The epidemiology of skin tears in the institutionalized elderly

While skin tears are a common occurrence in the institutionalized elderly population, nothing has been written about this problem. We retrospectively studied all incident reports during a 1-year period at a large, urban, long-term-care facility to identify residents with skin tears. The overall incidence of skin tears was 0.92 per patient per year. The incidence rate for females, but not for males, increased significantly with age (P = 0.012). The mean length of the skin tear was 1.9 cm +/- 1.4 (mean +/- SD). Eighty percent occurred in the upper extremities, with the most frequent location being the forearm. Almost half of the skin tears reported had an unknown cause. Wheelchairs and accidentally bumping into an object each accounted for a quarter of the skin tears where the cause was known. Transfers and falls contributed to a lesser extent. Impaired mental status was no more likely to be present in residents experiencing a skin tear than in all nursing home residents. Twenty-four of the 147 residents with skin tears had four or more tears, accounting for 40% of all skin tears reported. Ninety-seven percent of the episodes resulted in no attending physicians' orders other than the standing orders. Future studies should be designed to determine if there are adverse consequences of skin tears and to suggest programs to reduce their occurrence.