Skin tear conversation starters — for Support at Home teams

These conversation starters from Wounds Australia Life Member Dr JENNY PRENTICE are designed to support anyone caring for aging Australians in any setting, but particularly Support at Home teams.

Wound Awareness Week (1–7 September) puts chronic wounds — Australia’s hidden epidemic — under the spotlight. It’s not just a chance to start a national conversation about preventing and treating wounds, but also a great opportunity for aged care professionals to upskill in the special needs of older skin.

As skin ages, it becomes weaker, less elastic and more prone to injury and tearing. Skin tears are a costly and common wound type affecting millions around the globe, especially older people. Despite their prevalence, skin tears are largely preventable. Helping your clients understand how to maintain good skin integrity will reduce their risk of skin tears.

There are several factors that increase a person’s risk of experiencing skin tears, and lots of great ways to help your clients improve their skin integrity. These conversation starters will help you explore them.

Skin checks

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Conversation starter

Did you know that skin tears can be tiny, almost too small to notice? Do you check your hands, arms and legs every day or several times a week for any cuts, sun spots, bruising or any other unusual lumps in your skin? Is there anything you are concerned about?

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In addition to frequent skin checks, ensure that fingernails and toenails are trimmed regularly, and that the client is wearing properly fitting shoes and clothes that don’t rub and break the skin.

Dexterity/flexibility problems

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Conversation starter

Can you reach every part of your body when bathing? Are there any bits you find it hard to reach?

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It can be hard to properly care for skin you can’t see or reach, and easy to miss a small skin tear until it’s too late. Particularly vulnerable areas include between the toes, the underarms, the backs of the thighs and bony areas like shoulder blades. These areas need to be checked regularly.

Skin care

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Conversation starter

Did you know that some soaps can cause dryness of the skin?

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Using an unscented pH balanced soap free cleanser, having short showers and gently patting your skin dry, rather than rubbing, will help guard against dryness. A pharmacist can help your client choose the right option for their skin.

Regular moisturising

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Conversation starter

Did you know that moisturising your skin twice a day is really important in helping it stay strong and flexible and less susceptible to injury? How often do you moisturise?

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The evidence from research shows that moisturising plays a huge role in keeping our body’s best defence system — our skin — in good working order. Basic, unscented, emollient-based moisturisers, or those with urea and glycerine, or lotions like QV, ABENA or CeraVe are cheap and easy to find in supermarkets and pharmacies, and online.

Nutrition and hydration

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Conversation starter

What have you eaten and drunk in the past 24 hours, and was this typical for you? Are you having any trouble chewing or swallowing?

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Healthy skin relies on appropriate nutrition and hydration, which means eating a balanced diet and drinking plenty of water. Without this, skin becomes dry and brittle, and wounds take longer to heal. Issues with chewing and swallowing may prevent older people from eating properly. Dietary supplements like Argie Wound Care can support skin integrity and improve wound healing — and a pharmacist can advise on its appropriateness.

Sun protection

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Conversation starter

Do you cover up properly in the sun?

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Sun exposure can be extra damaging to aging skin, so it’s important that older people use sunscreen and wear protective clothing such as clothing with long sleeves, and hats.

Mobility

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Conversation starter

Can you move around your home easily without tripping or bumping into things? Do you feel stable when standing and walking?

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Even gentle bumps can break fragile skin, and trip hazards combined with balance issues associated with aging increase the chances of accidents occurring.

Medications

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Conversation starter

Which medications have you taken since my last visit, including over-the-counter products like painkillers or allergy medicine?

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Certain medications, such as antihistamines, steroids and diuretics, affect skin integrity and make older skin more prone to inflammation and tearing. People on anticoagulants or blood thinners will be prone to increased bleeding from a skin tear.

Sight issues

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Conversation starter

Can you see clearly?

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Good vision is essential to proper skin checks and care, and to ensuring that the home is a safe environment.

First aid for skin tears

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Conversation starter

Do you know what to do if you or someone you know develops a skin tear?

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The steps to follow are:

1. Apply light pressure over the skin tear with a clean cloth to stop any bleeding.
2. Wash your hands before attending the wound.
3. Flush the wound with clean lukewarm water to remove any dirt or debris.
4. If possible, unfurl any rolled skin and lie flat using a moist cotton bud or pad.
5. Cover the skin tear with a non-stick dressing and gently bandage.
6. Consider visiting a GP or pharmacist for further advice if the skin tear is:

• large or continues to bleed;
• shows signs of infection, which are heat, pain, redness, swelling, odour or pus.

Preventing skin tears

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Conversation starter

Do you know how to prevent skin tears?

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Along with twice daily skin moisturising, advise your clients to wear long-sleeved shirts and long pants or trousers to protect arms and legs. Also advise clients to remove any clutter or trip hazards in the home.

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Wound Awareness Week resources

On the Wound Awareness Week website (www.woundaware.org), you’ll find factsheets in six languages for consumers, carers and healthcare professionals on everything from the basics of good skin care to sources of support in the community. Plus, free daily webinars for care professionals that cover everything from different wound types to collaborative care teams.

And the International Skin Tear Advisory Panel (www.skintears.org) has a range of resources like the Skin Tear Tool Kit and Risk Assessment Pathway — to guide care professionals in managing this common and impactful wound type.

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Dr Jenny Prentice PhD RN STN, Cert., Palliative Care, is a Wound, Skin and Ostomy Consultant at Hall & Prior Health and Aged Care Group in WA. She is the Editor of the World Council of Enterostomal Therapist’s (WCET) WCET Journal and a pioneer in pressure injury research. With over 30 published articles, several books and 22 research projects to her name, Dr Prentice is also celebrated for her dedication to mentorship and patient-centred care.

Top image credit: iStock.com/SolStock