No abstract

As the older population in the UK continues to grow, so too will the number of people presenting with dermatological problems. Older people's skin is subject to dehydration internally and environmental factors externally. If, in addition, the individual suffers continence problems, he or she is at risk of painful incontinence-associated dermatitis, or even formation of a moisture lesion. The use of an effective barrier cream that gives protection while not interfering with continence pad efficacy can be an invaluable means of comfort to the older person.

Pressure ulceration causes much distress to patients and family, and can be taken as an indication of poor nursing care. It is vital that both parties understand when pressure damage can be prevented, and those circumstances when skin failure at the end of life cannot be avoided. Appropriate risk assessment, provision of all appropriate care, and use of pressure relieving equipment to minimize the risk of any loss of skin integrity are required. The recognition of Skin Changes at Life's End (SCALE) ulcers may herald the imminent demise of a loved one. Families require support and good communication from nursing staff at this difficult time.

As the population of older people increases it is likely there will be an associated increase in the numbers of patients presenting with pretibial lacerations to GP surgeries, accident and emergency departments and referred to community nurses. This will be due, in part, to the increasing frailty of the skin of the older person, as well as comorbidities, the number of which are also likely to increase with ageing. It is important that the older person with a pretibial laceration is treated promptly and appropriately to prevent complications and optimize healthcare resources.

Pressure ulcers cause a great deal of distress, loss of dignity for the patient and can be problematic in terms of management. Pressure ulceration in the sacral area may lead to added complications if the patient has problems with urinary and faecal incontinence. Maintenance of the patient’s skin integrity is vital to avoid added discomfort and distress due to moisture lesions. Prevention of wound and dressing contamination with urine and faeces is difficult and can lead to increases in clinical risk (infection) and cost if not managed successfully.