Comprehensive Geriatric Assessment (CGA): Skin integrity
The effects of normal ageing have a detrimental effect on the integrity and function of skin, which can be further exacerbated by the presence of other comorbidities and frailty.
In this population we see an increase in prevalence of chronic wounds such as pressure injuries, moisture lesions, leg ulcers and diabetic foot complications,1,2 making an assessment of skin integrity a vital part of CGA. It must be established if there are any areas of concern that require treatment, and identify any potential issues that could benefit from early intervention.
When identified early, many skin integrity concerns can be addressed by altering positioning or equipment to reduce pressure and the use of simple emollients to increase hydration of the skin.
In addition, when considering skin integrity in the context of frailty and CGA, it is vital to consider other co-morbidities or functional limitations that could be contributing, that will also need addressing to improve skin health. For example:
- Incontinence
-
Urine is damaging to skin, and the presence of urine or faeces can impair wound healing or cause infection (link to bladder and bowel)
See also: CGA: Bladder and bowel health
-
- Medication side effects
-
People with frailty are more likely to suffer with polypharmacy, and several medicines have been associated with poorer skin healing e.g. nicorandil. Medicines that affect perfusion of blood vessels may also have a detrimental effect on wound healing2 (link to medication)
See also: CGA: Medication history and review
-
- Nutrition and hydration
-
Poor nutrition and hydration can have a significant effect on skin health. Malnutrition has been linked to decreased muscle mass, increased incidence of falls, delayed wound healing and impaired mobility (link to nutrition)
See also: CGA: Nutrition and hydration
-
- Mobility
- Limited mobility may affect posturing and how long people are spending in one position/place, which can increase risk of pressure damage.
See also: CGA: Functional
- Limited mobility may affect posturing and how long people are spending in one position/place, which can increase risk of pressure damage.
The care plan generated from the CGA should recommend interventions to improve skin integrity considering this holistic approach.
References
References
Click to expand
- Beeckman D, et al. Best practice recommendations for holistic strategies to promote and maintain skin integrity. London, UK: Wounds International; 2020.
- Ferris AE, Harding KG. Are chronic wounds a feature of frailty? Br J Gen Pract. 2020 Apr 30;70(694):256-257. doi: 10.3399/bjgp20X709829. PMID: 32354831; PMCID: PMC7194753.
