Skin Care and the Individual with Alzheimer’s Disease Virginia Alzheimer’s Commission AlzPossible Initiative

SKIN CARE and the INDIVIDUAL WITH ALZHEIMER’S DISEASE

Panelists:Judy Nelson,

Gale Davis,

Dana Raborg

September 28, 2007

Skin Care and the Individual with Alzheimer’s Disease Virginia Alzheimer’s Commission AlzPossible Initiative

Skin CareSkin Care

Skin is our lifelong protection from heat and cold, sun, undue exposure to germs or harsh chemicals, and injuries of all kinds. 

Skin care refers simply to the ways we protect our skin on an everyday basis by:

• bathing

• applying lotion

• cleaning a cut with soap and water

• using sunscreen outdoors

• eating a balanced diet

• preventing injuries such as burns, and

• seeing a dermatologist when necessary. 

Skin Care and the Individual with Alzheimer’s Disease Virginia Alzheimer’s Commission AlzPossible Initiative

IDENTIFYING RISK FACTORSIDENTIFYING RISK FACTORS

Risk Factors

IMMOBILITYDECREASED LEVEL OF AWARENESS OR

DECREASED SENSATION

INCONTINENCE

POOR NUTRITION/LOW WEIGHT

ANEMIA, DIABETES OR OBESITY

DEHYDRATION

Aging in general causes skin to be fragile as the layers thin and lose their elasticity.  Other risk factors are:

Skin Care and the Individual with Alzheimer’s Disease Virginia Alzheimer’s Commission AlzPossible Initiative

IDENTIFYING RISK FACTORSIDENTIFYING RISK FACTORS

Most skin wounds begin in facilities, both in hospitals and in Most skin wounds begin in facilities, both in hospitals and in nursing homesnursing homes.  

It is estimated that over 70,000 people in America die each year from wound infections that begin with skin breakdown or “pressure sores.”  Other names for this injury are pressure ulcers, bed sores or decubitus ulcers. 

There are four stages of skin ulcers, from Stage I, the most superficial, to Stage IV, the deepest, extending into the muscles.  These sores are slow to heal and easily infected, so prevention is paramount. 

STAGE I (most superficial) STAGE IV (deepest)

Skin Care and the Individual with Alzheimer’s Disease Virginia Alzheimer’s Commission AlzPossible Initiative

IDENTIFYING RISK FACTORSIDENTIFYING RISK FACTORS

MEDICATIONS can affect the skin by: Increasing sensitivity to sunlightIncreasing sensitivity to sunlight.  Examples: doxycycline,

amiodarone, hydrochlorothiazide.

Causing dehydrationCausing dehydration.  Dehydration can result  in dry skin and other changes in the skin.  Examples: furosemide.

Increasing risk of bruisingIncreasing risk of bruising.  Examples: warfarin, clopidogrel, aspirin, gingko.

Impairing wound healingImpairing wound healing.  Steroids (topic and oral) can cause wounds to heal more slowly. Examples:  hydrocortisone, prednisone.

Causing nutritional deficienciesCausing nutritional deficiencies.  Medications can worsen nutritional status by impairing vitamin absorption, causing dry mouth and loss of appetite, or impairing swallowing.  Poor nutrition can affect the skin.

Check for warnings on the prescription vial or patient leaflet regarding risk of bruising or sun sensitivity.

Discuss possible skin-related medication effects with your pharmacist or prescriber.  

Skin Care and the Individual with Alzheimer’s Disease Virginia Alzheimer’s Commission AlzPossible Initiative

SKIN ULCER TYPES, CAUSES AND CARESKIN ULCER TYPES, CAUSES AND CARE

1

PRESSURE SORES

2 3

SHEARING INJURIES

FRICTION INJURIES

Skin Care and the Individual with Alzheimer’s Disease Virginia Alzheimer’s Commission AlzPossible Initiative

SKIN ULCER TYPES, CAUSES AND CARESKIN ULCER TYPES, CAUSES AND CARE

Pressure sores are most frequently caused by prolonged Pressure sores are most frequently caused by prolonged

pressure on a vulnerable areapressure on a vulnerable area—a bony prominence like the hip,

heel, tail bone, or ankle. When skin is squeezed between bone

and the mattress or a chair, the pressure limits blood flow to

the area.  Within hours, this can lead to tissue death.  

Always roll a person from side to side and gently remove soiled

linen without pulling against the skin’s surface.  A person who A person who

can’t move in bed can develop a pressure sore in as little as can’t move in bed can develop a pressure sore in as little as

two hourstwo hours.  Damp skin presents the greatest risk, so wet or

soiled clothing and bedding must be changed quickly. 

Skin Care and the Individual with Alzheimer’s Disease Virginia Alzheimer’s Commission AlzPossible Initiative

SKIN ULCER TYPES, CAUSES AND CARESKIN ULCER TYPES, CAUSES AND CARE

Friction injuries usually occur when skin rubs against a Friction injuries usually occur when skin rubs against a

resistive surface like a sheetresistive surface like a sheet.  When linen is pulled forcefully

out from under a person, such an injury can easily occur. 

Always roll a person from side to side and gently remove

(rolling up) soiled linen without pulling against the skin’s

surface! 

Shearing injuries occur when a person’s skin tends to stick to Shearing injuries occur when a person’s skin tends to stick to

the bed or chair and pulls away from the underlying tissue as the bed or chair and pulls away from the underlying tissue as

they slide down or are pulled or turnedthey slide down or are pulled or turned. The outer layer of

skin can become separated from its blood supply just below

the surface.  These shearing forces frequently result in

decubitus ulcers. 

Skin Care and the Individual with Alzheimer’s Disease Virginia Alzheimer’s Commission AlzPossible Initiative

PREVENTION

Inspect skin every dayInspect skin every day—several times for people confined

to bed or chair.  Pay special attention to pressure points

or moist areas, and report any sign of redness or injury to

a professional to check the area right away. 

Reducing friction by making sure a person is LIFTED and person is LIFTED and

NOT DRAGGEDNOT DRAGGED during repositioning, and that linen is

rolled, not yanked or pulled out from under him or her

will prevent many injuries.

Clean soiled or wet skin quicklyClean soiled or wet skin quickly. Ideally, skin should be

cleaned as soon as it is soiled.  When that is not possible,

use pads or briefs that absorb moisture and keep it away

from the skin. Stool needs to be removed immediately.  

Skin Care and the Individual with Alzheimer’s Disease Virginia Alzheimer’s Commission AlzPossible Initiative

PREVENTION

Daily bathingDaily bathing is necessary for comfort and cleanliness.

Use lotions, creams or oils to prevent dryness and Use lotions, creams or oils to prevent dryness and crackingcracking. Powder and lotion are both fine but together they can make a paste. Use one or the other for any one part of the body. Cornstarch can soothe like powder.

Change positions at least every two hoursChange positions at least every two hours in chair or bed to limit pressure over boney parts.

Lift, don’t drag a person during repositioning, and roll Lift, don’t drag a person during repositioning, and roll linen, don’t yank or pull out from under the personlinen, don’t yank or pull out from under the person. This will reduce friction and prevent many injuries.

Avoid donut-shaped rings or cushionsAvoid donut-shaped rings or cushions as they can cause pressure on the skin over the sacrum. 

Skin Care and the Individual with Alzheimer’s Disease Virginia Alzheimer’s Commission AlzPossible Initiative

PREVENTION

In Bed:

Keep heels off the bed at all timesKeep heels off the bed at all times—propped on pillows or person lying on side.

Use pillows for support or protectionUse pillows for support or protection, such as for heels, elbows, or between legs.  

Keep the head of the bed lowKeep the head of the bed low (30 degrees at the most) to prevent shearing injuries.

Use cornstarch-like powder to smooth over rough Use cornstarch-like powder to smooth over rough

surfacessurfaces in bed. 

Skin Care and the Individual with Alzheimer’s Disease Virginia Alzheimer’s Commission AlzPossible Initiative

RESOURCES and DISCUSSION

Discuss solutions at www.alzpossible.org (click on “forum”)

Resources and references will continue to be posted on the newsletter (www.alzpossible.org/newsletter/jul07.html)

Skin Care and the Individual with Alzheimer’s Disease Virginia Alzheimer’s Commission AlzPossible Initiative

TODAY’S PANELISTS

Judy Nelson, BS, RN is the Adult Care Services Manager for Senior Connections, The Capital Area Agency on Aging in Richmond, Virginia.  As such, she manages grants for respite and short term home care and assists families in assessing their care needs and finding resources in the community.  For the past three years she has helped to organize and co-teach a week long seminar for family caregivers with Dr. Ayn Welleford and the VCU Department of Gerontology. Ms. Nelson is a graduate of the University of Vermont with a Bachelor of Science in Nursing, and has worked at New York University Hospital in pediatrics, at Virginia Commonwealth University Medical Center as a consultant and in public health nursing for the past 12 years.

Gale Davis, MS joined the VCU Department of Gerontology staff in Fall, 2006. She is a Master’s Degree in Gerontology from VCU and undergraduate in Social Work from JMU. She is a Professional Geriatric Care Manager and member of the National Association of Professional Geriatric Care Managers. She teaches the course The Business of Geriatric Care Management for the Department of Gerontology. In addition Gale is the clinical site coordinator for GCM students at Senior Solutions of Richmond, a home care provider agency with a GCM practice. Gale’s work as Geriatric Care Manager started at Jewish Family Services of Richmond where she started their GCM Program and practiced there for 5 years.

Dana RaBorg, RN has worked with Hill-Rom’s home care division for over 5 years providing the appropriate products to patients at risk for and with active decubitus ulcers. Dana provides inservicing to the staff of Home Care Agencies and Assisted Living Facilities in the Richmond and surrounding areas. She has received extensive training in pressure ulcer prevention and management of pressure ulcers through Hill-Rom. She also gained much knowledge of preventing and managing pressure ulcers while working as a Home Health nurse and also as being the Director of Nursing for Long Term Care facilities in the Richmond area.