Properly caring for residents’ skin is a year-round requirement, but for many providers it becomes an especially tough challenge in summer months. The blazing sun and high temperatures can pose an even greater threat than usual to fragile, aging skin.
Just a few moments in direct sunlight can lead to a host of problems: sunburn, discomfort and the potential for subsequent skin breakdown. Higher temperatures (coupled with either excessive humidity or the dryness of arid climates) also can wreak havoc on skin integrity, experts warn.
“Aging skin is thinner, sensitive and more prone to damage, so good skin care is always important,” notes Eric Goldman, M.D., a Matrix Medical Network physician who works at Sarah Neuman Center for Healthcare and Rehabilitation in Mamaroneck, NY. “But as more people venture outdoors to enjoy the better weather, there are [additional] factors that need to be considered.”
Fortunately, keeping residents’ skin healthy and intact doesn’t require a tremendous amount of effort. With proper assessments, the right treatments and a healthy dose of staff education, providers can feel secure when their residents head outdoors to take in some fresh summer air.
Experts generally agree that many of the basic rules followed in cooler weather months will still apply.
Among the most important? Keep skin care tailored to each resident, as opposed to following a one-size-fits-all formula.
“Skin care should be individualized, based on the resident’s medical history (taking into consideration medication use, skin cancer history other dermatologic conditions, such as eczema or psoriasis),” says Sharon Brangman, M.D., president-elect of the American Geriatrics Society in New York.
Never ease up
Preventive skin and risk assessment protocols also should be followed faithfully, using tools such as the Braden Scale or Norton Scale. Risk assessments should take into consideration mobility, incontinence, sensory deficiency, and nutritional status, including conditions such as dehydration.
Although skilled nursing residents might be less likely to regularly venture outdoors, their caregivers cannot afford to become lax when it comes to summertime skin care regimens.
“In our setting, we are very proactive,” notes Darien Tully, RN, charge nurse at Lima Estates, an ACTS retirement community in Media, PA. “Every resident gets a [thorough, full-body skin assessment] once a week.”
Clinical practice should relate to the subscore of moisture on the Braden Scale, says Cindy Sylvia, MSC, MA, RN, CWOCN, educational development program manager for Gaymar Industries.
It’s important to note that humidity—when coupled with high temperatures—can increase perspiration and raise the risk of problems such as fungal infection and skin degradation.
“We need to do our best to keep skin dry and be on alert for moisture-induced infections,” Goldman reasons, adding that moisture is commonly trapped in skin folds of the abdomen, breasts and groin areas of the body.
Of course, this doesn’t mean staff should forego moisturizers. On the contrary. Keeping skin properly hydrated is essential for maintaining skin integrity and creating a healthy moisture barrier.
“Skin moisturizers should be applied to skin at least once a day, no matter the season, especially if the nursing home resident has a history of dry skin,” Brangman says.
“Harsh soaps, like those found in the soap dispensers in many resident’s rooms, should be avoided and soaping generally should be focused on strategic areas, such as the genitals and underarms. Rinsing with hot water should be avoided. Rinsing thoroughly with lukewarm water should be considered, especially for those with a history of dry skin.”
Bottoms up
Oral fluid intake is also essential for maintaining skin health, particularly in warmer weather months when dehydration can occur rapidly and often with little warning.
“In the summer, it can get quite hot and muggy, and I always worry about dehydration,” adds Goldman. “This can be especially problematic for residents on water pills. We push fluids and even have a cooler on our patio to encourage fluid intake. You have to stay on top of it.”
Residents who are able to enjoy time outdoors should avoid the sun entirely during the hottest part of the day—typically between 10 a.m. and 3 p.m.—and should have sunscreen applied at least 20 minutes prior to venturing outside. It should then be reapplied as needed, depending upon their exposure time and rate of perspiration. Family members, who are typically responsible for supplying sun protection products, should also be informed of their importance and encouraged to keep the resident protected during any off-site trips.
Sunscreen always
Because thin, fragile skin is more susceptible to sunburn, sunscreen should be applied year-round when residents are heading outdoors, experts advise.
“I suggest one that has the physical blocks, titanium and zinc. Also, a hat in the summer is a must for added protection against sun damage,” says skin care expert Joanna Vargas of Joanna Vargas Skin Care in New York.
Goldman, too, suggests caregivers aim high on protection. He prefers a sunscreen with at least SPF 45, a wide-brimmed hat and lightweight, light colored moisture-wicking clothing.
He also urges skilled nursing providers to adequately train staff, especially certified nursing assistants (the most hands-on with residents) about the importance of sun protection, even on overcast days. Further, it’s essential that caregivers and family members understand that sun protection is important for all residents, even those with darker skin.
“It’s important not to forget to apply sun block to all potentially exposed areas. It’s common to focus attention on the face and arms, but any exposed skin is susceptible,” Goldman says, noting that the feet, for example, may be inadvertently overlooked.
Generally, those with a history of skin cancer should avoid the sun altogether. Specific instructions should be obtained from residents’ physician in these instances, according to Brangman.
Check meds
If vitamin D deficiency is a concern, vitamin D supplements are a viable option.
“The sun is a good source of vitamin D, but for those with a history of skin cancer [or other conditions that make them more susceptible to the sun] it’s better to exercise caution and avoid it altogether,” Goldman explains.
Skilled nursing residents’ medications should be carefully considered before taking residents outdoors during the warm, sunny summer months. A number of drugs could put residents at greater risk for sun sensitivity or dehydration, so caregivers should stay alert to any medication changes and make adjustments to outdoor visits, as necessary.
“Some medications, such as hydrochlorothiazide, an antihypertensive used to control elevated blood pressure, can cause photosensitivity or a rash after the skin is exposed to the sun,” according to Brangman.
“Nursing home residents should have a review of their medications done by a physician or pharmacist to see if they are taking any medications that might cause a skin reaction after sun exposure.”
Certain perfumes also can cause a photosensitive skin reaction when exposed to sunlight. Brangman suggests seniors avoid using perfume, cologne, aftershave or other scented products when planning to spend time outdoors.
Fragrance-free moisturizers and skin care products are another good idea and can help residents avoid allergic reactions and another common pitfall associated with spending time outdoors: insect bites.
“Doing what we can to prevent bug bites and other forms of skin irritation is just” good practice, Tully stresses.
He adds that persistent scratching can result in skin tears and even decubitus ulcers. Therefore, in regions where mosquitoes and other biting insects are prevalent, providers might want to consider using mild bug repellants, especially in the evenings and in more shaded, woody areas where insects tend to pose a greater threat.
“There’s a lot to consider, but with the proper assessments, good hydration and the use of good products and common sense, it is possible to keep skin healthy year-round,” Tully assures.
From the July 01, 2009 Issue of McKnight's Long-Term Care News
