Skin property can predict the development of skin tears among elderly patients: a prospective cohort study

Abstract

The aim of this study was to identify skin properties that may be used to predict the development of a skin tear (ST) among elderly patients. A prospective cohort study was conducted among elderly patients aged 65 and older (N = 149) at a long-term medical facility in Japan over an 8-month period. Skin properties at baseline were measured on the forearm using a 20-MHz ultrasound scanner, which measured the thickness of the dermis layer and low-echogenic pixels, and skin blotting method, which evaluated the levels of collagen type IV, matrix metalloproteinase-2 and tumour necrosis factor-alpha. Adjusted hazard ratios (HRs) for the main confounders were obtained using the Cox proportional hazard model. A total of 52 STs were recorded among the 21 patients, resulting in an incidence rate of 1·13/1000 person-days. The predictor of STs was dermis thickness (HR = 0·52; 95% confidence interval = 0·33-0·81; P-value = 0·004). The cut-off point for dermis thickness was 0·80 mm (area under the curve = 0·77; 95% confidence interval = 0·66-0·88; P-value = 0·006). Our results suggest that measuring the dermis thickness at baseline is an easy and accurate way to identify a high-risk patient.

Malnutrition is independently associated with skin tears in hospital inpatient setting—Findings of a 6‐year point prevalence audit

“…Advanced age is a well‐defined risk factor for skin tears and is an important consideration with Australia's aging population where the number of people aged over 65 years will rise to 18% in 2021 and 26% in 2051 . Aging leads to structural skin changes, including reduced dermal thickness, elasticity, loss of underlying fat, resilience, and increased dryness increasing susceptibility to injury . Due to these physiological changes, people aged 70 to 75 years are twice as likely to develop pressure injuries as those aged 55 to 69 years…”

A risk model for the prediction of skin tears in aged care residents: A prospective cohort study

“…Koyano et al had previously implicated these secreted proteins in the risk of skin tears. Subsequent research by the authors failed to identify any significant association with skin tears …”

“…Subsequent research by the authors failed to identify any significant association with skin tears. 10…”

“…They are commonly defined as “a traumatic wound occurring principally on the extremities of older adults, as a result of friction alone or shearing and friction forces which separate the epidermis from the dermis (partial‐thickness wound) or which separates both the epidermis and the dermis from underlying structures (full‐thickness wound)” . Published epidemiological data on the prevalence and incidence of skin tears in aged care facilities indicate that they occur in 41% to 59% of Australian, 14% to 22% of North American, and 4% to 14% of Japanese residents . Regardless of the geographical location of published studies, skin tears principally occur on the upper extremities, followed by the lower extremities, of older individuals …”

“…7 Published epidemiological data on the prevalence and incidence of skin tears in aged care facilities indicate that they occur in 41% to 59% of Australian, 14% to 22% of North American, and 4% to 14% of Japanese residents. 1,3,[8][9][10][11] Regardless of the geographical location of published studies, skin tears principally occur on the upper extremities, followed by the lower extremities, of older individuals. 2,8,12,13 A recent review of the literature identifying individual attributes or clinical characteristics that predicted the risk of skin tears in older adults found that the vast majority of articles were based on lower levels of scientific evidence including expert opinion, case series, and observational studies.…”