Dermatoporosis is a chronic skin fragility syndrome, caused by age and environmental factors. People with dermatoporosis have skin whose protective mechanical function is reduced and which has a decreased tolerance for friction and shearing forces. Skin tears are another clinical consequence of age-associated skin vulnerability and people with dermatoporosis are at increased risk of skin tears. Dermatoporosis may also delay the healing of skin tears, making it vital that healthcare professionals are aware of this condition. Skin tears have profound effects on the health and well-being of older people, and these kinds of injuries are being seen more frequently in clinical practice as the average age of the population increases. The treatment of skin tears in three older people with dermatoporosis is discussed and the clinical decisions made in each case.

Dermatoporosis is a chronic cutaneous insufficiency/fragility syndrome with a high prevalence in older adults. Dermatoporotic skin becomes thin and fragile and tends to tear. It may lead to deep dissecting haematomas (DDHs) as a final stage of dermatoporosis, which is a clinical emergency. Management can be challenging, as patients with lower-limb haematomas are frequently older and affected by multiple comorbidities, or are probably on medications that negatively influence wound healing. This article describes the essential role of nurses in prevention, early recognition and wound management of DDHs in patients with dermatoporosis.

BACKGROUND Pain is an important symptom in wound management, and the choice of treatment directly affects the patient's quality of life. Pain assessment (PA) is essential for quality wound care and, in Italy, mandatory by law. OBJECTIVE To administer a dedicated learning survey to obtain a better sense of current PA practices, ensure more training, improve procedures, and reduce malpractice. METHODS A 16-month learning survey of nurses based on a validated questionnaire developed for this project. RESULTS The survey sample comprised 512 questionnaires. Of respondents, 78% were female, 56.1% were older than 40 years, 94% were RNs, and 6% were wound care specialist nurses. Participants performed a range of dressing changes per week (1-5, 46.3%; 6-20, 34.4%; >21, 19.3%). Although 93% of respondents considered PA important, only 26% recognized it as a vital parameter, and barely one-quarter (25.4%) were aware of current legislation mandating PA. The majority (95.3%) believed that PA is not consistent with pain perceived by the patient. Further, 87.3% stated that they did not have adequate knowledge to conduct a PA, 91.4% did not consider themselves up-to-date on PA, and 81% did not document PA results. However, specific wound care training leads to significantly better PA (P < .001): 71.9% of wound care specialist nurses recognized pain as a vital parameter, and 59.4% were aware of current legislation regarding PA; further, 81.3% consistently evaluated pain, 59.4% documented PA results, and 50% communicated the outcome to the physician in charge. CONCLUSIONS The results illustrate the lack of sensitivity, training, and education that Italian RNs have regarding PA in wound care.

Skin tears are acute wounds, often mismanaged and misdiagnosed that can convert to chronic wounds, representing a common but relevant burden to both the individual and the health care system. The implementation of prevention protocols and training programs is essential to manage these wounds in the community. Managing a skin tear-related problem at home represents a challenge, due to some critical issues and specific conditions. A multifaceted prevention programme should consider the involvement of relatives, caregivers and personal care aides in order to promote patients' safety, to minimise the risk of trauma and to improve patients' outcomes following a skin injury.

Skin fragility caused by structural and functional deterioration is ubiquitous especially in older people, and it determines a significant impact on quality of life. Dermatoporosis is a relatively new term used to describe the chronic skin insufficiency and fragility syndrome marked by morphological and functional manifestations. It is much more than a merely cosmetic problem. Dermatoporosis' manifestations may determine an increased risk of morbidity and mortality. Severe stages of dermatoporosis may determine skin lacerations, deep dissecting hematomas, and skin necrosis. Most patients affected by dermatoporosis are between 70 and 90 years old, but first clinical signs may start at around 40–60 years. Nurses have a key role in preventing dermatoporosis and managing its complications, promoting patients' safety and skin integrity.