Maintaining Good Skin Integrity In The Elderly And Immobile

As we age it becomes more important that we pay closer attention to our skin. For right now I will put emphasis on the elderly and the immobile. Their skin can be extremely fragile, but there are a few things you can do to help maintain good skin integrity and prevent skin breakdown. Immobilization can be a major obstacle when trying to maintain good skin integrity. The most important thing to remember in your immobile population is that it is extremely important to make sure that they are turned a minimum of once every two hours. Be aware of the fact while turning an immobile person, that rubbing and friction to the skin during repositioning can also impair the skin, so be careful during your turns. The first turn can be to the left or the right side. Alternate left and right turns with the person laying on their back. To help you remember the last position used you should document your position changes in a turn log.

It is also very important to keep the heels elevated off of the bed. A pillow can be used for this, even two. Foot drop can be avoided by positioning a pillow against the soles of the feet. This keeps the feet from falling forward. Be sure to massage (if no redness is present) and exercise the feet and upper extremities daily by flexing them; this can prevent or decrease muscle atrophy (wasting or loss of muscle tissue). For those with less fat tissue who have bony areas use a pillow between the knees or under the hip area.

I have to tell you that it doesn’t take long for the skin to become compromised after a person has been in one position for too long. The skin could look perfectly fine from the outside, but then once it breaks you could possibly have deterioration down to the muscle, opening the person up for infection. They could even become septic (infection in the blood stream.) I have seen patients come into the hospital with non stageable pressure ulcers, and it only took a week for their skin to get in that condition.

Make sure the skin stays clean. Be prompt after soiling in cleaning the area and always moisturize the skin, especially dry skin. Moisturizers rich in vitamin E and aloe are recommended. Your older population can have extremely fragile skin to the point of being paper thin, so during skin care be very careful.

Most people don’t realize that diet can play a very important role in tissue regeneration. In the hospital setting patients with impaired skin integrity are immediately put on a high protein diet ( Important for the growth and repair of tissue cells.)

The following supplements should also be added to the diet:

Vitamin C : This helps to prevent free radical production which could inhibit healing.

Arginine : Promotes collagen synthesis for new skin. It also increases the blood flow to the wound and may help to fight off infection.

Vitamin B12 : Aids in wound healing and tissue repair.

Zinc : Required for tissue regeneration and repair (BUT could also suppress the function of the immune System.)

Look for foods rich in these supplements and add them to the diet. If I was going to put emphasis on one thing it would be the protein. Finally, inspect the skin daily. This could be done during the time that you do your turns and also during soil changes. Document the condition of the skin on a skin log. Anything different that you notice should be documented on the log. Look for any signs of possible breakdown, which may include a redness that doesn’t go away once position is changed and pressure is removed from the area. Also be suspicious of open or blistered skin. Should you notice these or any sign suggestive of skin breakdown, immediately take pressure off of the area and keep it clean of urine and feces. If the skin is broken seek medical advice to obtain the best possible treatment to heal the ulcer. If there is redness do not massage the area. If you notice a progression seek medical advice for prompt treatment.

Any problems can be avoided if turns are done with diligence. Remember…..every two hours! Visit for more information concerning turn and skin logs.