Elsevier

Geriatric Nursing

Volume 32, Issue 4, July–August 2011, Pages 257-262
Geriatric Nursing

Feature Article
Dry Skin in Older Adults

https://doi.org/10.1016/j.gerinurse.2011.03.003Get rights and content

Dry skin is a common problem in the older individual due to physiological changes of the aging process as well as chronic health conditions. Dry skin can worsen if management is inappropriate or lacking. Nursing management of dry skin in the elderly is comprehensive including applying topical products to replenish lipids and reduce water loss, maintaining or increasing fluid intake, limiting sun exposure, and reducing symptoms of chronic illnesses.

Section snippets

Dry Skin in Older Adults

Dry skin is estimated to affect between 30% to 60% of all older adults.4, 5 Changes in the skin related to normal aging may increase the likelihood of dry skin. With age, the number of small blood vessels is reduced, resulting in a diminished supply of blood and nutrients to the skin. The number of sweat and sebaceous glands, as well as in lipid production, are reduced in the skin. Thinning of the epidermis and elastic fibers that provide dermal support reduces the strength of the barrier layer

Dry Skin and Systemic Disease

Dry skin is a common symptom of several chronic systemic diseases, including hypothyroidism, diabetes mellitus, end-stage renal disease, liver disease, and human immunodeficiency virus (HIV). Appropriate treatment of the underlying disease contributes to resolution of dry skin. Hypothyroidism promotes abnormal lipid synthesis and can reduce sweat and oil gland activity. These are the factors thought to be associated with the development of dry skin.6 The prevalence of dry skin in patients with

Lifestyle and Dry Skin

Lifestyle factors associated with dry skin include inadequate food or fluid intake, exposure to sunlight and dry climates, and the use of alkaline cleansers. Men infected with HIV who lacked adequate food intake were twice as likely as non-HIV-infected men to have dry skin. Nutritional state affects the structure and function of the body organs, including the skin. Adequate fluid intake is important to maintaining adequate skin hydration. Healthy older adults are recommended to drink 1,500

Dry Skin Assessment

Despite the prevalence of dry skin in the elderly, no standardized clinical instrument has been adopted in practice or used in research to assess it. There are 4 instruments in the literature that measure dry skin severity and treatment effectiveness: the Black and Gaspar Foot Assessment Tool (BGFAT),18 Skin Condition Data Form (SCDF),19 Bauman Skin Type Indicator (BSTI),20 and the Wehr Xerosis Grading Scale.21 Only the SCDF has had testing of its psychometric properties, and its validity and

Intervention Options

The main interventions for the management of dry skin include topical treatments, fluid management, moderation of sun exposure, and disease management of any exacerbating conditions. The skin indicators of tissue integrity include the restoration of skin smoothness and suppleness as manifested by decreased skin scaling and flakiness, repair of cracking and redness, and resolution of hyperkeratosis, rash, or itching associated with skin dryness.

Summary

Dry skin is a disruption of the surface of the skin due to inadequate oil or water content. Signs of dry skin include flaking, scaling, cracking, and redness. Dry skin is associated with normal aging changes, making it a common problem for older adults. It can also be related to environmental conditions, comorbid illnesses, and skin care regimes. Optimal topical treatments containing a physiologic mixture of ingredients that reduce transepidermal water loss and replenish the lipids lost in dry

JENNIFER HURLOW, GNP-BC, CWOCN, Nurse Practitioner, Plastic Surgery Group of Memphis, Memphis, TN.

References (44)

  • S. Ward

    Eczema and dry skin in older people: identification and management

    Br J Community Nurs

    (2005)
  • M. Aye et al.

    Dermatological care of the diabetic foot

    Am J Clin Dermatol

    (2002)
  • C. Niederau et al.

    Cutaneous signs of liver disease: value for prognosis of severe fibrosis and cirrhosis

    Liver Int

    (2008)
  • G. Yosipovitch et al.

    Skin barrier structure and function and their relationship to pruritus in end-stage renal disease

    Nephrol Dial Transplant

    (2007)
  • D. Lee et al.

    Prevalence and factors associated with dry skin in HIV infection: the FRAM study

    AIDS

    (2007)
  • R.M. Allman

    Pressure ulcers among the elderly

    JAMA

    (1989)
  • S. Mac-Mary et al.

    Assessment of effects of an additional dietary natural mineral water uptake on skin hydration in healthy subjects by dynamic barrier function measurements and clinic scoring

    Skin Res Technol

    (2006)
  • H. Tagami

    Functional characteristics of the stratum corneum in photoaged skin in comparison with those found in intrinsic aging

    Arch Dermatol Res

    (2008)
  • D. Black et al.

    Seasonal variability in the biophysical properties of stratum corneum from different anatomical sites

    Skin Res Technol

    (2000)
  • Y. Sunwoo et al.

    Physiological and subjective responses to low relative humidity in young and elderly men

    J Physiol Anthropol

    (2006)
  • D. Voegeli

    The effect of washing and drying practices on skin barrier function

    J Wound Ostomy Continence Nurs

    (2008)
  • M.M. Brown et al.

    Nursing innovation for dry skin care of the feet in the elderly: a demonstration project

    J Gerontol Nurs

    (1982)
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    JENNIFER HURLOW, GNP-BC, CWOCN, Nurse Practitioner, Plastic Surgery Group of Memphis, Memphis, TN.

    DONNA ZIMMARO BLISS, PhD, RN, FAAN, FGSA, Professor, University of Minnesota School of Nursing, Minneapolis, MN.

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