Resident skin tears in senior living communities

Skin tears are a common concern among senior living residents. As residents age, their skin undergoes significant changes influenced by a lifetime of sun exposure, personal habits, diet, disease processes, and medication regimens. Skin tears occur due to friction or shearing forces that separate the epidermis from the dermis or both layers from the underlying tissue.

Skin tears can lead to pain, bleeding, infection, and delayed healing, significantly impacting an individual’s well-being. They can also be perceived as an abuse or neglect by the staff, especially if they are not reported, documented, or treated properly.

When a resident with very fragile skin enters your facility, it becomes crucial to implement preventive measures to avoid skin tears. Preventative measures may include:

• Comprehensive Skin Assessment:

• Regularly assess the resident’s skin for elasticity, dryness, hydration, and any previous skin tears.
• Identify vulnerable areas that require special attention.

• Hydration and Moisturization:

• Moisturize the skin at least twice a day using enriched moisturizers.
• Gently pat the skin during application to avoid friction.

• Protective Measures:

• Use cushioned protectors or sheepskin on wheelchair leg and arm supports, dining room chairs and bedside rails.
• Encourage fluid intake and provide a recommended diet to enhance skin integrity.

• Clothing Choices:

• Residents should wear long-sleeved shirts and pants to protect their extremities.
• Arm and leg protectors can offer additional safeguarding.

• Tape Considerations:

• Avoid using medical tape directly on the skin.
• If necessary, opt for gentle paper tape.

• Staff and Family Education:

• Train staff to handle residents with fragile skin gently during transfers, lifts and turning.
• Emphasize extreme caution to prevent skin tears.

Handling skin tears

Despite the facilities best efforts to prevent skin tears, they may still occur. In such cases, consider using the Payne-Martin Classification System for Skin Tears.¹ This system categorizes skin tears into three types:

• Category I: Skin tears without tissue loss.
• Category II: Skin tears with partial tissue loss.
• Category III: Skin tears with complete tissue loss.

The purpose of skin tear treatment is to support healing with minimal trauma, pain relief and infection prevention. Every facility should have a skin tear treatment protocol, which may include the following steps:

• Clean the area gently with normal saline or pH-neutral cleanser, avoid rubbing.
• Dry the area gently by patting or air drying.
• Evaluate and stage the skin tear. Record the size according to the facility policy.
• Align the skin flat, without stretching it. Use a saline-moistened Q-tip to help roll the skin back into place.
• Apply the skin sealant, petroleum-based ointment, hydrogel sheets or other water-or glycerin-based products that can keep the wound moist. Use gauze wraps or elastic net to secure if possible.

When skin tears occur, keep it simple. Educate the resident, family and staff and follow the policy to protect the skin tear from infection and further injury.

[1] No More Skin Tears – WoundAdvisor