Recognising and managing age-related dermatoporosis and skin tears

Dermatoporosis in Upper Limbs Treated With Polymethylmethacrylate Microspheres Using the BioSculpt® Technique

Dermatoporosis is a syndrome of fragility or chronic cutaneous insufficiency. It presents with localized violaceous spots on the extensor face of the upper limbs of older people, with signs such as senile purpura, actinic purpura, or Bateman purpura, in addition to atrophy of the skin and subcutaneous tissue. These lesions can be painful and a source of morbidity. We report a case of an 80-year-old patient presented for the treatment of dermatoporosis in the upper limbs with polymethylmethacrylate (PMMA) using the BioSculpt®technique. The photographic and ultrasonographic clinical responses of the soft tissue were evaluated before and after nine months of treatment.

Barriers and facilitators to delivering everyday personal hygiene care in residential settings: A systematic review

INTRODUCTION

Globally, the population is ageing, and more people live in residential care. Best practice in personal hygiene care may reduce distressing and debilitating skin and oral problems and improve resident outcomes. Although there is guidance on personal hygiene care, implementation may be a challenge.

AIM

To identify barriers and facilitators to delivering personal hygiene care for older persons in residential care settings.

METHODS

Systematic review reported according to PRISMA 2020 guidance. Databases MEDLINE, CIHAHL and PsychINFO were systematically searched using terms and synonyms 'barriers', 'facilitators', 'hygiene', 'older adults' and 'residential care'. Only empirical studies, reporting everyday skin and oral care, in English, peer reviewed and published from 2000 to 2021 were included. Due to methodological heterogeneity, a narrative synthesis was conducted.

RESULTS

Sixteen papers yielded nine categories of barrier or facilitator. Five related to skin and oral care: (i) knowledge, (ii) skills relating to hygiene care, (iii) skills relating to supporting 'uncooperative' behaviours, (iv) lack of resources and (v) time, workload and staffing levels. The remainder related only to oral care: (vi) resident, family or carer motivation, (vii) dislike of hygiene care, (viii) carer attitudes and beliefs and (ix) social influences and communication. Six papers reported interventions to optimise care.

CONCLUSION

This review highlights the persistent dearth of research into everyday personal hygiene practices, in particular skin hygiene in residential care. Existing literature identifies a range of barriers; however, there is a mismatch between these and reported interventions to improve practice.

RELEVANCE TO CLINICAL PRACTICE

Advances in implementation science to support optimal care have yet to be applied to interventions to support hygiene practices in care homes and it is imperative this is addressed. Future interventions should involve: (i) systematically and theoretically assessing barriers, (ii) application of tailored behaviour change techniques (iii) using these co-design pragmatic, locally acceptable strategies.

Relationship between Vitamin C Deficiency and Cognitive Impairment in Older Hospitalised Patients: A Cross-Sectional Study

Vitamin C is a powerful antioxidant and facilitates neurotransmission. This study explored association between vitamin C deficiency and cognitive impairment in older hospitalised patients. This prospective study recruited 160 patients ≥ 75 years admitted under a Geriatric Unit in Australia. Cognitive assessment was performed by use of the Mini-Mental-State-Examination (MMSE) and patients with MMSE scores <24 were classified as cognitively-impaired. Fasting plasma vitamin C levels were determined using high-performance-liquid-chromatography. Patients were classified as vitamin C deficient if their levels were below 11 micromol/L. Logistic regression analysis was used to determine whether vitamin C deficiency was associated with cognitive impairment after adjustment for various covariates. The mean (SD) age was 84.4 (6.4) years and 60% were females. A total of 91 (56.9%) were found to have cognitive impairment, while 42 (26.3%) were found to be vitamin C deficient. The mean (SD) MMSE scores were significantly lower among patients who were vitamin C deficient (24.9 (3.3) vs. 23.6 (3.4), p-value = 0.03). Logistic regression analysis suggested that vitamin C deficiency was 2.9-fold more likely to be associated with cognitive impairment after adjustment for covariates (aOR 2.93, 95% CI 1.05−8.19, p-value = 0.031). Vitamin C deficiency is common and is associated with cognitive impairment in older hospitalised patients.

A Recent Advance in the Closure of Skin Wounds on Fragile Skin

The delicate nature of the skin in elderly patients poses a difficult challenge to healthcare providers. Emergency departments are frequently presented with traumatic skin tears and soft tissue avulsions in this group of patients. Procedures aimed at closure of these types of wounds often result in worsening of the tears. The DermaClip® skin closure device, which can eliminate the need for anesthesia, addresses these disadvantages and allows for atraumatic, cosmetically satisfactory closure in a rapid and efficient manner, saving time, and costs.

Deep dissecting haematoma in patients with dermatoporosis: implications for home nursing

Dermatoporosis is a chronic cutaneous insufficiency/fragility syndrome with a high prevalence in older adults. Dermatoporotic skin becomes thin and fragile and tends to tear. It may lead to deep dissecting haematomas (DDHs) as a final stage of dermatoporosis, which is a clinical emergency. Management can be challenging, as patients with lower-limb haematomas are frequently older and affected by multiple comorbidities, or are probably on medications that negatively influence wound healing. This article describes the essential role of nurses in prevention, early recognition and wound management of DDHs in patients with dermatoporosis.