Skin Tears Can be Problematic, but Preventable With the Right Care

By Jasmyne Ray

Fragile skin of the elderly may be more susceptible to tearing depending on medication, comorbidities, and other factors, but care providers can take steps to manage skin tears and implement prevention strategies.

A 2020 study published in the Journal of Wound Care found a skin tear prevalence of 20.8% among 380 long-term care residents, and an incidence of 18.9% within four weeks.

An article in Home Healthcare Nurse noted the risks and contributing factors to skin tears. While they can occur anywhere on the body, arms and hands are the most vulnerable.

“There’s these structures that kind of attach the different skin layers, most structures get a little thinner or narrower, so the skin layers don’t really adhere together as well,” Bonnie Thompson, RN, CWOCN, one of the article’s authors told HealthLeaders. “They’re a little looser, so that strength is impaired because of that and blood supply can be reduced, and they can have different nerve sensations, so they don’t know when they have damaged their skin.”

These patients can also be prone to bleeding and if they regularly take aspirin or blood-thinning medication, they’re likely to bleed even more easily, Thompson said.

The changes that occur in aging skin vary depending on their comorbidities, vascular status, blood sugar, and even the medication they take, she said.

“Cell growth and turnover rate is decreased, so you have drier skin,” Thompson explained. “The oil glands have kind of decreased production, the sweat glands have less production, the immune system is weaker, so with all of those things it can affect the integrity of the skin.”

There are two types of skin tears: Partial-thickness is where the epidermis is separated from dermis secondary to friction or shearing force trauma; and full-thickness, where both the epidermis and the dermis separate from the underlying tissue.

Skin tears don’t necessarily result in serious wounds, but they can lead to discomfort and infection if not treated in a timely and efficient way, according to Thompson.

Caring for skin tears is like caring for other wounds, beginning with an assessment by a nurse, Thompson said.

There must be a good balance of moisture in the wound and the skin around it must be protected, she said. When dressing the wound, providers must be careful not to use anything with an aggressive adhesive to avoid tearing the skin further during dressing changes, she said.

“The big thing is just realizing that your patient is at risk. If they’re an older adult, you’re looking at their age, their comorbidities, their medication, their nutrition status,” Thompson said. “Depending on what setting you’re in—acute care versus home care—you look at if they have a safe environment as far as not falling, not hitting their arms on the sides of things, [and] taking care of their skin every day.”

Educating patients and their caregivers on how to maintain good skin integrity is the best way to keep the skin it the best condition, Thompson said. This includes:

• Ensure optimal nutrition, tailoring plans to any food sensitivities the patient may have.
• Make sure the patient stays hydrated throughout the day; 2-3 quarts of fluid is recommended.
• Use hypoallergenic and gentle moisturizers twice a day, with special attention to hands and arms to moisturize skin.
• Limit bathing and use a mild pH-balanced soap; refrain from using perfumed, alkaline soaps.
• Protect arms and legs with long sleeves and pants, and thick socks to protect feet.