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

Fujimura, Tsutomu; Makino, Mayumi; Takagi, Miyuki; Maki, Kumiko; Murakami, Emiko; Tasaka, Yoshiko; Sato, Noriko; Akiba, Shunichi; Hotta, Mitsuyuki; Kitahara, Takashi; Ando, Kikue

doi:10.1111/ijd.13170

Cited by 14 publications

(18 citation statements)

References 27 publications

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“…We acknowledge that this study was conducted on a relatively young cohort of healthy volunteers, and although age is not considered a risk factor of IAD, it is associated with a high prevalence of incontinence [64], and older adults are characterized by a diminished skin buffering capacity due to decreased barrier function [30, 56]. Additionally, the prescribed 2-h exposure period was practical for experimental testing on volunteers; however, with the increasing use of absorbent pads to contain incontinence, changing intervals can vary and urine may remain in contact with the skin for longer periods.…”

Section: Discussionmentioning

confidence: 99%

“…In incontinent patients, exposure to urine for extensive periods of time macerates the skin, leading to an overhydrated epidermis, swelling of corneocytes in the SC, barrier disruption, and enhanced upregulation of proinflammatory cytokines [29][30][31]. The damage is aggravated in the presence of urease-producing bacteria from the perineum or the nearby urinary tract that convert urea in urine into ammonia.…”

Section: Introductionmentioning

confidence: 99%

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An Exploratory Study of the Effects of the pH of Synthetic Urine on Skin Integrity in Healthy Participants

Koudounas¹,

Bader²,

Voegeli³

2022

Skin Pharmacol Physiol

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Background: Incontinence-associated dermatitis (IAD) develops from prolonged exposure of skin to urine and/or stool and represents a common complication in older adults, reducing the quality of life. Increased pH is an important etiologic factor of IAD, however, the relationship between urinary pH and skin barrier disruption remains unclear. Objective: To examine the effects of synthetic urine (s-urine) at various pH on transepidermal water loss (TEWL), stratum corneum hydration (SCH) and skin surface pH. Methods: S-urine solutions (pH 5.0-9.0) were applied to the volar forearms of 15 healthy participants for 2 hrs, with another site serving as the untreated control. Measurements of TEWL, SCH and skin surface pH were obtained at baseline and after each challenge. Skin buffering capacity was also examined in 5 volunteers by recording skin pH at baseline, after 2 hrs exposure and every 5 mins for 40 mins. Results: TEWL and SCH were increased following exposure to s-urine compared to baseline values. Although there was tendency for pH to an increase after exposure, further investigation showed that changes are only temporal as pH value is restored to baseline within 5 mins. There were no significant differences between solutions. Conclusions: This study revealed that urine disrupts healthy skin integrity; however, its effects are not pH dependent. Transient changes were observed on the acid mantle of the skin due to its innate buffering capacity. Future studies need to examine the effects of urine combined with bacteria responsible for pH elevation in patients with urinary incontinence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An Exploratory Study of the Effects of the pH of Synthetic Urine on Skin Integrity in Healthy Participants

Koudounas¹,

Bader²,

Voegeli³

2022

Skin Pharmacol Physiol

View full text Add to dashboard Cite

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“…The gender differences can be compared with a previous study at the skin sites of healthy volunteers aged >50 years, which reported higher female SC hydration values but similar TEWL values. 35 In addition, significantly higher TEWL and SC hydration values have been reported in bedridden incontinent patients, 36 as well as in healthy individuals subjected to moisture in combination with mechanical loading. 25 The present findings represent the first to present a correlation between two biophysical parameters, which was statistically significant for Session 2 (Figure 5), for patients presenting with skin sites demonstrating a category I PU.…”

Section: Discussionmentioning

confidence: 99%

Spatial and temporal changes in biophysical skin parameters over a category I pressure ulcer

Abiakam

Jayabal

Filingeri

et al. 2023

International Wound Journal

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In acute care facilities, the detection of pressure ulcers (PUs) relies on visual and manual examination of the patient's skin, which has been reported to be inconsistent and may lead to misdiagnosis. In skin and wound research, various biophysical parameters have been extensively employed to monitor changes in skin health. Nonetheless, the transition of these measures into care settings as part of a routine clinical assessment has been limited. This study was designed to examine the spatial and temporal changes in skin biophysical parameters over the site of a category I PU, in a cohort of hospitalised patients. Thirty patients, each presenting with a category I PU, were enrolled in the study. Skin integrity was assessed at the PU‐compromised site and two adjacent areas (5 and 10 cm away). Data was collected over three sessions to examine both temporal differences and longitudinal changes. Skin integrity was assessed using two biophysical parameters, namely, transepidermal water loss (TEWL) and stratum corneum (SC) hydration. In addition, the influence of intrinsic factors, namely, incontinence and mobility status, on the parameters was evaluated. TEWL values at the sites compromised by PU were statistically significantly greater (P < .001) than corresponding values at the adjacent control sites at 5 and 10 cm, which were consistent with a normative range (<20 g/h/m2). By contrast, SC hydration values did not reveal clear distinctions between the three sites, with high inter‐patient variation detected at the sites. Nevertheless, individual profiles were consistent across the three sessions, and the PU site was observed to be either abnormally dry or overhydrated in different individuals. No consistent temporal trend in either parameter was evident. However, intrinsic factors were shown to influence the parameters, with females, bedridden and incontinent patients presenting significantly higher TEWL and SC hydration values (P < .05). TEWL was able to identify differences in skin responses at skin sites compromised with a category I PU when compared to healthy adjacent skin sites. Accordingly, this parameter could be included in the clinical assessment for the identification of PU risk. Further studies are required to elucidate the role of hydration and skin barrier function in the development of PUs and their ability to monitor temporal changes in skin integrity.

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“…On a different note, dermatitis is associated with improper management of diapers or external collection urinary drainage. Indeed, incontinence-associated dermatitis can be reduced by changing pads more often, as well as by using the proper pad type [20]. …”

Section: Discussionmentioning

confidence: 99%

Prevalence and management status of urologic diseases in geriatric hospitals in South Korea: A field research

et al. 2017

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PurposeWe aimed to investigate the current management status of urologic diseases in geriatric hospitals in South Korea.Materials and MethodsQuestionnaire surveys and in-depth person-to-person interviews were conducted at 13 hospitals within the Seoul and Incheon areas.ResultsThe study was carried out from July to December 2014; 75.6% of patients (1,858/2,458) and 77.5% (779/1,031) of medical personnel responded to our survey. All surveys and interviews were performed by urology specialists, fellows, residents, or nurses. The hospitals included in the study had an average of 215.2 beds (range, 110–367), 189.1 patients (range, 90–345), and 40.2 nurses (range, 10–83). The average number of physicians was 6.2 (range, 3–11), but none of these were certified urologists. Only 4 hospitals provided consultation services for urological disorders. In total, 64% of patients had urological disorders, although only 20.7% of patients were receiving medication. Most patients were being treated using urological interventions; diapers (49.7%), indwelling catheters (19.5%), clean intermittent catheters (12.2%), and external collection urinary drainage (7.9%). However, most interventions were inadequately implemented, and only 17% of the patients had been examined by a certified urologist. Urological complications were found in 20.2% of patients, and secondary complications occurred in 18.8%. Excluding redundant cases, the total prevalence of urological complications was 39.0%.ConclusionsUrologic diseases are poorly managed, and no certified urologists work in geriatric hospitals. Therefore, more designated urologists are needed in geriatric hospitals.

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

Cited by 14 publications

References 27 publications

An Exploratory Study of the Effects of the pH of Synthetic Urine on Skin Integrity in Healthy Participants

An Exploratory Study of the Effects of the pH of Synthetic Urine on Skin Integrity in Healthy Participants

Spatial and temporal changes in biophysical skin parameters over a category I pressure ulcer

Prevalence and management status of urologic diseases in geriatric hospitals in South Korea: A field research

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