Skin Changes
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Skin Changes

As people age and near the end of life, their skin becomes more fragile and prone to damage. Common issues include pressure ulcers, skin tears, itching, and wounds that may not heal. These problems often result from poor circulation, prolonged sitting or lying in one position, incontinence, medication side effects, and underlying illness. Nurses and careworkers can prevent and manage skin changes through regular checks, gentle care, and early treatment of discomfort.

What I can do

Act to prevent problems arising:

  • Reposition people regularly — at least every two hours in bed and every hour when seated
  • Use pressure-relieving surfaces such as appropriate mattresses, cushions, and heel protectors to reduce pressure on bony areas such as heels, sacrum, and elbows
  • Keep skin clean and dry by gently washing with pH-neutral cleansers, patting dry, and applying non-perfumed moisturiser to prevent dryness and irritation.

Assess for early signs by:

  • Checking skin daily for redness, swelling, dryness or changes in texture, especially over bony areas
  • Use a gentle press test (3 seconds) to check if discoloured skin returns to normal or stays the same
  • Check for pain or itching that could be an early warning sign of skin breakdown.

In managing pressures sores:

  • Provide emotional support as well as physical care—a wound can have a big impact on a person’s wellbeing and can cause them to feel anxious or depressed
  • Treat broken skin carefully, keeping wounds clean and applying appropriate dressings
  • Address infection risks like odour, heat, or increased pain, and escalate concerns promptly.
Tips for Careworkers: Skin and wound care
 
Tips for Nurses: Skin and wound care

What I can learn

The palliAGED Practice Tips give helpful guidance on skin and wound care at the end of life. There is a version for nurses as well as one for careworkers.

Nurses can read more about skin failure and pressure injuries in the CareSearch Nurses Hub.

Familiarise yourself with the Australian Government’s guidelines on pressure injuries within the National Aged Care Mandatory Quality Indicator Program Manual 3.0 – Part B.

What I can give

If the older person, their family or carer need information or support in preventing or managing skin issues, these resources from Marie Curie (UK) may help:

What I can suggest

Regularly review pressure injury prevention policies and processes, focusing on:

  • Ongoing staff training in prevention, routine assessment, and management of pressure sores and other skin issues
  • Repositioning schedules and documentation practices
  • Use of risk tools such as the Braden Scale (23kb pdf), Waterlow Scale, or Norton Scale (85kb pdf).

Invest in and have adequate supplies of equipment including:

  • Pressure-relieving mattresses, cushions, and heel protectors
  • pH-neutral cleansers, skin-friendly moisturisers, and barrier creams
  • Wound dressing and repositioning aids for prompt care.

Establish a clear referral pathway to occupational therapists for equipment guidance, as well as continence and wound care specialists for complex cases.


Page updated 26 February 2025