Question

Skin integrity and sensory alterations are, at times, closely interrelated for the older adult. Discuss three effective interventions that may be implemented for an older adult with limited physical functions

Answer 1

1. Cleansers

Skin cleansers are available globally in varying forms, including
bars, liquids, gels, and creams, to be used in combination with wa-
ter. The type of surfactant used has
an effect on the mildness or otherwise of the product.
The major groups of surfactant are natural and synthetic. Natural
surfactants (soaps) are the most common cleansing agents. Some
products, for example, superfatted soaps, transparent soaps, and
combination bars, have components to reduce irritancy. Alternatives to soap-based cleansers include synthetic sur-
factant-based syndet (synthetic detergent) products (for example,
Dove) and emollient-rich bath additives and shower
preparations. There are also some prepackaged specialist bed bath
wipes, which contain premoistened cloths with evaporating no-
rinse cleansers and emollients, for example, Bag-
Bath.

2. Drying

After cleansing with water and a cleansing agent, drying of the
skin is essential and is generally achieved by towel drying using
either a rubbing or patting action. Towel drying incurs the risk
of direct mechanical damage to the stratum corneum; however, if
the skin is not dried thoroughly, there is a risk of over-hydration
and maceration. No skin drying is required after
the use of bed bath wipes.

3. Emollients

Simple emollients are skin moisturisers that leave a barrier of ar-
tifical lipids, such as petrolatum or mineral oil, on the skin sur-
face, thus, trapping water into the stratum corneum (SC) (reduc-
ing transepidermal water loss). The consistency
and occlusive properties of the emollient depends on the levels
of lipid or oil and water, which underpins the categorisation of
emollients as ointments, creams, or lotions. Ointments have the
least amount of water and the most lipids and therefore exhibit
greater skin occlusion. Creams contain similar amounts of water
and oil and are more easily spread across the skin compared with
ointments, making them more cosmetically acceptable. To emul-
sify the lipid and aqueous phases of an emollient, surfactants are
required. As with cleansers, a wide range of different surfactants
are used to emulsify emollients, the choice of which affects the ir-
ritant potential of the formulation. Ingredients, such
as humectants, physiological lipids, and antipruritic agents, can be
added to emollient bases. Humectants, includ-
ing urea, attract and trap water in the stratum corneum . This can off-set the reduced levels of natural moisturis-
ing factor (NMF) and other natural moisturising agents in dry
and older skin.