment and 1.0 in the second assessment. Conclusion: after the integrative literature review, the material was constructed and validated by professionals with experience in evaluating and treating individuals with wounds, obtaining consensus among the evaluators in the second evaluation.

Desenvolvimento de um material educativo para a prevenção e o tratamento das lesões por fricção

Objetivo: desenvolver e validar uma cartilha educativa para ajudar o profissional da saúde a prevenir e tratar da lesão por fricção. Método: estudo metodológico. Foi realizada revisão integrativa da literatura dos periódicos publicados entre 2009 e 2019 nas principais bases de dados de Ciências da Saúde. A avaliação da cartilha educativa foi conduzida com 32 enfermeiros, utilizando a técnica de Delphi. A análise estatística utilizada foi o Índice de Validade de Conteúdo. Resultados: os juízes consideraram o conteúdo da cartilha educativa entre os conceitos “inadequado” e “adequado”, na primeira avaliação; após as correções solicitadas pelos juízes, a cartilha foi reenviada aos avaliadores e o conteúdo da cartilha educativa foi avaliado entre “adequado” e “totalmente adequado”. O Índice de Validade de Conteúdo geral foi de 0,8118 na primeira avaliação e 1,0 na segunda avaliação. Conclusão: após a revisão integrativa da literatura, o material foi construído e validado por profissionais com experiência em avaliar e tratar de indivíduos com feridas, obtendo consenso entre os avaliadores na segunda avaliação.

Validity of skin blot examination for albumin and nerve growth factor β to detect itching of the skin in Indonesian older adults

AIM

Itching, a common skin disorder, impacts the quality of life of individuals. Itchy skin occurs more with increasing age and the prediction of itchy skin prognosis is necessary to provide good skincare. This study validated biomarkers in skin blotting to identify and measure itching sensation as well as conventional methods to measure skin barrier function.

MATERIALS AND METHODS

From a cross-sectional study conducted in Long-term Care (LTC) facilities in Indonesia itching symptoms were obtained through a questionnaire. Skin conditions were assessed using photographs, stratum corneum (SC) hydration, skin pH, and skin blotting for biomarkers: albumin, interleukin 2 (IL2), nerve growth factor β (NGFβ), and thymic stromal lymphopoietin (TSLP). Association of skin measurements with the presence of skin blotting and trends analysis were conducted.

RESULTS

Altogether, 564 LTC residents (average age, 70 years) participated. The SC hydration, skin pH, albumin, and NGFβ were associated with the presence of itch (p value= <0.001, <0.001, <0.001, and <0.001, respectively). The signal levels of skin blotting biomarkers were higher in itch group than in the non-itch group. Additionally, the higher quantile of SC hydration was significantly associated with a lower intensity level of NGFβ and TSLP (p value = 0.005, 0.003, respectively). The lower quantile of skin pH (better skin condition) was significantly associated with lower albumin, NGFβ, and TSLP (p value = 0.048, 0.035, and <0.001, respectively).

CONCLUSION

The albumin, NGFβ, and TSLP could be a candidate for measurement of itchy skin among older adult with disrupted skin barrier function and local skin inflammation.

Skin tear prevalence and incidence in the long-term care population: a prospective study

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.

The relationship between skin ultrasound images and muscle damage using skin blotting in wheelchair basketball athletes

STUDY DESIGN

Secondary analysis of a cross-sectional observation study.

OBJECTIVES

To determine the relationship between skin ultrasound images and muscle damage in wheelchair basketball athletes, using skin blotting examinations of the ischial regions.

SETTING

Community, Japan.

METHODS

Fourteen elite wheelchair basketball athletes were recruited. We obtained data regarding participants' characteristics. We undertook ultrasonographic images and quantitative skin blotting of the ischial region before and after training, and after rest.

RESULTS

We identified Category II and III pressure injuries in 2 of the 12 participants. Structural features were classified into four categories based on ultrasonographic features, namely, normal skin structure, unclear superficial and deep fascia, cloudy fat layer, and fat infiltration and low-echoic lesion/anechoic lesions. The muscle-type creatinine kinase (CK-M) level (median [interquartile range: IQR], 2.98 [2.80-3.47]) in the fat infiltration and low-echoic lesion/anechoic lesion group was significantly higher (1.43 [1.41-1.49]) than in a nonfat infiltration and low-echoic lesion/anechoic lesion group after training (p = 0.03). The interleukin-6 (IL-6) level (median [IQR], 23.5 [16.15-58.97]) in the fat infiltration and low-echoic lesion/anechoic lesion group was significantly higher (1.94 [1.74-4.44]) than in the nonfat infiltration and low-echoic lesion/anechoic lesion group after rest (mean difference = -25.4, 95% CI -61.1 to 10.7, p = 0.03).

CONCLUSIONS

The combination of ultrasonographic images and skin blotting using CK-M and IL-6, could detect early deep tissue damage in wheelchair athletes. These techniques could be potentially useful in the treatment and prevention of pressure injuries.

SPONSORSHIP

This study was supported in part by YAMAHA Motor Foundation for Sports.

Models for predicting skin tears: A comparison

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.

Risk of skin tears and its predictors among hospitalized older adults in Singapore

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.

Clinical purpura and elastosis and their correlation with skin tears in an aged population

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.

A risk model for the prediction of skin tears in aged care residents: A prospective cohort study

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.

Malnutrition is independently associated with skin tears in hospital inpatient setting-Findings of a 6-year point prevalence audit

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.

Skin avulsion injuries caused by the application of adhesive drapes during total knee arthroplasty: A case report

RATIONALE

The use of adhesive drapes has decreased the incidence of surgical-site infections.

PATIENT CONCERNS

Despite the obvious benefits of the proper use of drapes, there remain many potential risks.

DIAGNOSE

A 66-year-old man with a history of left knee osteoarthritis and varus deformity underwent total knee arthroplasty at our hospital, upon removal of the adhesive drape by delicate peeling and warm saline lavage, a large area of the skin avulsion happened.

INTERVENTIONS

A standardized set of care measures were applied to the wound to avoid wound infection.

OUTCOMES

After 6 weeks of treatment, the avulsed wound showed no signs of infection and had undergone re-epithelialization.

LESSONS

Individuals with high-risk skin avulsion injuries should be provided with preventive measures and the necessity of continuous application of adhesive drapes should be further studied.

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

AIM OF THE STUDY

This study aimed to investigate the association of frailty and body mass index (BMI) with biophysical properties of the skin in community-dwelling older people.

MATERIALS AND METHODS

A cross-sectional study was conducted in a suburban Japanese city. Older adults aged ≥65 years and participating in a health checkup program were recruited (n = 128). Stratum corneum hydration, clinical manifestations of dry skin, skin elasticity and condition of the dermis (as measured by ultrasonography) were evaluated on the volar forearm. Frailty phenotype and BMI were also evaluated.

RESULTS

The mean age of participants was 74.5 years, and 96.1% were women. Skin thickness was significantly decreased in frail participants compared with non-frail participants in an age-adjusted multivariate model (p = 0.009). Frail participants showed significantly lower skin elasticity values than non-frail participants in a univariate analysis (p = 0.024), but this was not significant in the multivariate model. In participants with BMI ≥25 kg/m², clinical manifestations of dry skin were significantly decreased compared with BMI <21.5 kg/m² (p = 0.002). Participants with BMI ≥25 kg/m² and with 21.5 ≤ BMI <25 kg/m² showed significantly higher skin elasticity values than participants with BMI <21.5 kg/m² (p = 0.014 and p = 0.042, respectively).

CONCLUSION

Frailty was associated with decreased skin thickness and decreased skin elasticity partially via the influence of chronological aging. Low body mass was associated with increased xerosis manifestations and decreased skin elasticity in community-dwelling older adults.

Chronic Skin Fragility of Aging: Current Concepts in the Pathogenesis, Recognition, and Management of Dermatoporosis

Thin skin and the appearance of bruises, seemingly unprovoked, are frequent complaints of elderly patients. Chronic cutaneous insufficiencies such as these are termed dermatoporosis. Although it is seldom the primary reason for consultation, dermatoporosis is associated with bleeding and healing complications and presents an opportunity for patient education and prevention. In this review, the authors explore the risk factors, pathogenetic mechanisms, clinical expression, and evidence-based therapies reported for chronic skin fragility due to aging.