Preventing incontinence-associated dermatitis in older people
Incontinence can contribute to anxiety and depression, cause an increase in urinary tract infections and increase the risk of falls. The greatest risk, however, is skin damage caused by incontinence-related dermatitis. It is a multifaceted condition so a full assessment is vital.
The skin of older people is particularly vulnerable because of age-related changes, including thinning of the dermis and epidermis, which makes it more fragile and prone to damage from washing and drying.
The skin also becomes dry because of a decrease in sebum production, loses elasticity because of flattening of the dermo-epidermal junction, and healing time is increased because cells are replenished more slowly.
Healthy skin has a so-called acid mantle formed by a mixture of sebum and sweat. This maintains a pH of 4.4-5.5. Exposure to urine and faeces can damage this mantle and make the skin more alkaline. Liquid faeces are particularly damaging because they have a higher level of digestive enzymes.
The skin should be cleansed immediately using a cleanser with a similar pH to healthy skin – avoiding soap and water, which are alkaline. The skin should be dried carefully and a barrier product should be applied to protect it. All barrier products should be applied sparingly and in line with manufacturers’ recommendations. Concern has been expressed in the past that greasy creams and ointments might clog pores on continence pads leading to failure and leakage. However, recent developments in pads mean that this may no longer be a problem.
Yates A (2018) Preventing skin damage and incontinence-associated dermatitis in older people. British Journal of Nursing. 27, 2, 76-77.
Compiled by Ruth Sander, independent consultant in care of the older person