Incontinence-associated dermatitis:protecting the older person

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.

Prevention and Care for Incontinence-Associated Dermatitis Among Older Adults: A Systematic Review

“…Incontinence-associated dermatitis (IAD) is a type of moisture-associated skin damage (MASD) caused by physical and chemical irritants. 1 Older adults are prone to skin damage, especially when hospitalized in semi-intensive care units, intensive care units, or living in long-term care facilities. 2 When exposed to urine and fecal matter, the skin becomes erythematous with the potential of developing dermal and epidermal erosion.…”

“… 4 In addition, the presence of friction and shear mechanical forces can decrease skin functioning and cause skin injury. 1 , 2 , 5 Thus, the potential for skin breakdown among incontinent older adults requires careful assessment and care.…”

“…Fecal incontinence has been reported to be from 1% to 10% of healthy older adults and from 17% to 66% of hospitalized older patients. 1 , 4 Urinary and fecal incontinence caused IAD in 33% of the hospitalized patients and 41% of residents in long-term care facilities. 4 …”

The influence of incontinence on the characteristic properties of the skin in bedridden elderly subjects

“…Overhydration, the penetration of stimuli into the skin, higher pH, colonization of microorganisms, and friction due to the cloth (diaper), which are induced by the occlusion environment, urine, and fecal matter, have been identified as risk factors for skin breakdown . These phenomena cause skin tears and abrasions followed by infections and/or pressure ulcers …”

“…9,10 These phenomena cause skin tears and abrasions followed by infections and/or pressure ulcers. 2,3,10,11 Proposed mechanisms for these problems show that water and moisture induce overhydration of the stratum corneum (SC) and then accelerate the penetration of low molecular weight stimuli into the skin followed by the induction of inflammation of the skin. 9,10 Water and moisture also induce an increased coefficient of friction, 12,13 and increases in friction force between diapers and the skin due to wetting is also considered to induce serious skin breakdown.…”