Skin breakdown refers to a range of injuries affecting the skin and underlying tissue, including pressure injuries, skin tears, and moisture-associated dermatitis. Aging skin is uniquely susceptible because it undergoes natural structural changes that reduce its protective function. The dermis thins, causing a loss of elasticity and tensile strength, making the tissue less resilient to external forces. Furthermore, age-related reductions in circulation and slower cellular turnover impair the skin’s ability to repair itself after minor trauma.
Optimizing Skin Health Through Daily Care
Maintaining the skin’s surface requires balancing cleanliness with moisture preservation to support the natural protective barrier. Avoid traditional, harsh bar soaps and very hot water, as they strip the skin of its natural oils necessary for barrier function. Instead, use gentle, pH-neutral cleansers to remove impurities without disrupting the skin’s slightly acidic mantle. After cleansing, pat the skin dry rather than rubbing vigorously, which prevents friction that can lead to fragile skin tears.
Applying emollients and skin barrier creams compensates for the age-related decrease in natural oil production. These products trap moisture within the skin, improving hydration and maintaining suppleness. For individuals managing incontinence, prompt cleansing after episodes is necessary to eliminate irritants like urine and stool. A specialized moisture barrier product should be applied to shield high-risk areas from chronic moisture exposure, preventing moisture-associated skin damage and reducing the risk of pressure injury.
Strategies for Pressure and Friction Relief
Mechanical stress—pressure, friction, and shear—is the primary external factor leading to skin breakdown, particularly over bony prominences. For individuals with limited mobility, a structured repositioning schedule is necessary to relieve sustained tissue loading. While a two-hour turning schedule is standard, frequency should be individualized based on skin tolerance and the support surface used. When repositioning, caregivers must use proper lifting techniques or assistive devices like slide sheets to avoid dragging the skin.
Dragging causes shear, a force that stretches and distorts tissue layers beneath the skin, potentially leading to deep tissue injury even if the surface remains intact. When lying on the side, using a 30-degree lateral position instead of a full 90-degree position shifts pressure away from the greater trochanter (hip bone) and is preferable for pressure relief. For those seated, tilting the wheelchair back by 30 degrees helps redistribute pressure off the sacral area.
Specialized support surfaces are instrumental in distributing body weight over a larger area, reducing focal pressure points. Mattresses using technologies like low-air-loss or alternating pressure manage heat and moisture at the skin surface while cyclically changing load-bearing areas. High-risk areas, such as the heels, often require additional offloading using specialized boots or positioning devices to ensure the heel is suspended entirely off the mattress surface.
The Role of Nutrition and Hydration
Skin health is supported by internal, systemic factors that maintain tissue structure and fuel the repair process. Adequate protein intake is important because amino acids are required for collagen synthesis and tissue regeneration. For individuals at risk of or experiencing skin damage, protein guidelines often suggest an intake ranging from 1.25 to 1.5 grams per kilogram of body weight daily.
Sufficient fluid intake is important for maintaining skin turgor and supporting overall circulation. Dehydrated skin loses elasticity and becomes more susceptible to breakdown, and poor hydration impairs the blood flow that delivers oxygen and nutrients to the tissues. Micronutrients, including Vitamin C and Zinc, play roles in maintaining skin integrity and promoting healing. Vitamin C is a cofactor for collagen formation, and Zinc supports tissue growth and immune function.
Identifying and Addressing Early Indicators
Careful, regular inspection of the skin is the first step in identifying damage before it progresses to an open wound. Areas over bony prominences, such as the tailbone, hips, and heels, should be checked daily for subtle changes. Early signs include a localized area that is warmer or cooler than the surrounding skin, or a change in texture, often feeling spongy or hard.
A persistent change in skin color is a warning sign, appearing as persistent redness in lighter skin tones or purple, blue, or shiny patches in darker skin tones. The “blanching test” assesses damage severity: when light pressure is applied to a reddened area, healthy skin briefly turns white (blanch) and then returns to red. If the redness does not blanch, this non-blanchable erythema indicates that tissue damage has begun beneath the surface.
A stage one pressure injury is characterized by persistent, non-blanchable discoloration with intact skin. If discoloration remains for more than 30 minutes after pressure relief, immediately eliminate pressure from that site and contact a healthcare provider for assessment. Recognizing and acting on these early indicators prevents the progression to deeper, more complex wounds.