Caring for patient skin, thinning with age: What you need to know

The largest organ of the human body is the skin, spanning up to 2 meters. It works hard to protect the body against UV light from the sun and other environmental factors. But the skin’s protective power declines throughout the years. This deterioration in skin health adds to the challenge of caring for older adults. It’s important to choose the right clinically targeted skin cleanser and other skin care products to help protect skin from breakdown.

As people age, their skin cells go through changes due to both external influences and normal internal processes. Aging skin is also weakened by a decrease in sebaceous gland activity, and the depletion and dehydration of lipids, which Ronald Krinn BSN, BA, RN, CWOCN, Medline Director of Business Development describes as “the mortar that holds cells together.”

External factors such as sun exposure, medications, comorbidities, smoking and environment can further contribute to skin breakdown. “Age-related changes in tenacity and strength naturally occur in the skin due to the loss of collagen and important proteins that occur in the evolution process of new skin cells,” Krinn says. In terms of skin health, this translates to dry, translucent and thin skin that tears more easily and is at higher risk for pressure injuries. In turn, these wounds leave your patients open to potential infection.

To decrease the risk of infection on fragile, older skin, Gail Dereczyk BSN, RN, CWOCN, Medline Clinical Nurse Educator, stresses the importance of “keeping the skin clean and free of bacteria that are not part of the normal flora.”

Choosing the right cleanser for the job is the first step in caring for aging skin.

Unfortunately, many traditional, over-the-counter soaps and skin cleansing products fall short. “Harsh soaps and surfactants in cleansers can cause damage to skin proteins and lipids, inflammation and swelling of the stratum corneum, and altered lipid rigidity,” explains Kim Kehoe, BSN RN CWOCN DAPWCA, Medline Clinical Education Specialist.

The wrong cleanser can also compound dryness and itching, strip the skin’s acid mantle and disturb the pH of the epidermis, increasing the risk of skin breakdown. The right cleansing product for older skin aims to counteract these issues, helping to maintain skin moisture.

When it comes to choosing the right cleanser for older adults, there are several key characteristics that can help protect against skin breakdown.

1. pH balanced
   While optimal skin pH is slightly acidic, aging skin tends to be more alkaline. “Many traditional soaps include amphiphilic cleaning agents that are highly alkaline and contain harsh detergents that can quickly dry out the skin and strip the skin of its acid mantle,” Kehoe says. A pH-balanced cleanser can help bring back some of that acidity.
2. Gentle
   Harsh soaps can “strip the skin of its natural oils and defense mechanisms,” Krinn remarks. This leads to tightness, dryness, barrier damage, irritation, pH disruption, increased transepidermal water loss (TEWL) and itching, Kehoe says. Fragrances can also cause allergic reactions or sensitivities, so it’s a good idea to choose a hypoallergenic cleanser.³Particularly for patients requiring frequent cleansings, a no-rinse foaming cleanser provides gentle care and unscented moisture support.
3. Nourishing
   “Cleanser technology has come a long way from merely cleansing for the removal of sebum, soil, dirt and bacteria to providing mildness, moisture and now nourishment to the skin, in addition to cleansing,” Kehoe explains.

When it comes to caring for skin that’s thin and fragile from aging, it’s important to choose the right skin cleanser that’s pH-balanced, gentle and nourishing. The right cleanser for aging skin should be part of a system of skin care products that includes nourishing treatments to protect skin and maintain moisture balance.