The biological reasons for fragile skin
As people age, their skin undergoes several natural changes that make it more vulnerable to injury and slower to heal. The outer layers of the skin thin, and the protective fatty layer beneath diminishes, reducing natural cushioning. This makes aged skin less able to resist shearing forces, where skin slides against a surface, meaning even small movements can cause damage.
Elderly skin also has fewer and more fragile blood vessels, leading to easy bruising and impaired blood flow. Reduced circulation hinders the delivery of oxygen and nutrients needed for tissue repair, increasing the risk of wounds and slowing healing. Conditions like diabetes and vascular issues further compromise circulation.
Types of sores common in the elderly
Elderly skin is prone to several specific types of sores due to its fragility and other age-related issues. The most prevalent include:
- Pressure Ulcers (Bedsores): Caused by prolonged pressure over bony areas, cutting off blood flow and leading to tissue death.
- Skin Tears: Traumatic wounds from friction or shearing, often occurring during transfers or bumps.
- Venous and Arterial Ulcers: Resulting from poor blood circulation in the legs.
Key risk factors for developing skin sores
Beyond natural aging, several other factors increase the risk of sores in older adults.
Immobility and reduced sensation
Individuals who are immobile have a higher risk of pressure ulcers. Reduced sensation due to neurological conditions or dementia can also prevent individuals from shifting position to relieve pressure. The Braden Scale is used to assess these risks.
Poor nutrition and hydration
Inadequate protein, vitamin, and mineral intake, along with dehydration, impairs skin health and wound healing.
Moisture from incontinence
Chronic exposure to moisture from bodily fluids can irritate and damage fragile skin, increasing susceptibility to bedsores and infections.
Comparison of ulcer types
Distinguishing between types of ulcers is crucial for treatment. This table compares arterial and venous ulcers, common leg sores in the elderly.
| Feature | Venous Leg Ulcers (Stasis Ulcers) | Arterial Leg Ulcers (Ischemic Ulcers) |
|---|---|---|
| Underlying Cause | Improper blood flow back to the heart (venous insufficiency) causes blood pooling in the legs. | Insufficient blood flow to the affected area due to narrowed or blocked arteries (PAD). |
| Appearance | Shallow, irregularly shaped wounds with uneven edges; may have dark red, purple, or brown skin pigmentation around the wound. | Deep, "punched-out" wounds with well-defined, regular edges; wounds may be yellow, brown, gray, or black. |
| Location | Commonly located on the lower leg, particularly above the ankle. | Typically found on the bony parts of the feet, such as the heels, toes, or outer ankle. |
| Pain Level | Mild to moderate achiness or pain that often improves when the legs are elevated. | Severe pain that worsens with leg elevation and is often worse at night. |
| Skin Features | Surrounding skin is often warm, swollen, and discolored. | Surrounding skin may appear shiny, thin, hairless, and cool to the touch. |
| Treatment Focus | Compression therapy to improve blood flow, leg elevation, and specific wound care. | Requires interventions to restore blood flow, such as bypass surgery or angioplasty. |
Comprehensive prevention and care strategies
Preventing and managing skin sores involves a multi-faceted approach:
- Regular Repositioning: Change position every two hours for bedridden individuals and every 15-30 minutes for those in wheelchairs to relieve pressure.
- Use of Support Surfaces: Pressure-relieving mattresses and cushions distribute weight. Avoid donut cushions.
- Proper Skin Care: Keep skin clean and dry with mild cleansers and moisturizers. Use barrier creams for incontinence and change soiled items promptly.
- Gentle Handling: Use lift sheets during transfers to prevent shearing and friction.
- Maintain Good Nutrition and Hydration: Ensure adequate protein, vitamins (C, A), and minerals (zinc) for skin health and healing.
- Regular Skin Inspections: Check skin daily for redness or other changes, especially over bony areas.
Conclusion
Understanding why elderly get sores on skin is crucial for effective care. Fragile skin, reduced mobility, and underlying health issues are key factors, but these risks are manageable through diligent prevention and care strategies. Regular skin inspection, repositioning, using specialized support surfaces, and maintaining proper nutrition can significantly reduce the risk of sores. Caregivers are essential in implementing these measures to enhance older adults' quality of life. If a sore develops, prompt medical attention and appropriate wound care are vital for healing and preventing complications.
