Maintaining Skin Integrity in the Aged
Maintaining Skin Integrity in the Aged
Ageing is associated with structural and functional changes of the skin that result in increased vulnerability. The aim of this systematic review is to synthesize empirical evidence about the efficacy and effectiveness of basic skin care interventions for maintaining skin integrity in the aged. The databases Medline, EMBASE, CINAHL (1990–2012), Scopus, SCI (February 2013) and reference lists were searched. Inclusion criteria were primary intervention studies using skin care products in physiologically aged skin (lower age limit 50 years). Study and sample characteristics, interventions and outcomes were extracted. The methodological quality was assessed and a level of evidence was assigned. From 1535 screened articles 188 were read in full text. From these, 33 articles were included reporting results on treating dry skin conditions, and preventing incontinence-associated dermatitis and superficial ulcerations. Most studies had lower levels of evidence of 3 or 4. Skin-cleansing products containing syndets or amphoteric surfactants compared with standard soap and water washing improved skin dryness and demonstrated skin-protecting effects. Moisturizers containing humectants consistently showed statistically significant improvements in skin dryness. Skin barrier products containing occlusives reduced the occurrence of skin injuries compared with standard or no treatment. Owing to methodological limitations the current evidence base for basic skin care in the aged is weak. Using low-irritating cleansing products and humectant- or occlusive-containing moisturizers seems to be the best strategy for maintaining the skin barrier function and integrity. We know little about the effects of cleansing regimens and about the benefits of moisturizers when compared with each other.
The world's population is growing and ageing. Today there are more than 7 billion people, of whom more than 17 million are aged ≥ 80 years. Longevity is a worldwide phenomenon. For instance in Europe, the median population age has increased steadily over the past decades and is now > 40 years. The ageing process is associated with inevitable anatomical, morphological, physical and psychosocial changes. These changes also compromise the skin. In ageing skin, cell replacement is continuously declining, the barrier function and mechanical protection are compromised, wound healing and immune responses are delayed, thermoregulation is compromised and sweat and sebum production are decreased. On the cellular level, the content of natural moisturizing factors and lipids in the stratum corneum is reduced leading to decreased lamellar bilayers and poorer water-holding capacity. Chronic diseases, drugs and environmental factors including detrimental skin care habits damage the skin barrier integrity in the elderly.
The age-related skin changes often result in dermatological disorders and skin injuries. One of the most common dermatological diagnoses in the elderly is xerosis cutis with prevalences ranging from 30% to 85%. The prevalence of dry skin-related pruritus also increases with increasing age; this severely affects quality of life and worsens the skin status. Because of the flattening of the dermoepidermal junction and increasing skin stiffness, elderly patients are at increased risk of shear-type injuries such as skin tears or other partial to full-thickness wounds such as superficial pressure ulcers (SPUs). Depending on the setting, skin tear and SPU prevalence varies between 2% and 40%. In geriatric care, incontinence-associated dermatitis (IAD) is a common problem. Excessive moisture from urine and/or stools leads to overhydration and chemical irritation of the epidermis. Physical irritation (e.g. cleansing) contributes to the destruction of the epidermis and dermis. Across all healthcare settings IAD affects up to 50% of all incontinent patients, and geriatric patients are most often affected.
Adequate skin care is regarded as a major strategy for maintaining the skin barrier, skin integrity and health. This is especially true for high-risk populations such as geriatric patients. Special bathing products and cleansing procedures, moisturizers, barrier creams or other leave-on products are widely recommended for preventing and treating xerosis, for preventing skin injuries such as skin tears, IAD or other vulnerable skin conditions. However, there is no up to date systematic synthesis and appraisal about the evidence base supporting these basic skin care treatments in the aged population. Therefore, the aim of this systematic review was to evaluate the empirical evidence about the effectiveness of nondrug topical skin care interventions for promoting and maintaining skin integrity and skin barrier function in the aged.
Abstract and Introduction
Abstract
Ageing is associated with structural and functional changes of the skin that result in increased vulnerability. The aim of this systematic review is to synthesize empirical evidence about the efficacy and effectiveness of basic skin care interventions for maintaining skin integrity in the aged. The databases Medline, EMBASE, CINAHL (1990–2012), Scopus, SCI (February 2013) and reference lists were searched. Inclusion criteria were primary intervention studies using skin care products in physiologically aged skin (lower age limit 50 years). Study and sample characteristics, interventions and outcomes were extracted. The methodological quality was assessed and a level of evidence was assigned. From 1535 screened articles 188 were read in full text. From these, 33 articles were included reporting results on treating dry skin conditions, and preventing incontinence-associated dermatitis and superficial ulcerations. Most studies had lower levels of evidence of 3 or 4. Skin-cleansing products containing syndets or amphoteric surfactants compared with standard soap and water washing improved skin dryness and demonstrated skin-protecting effects. Moisturizers containing humectants consistently showed statistically significant improvements in skin dryness. Skin barrier products containing occlusives reduced the occurrence of skin injuries compared with standard or no treatment. Owing to methodological limitations the current evidence base for basic skin care in the aged is weak. Using low-irritating cleansing products and humectant- or occlusive-containing moisturizers seems to be the best strategy for maintaining the skin barrier function and integrity. We know little about the effects of cleansing regimens and about the benefits of moisturizers when compared with each other.
Introduction
The world's population is growing and ageing. Today there are more than 7 billion people, of whom more than 17 million are aged ≥ 80 years. Longevity is a worldwide phenomenon. For instance in Europe, the median population age has increased steadily over the past decades and is now > 40 years. The ageing process is associated with inevitable anatomical, morphological, physical and psychosocial changes. These changes also compromise the skin. In ageing skin, cell replacement is continuously declining, the barrier function and mechanical protection are compromised, wound healing and immune responses are delayed, thermoregulation is compromised and sweat and sebum production are decreased. On the cellular level, the content of natural moisturizing factors and lipids in the stratum corneum is reduced leading to decreased lamellar bilayers and poorer water-holding capacity. Chronic diseases, drugs and environmental factors including detrimental skin care habits damage the skin barrier integrity in the elderly.
The age-related skin changes often result in dermatological disorders and skin injuries. One of the most common dermatological diagnoses in the elderly is xerosis cutis with prevalences ranging from 30% to 85%. The prevalence of dry skin-related pruritus also increases with increasing age; this severely affects quality of life and worsens the skin status. Because of the flattening of the dermoepidermal junction and increasing skin stiffness, elderly patients are at increased risk of shear-type injuries such as skin tears or other partial to full-thickness wounds such as superficial pressure ulcers (SPUs). Depending on the setting, skin tear and SPU prevalence varies between 2% and 40%. In geriatric care, incontinence-associated dermatitis (IAD) is a common problem. Excessive moisture from urine and/or stools leads to overhydration and chemical irritation of the epidermis. Physical irritation (e.g. cleansing) contributes to the destruction of the epidermis and dermis. Across all healthcare settings IAD affects up to 50% of all incontinent patients, and geriatric patients are most often affected.
Adequate skin care is regarded as a major strategy for maintaining the skin barrier, skin integrity and health. This is especially true for high-risk populations such as geriatric patients. Special bathing products and cleansing procedures, moisturizers, barrier creams or other leave-on products are widely recommended for preventing and treating xerosis, for preventing skin injuries such as skin tears, IAD or other vulnerable skin conditions. However, there is no up to date systematic synthesis and appraisal about the evidence base supporting these basic skin care treatments in the aged population. Therefore, the aim of this systematic review was to evaluate the empirical evidence about the effectiveness of nondrug topical skin care interventions for promoting and maintaining skin integrity and skin barrier function in the aged.
