Q: Why is aging skin more vulnerable to damage from pressure and other trauma?
A: Skin is an organ that provides barrier function and protection against microorganisms, and it has functions that include maintenance of blood pressure, temperature and water balance.
Biologic mechanisms of aging are both intrinsic and extrinsic. Intrinsic aging refers to genetically dependent changes, including disease processes and comorbidities, while extrinsic aging refers to environmental influences, primarily sun exposure.
Reduced cellular proliferation and less acidity in the epidermis alter bacterial balance. Cells that govern the immune process and deter pathogenic organisms decrease. Skin becomes thinner with fewer macromolecules such as collagen and elastin. The result is loss of elasticity and moisture needed to maintain the barrier function.
Age-related deficits are further impacted by stressors and comorbidities that can be both acute and chronic. This increases vulnerability to mechanical stress with predisposition for skin failure and impaired wound healing. Wound healing is prolonged in older individuals, with increased rates of postoperative wound disruption and dehiscence.
Skin changes profoundly over a lifetime, becoming progressively compromised in both structure and function. The compromised physical structure, along with deficits in microcirculation and impaired delivery of oxygen and nutrients, and removal of waste products, predispose the skin to damage and impaired wound healing.
Medical technology and improvements in public health have endowed us with an extended life span. This, in combination with the prevalence of multiple comorbidities, has given rise to an expanding “silent epidemic” of chronic wounds that will multiply the demand for wound care practitioners in the foreseeable future.