Maintaining skin integrity in the aged: A systematic review.

Area of Science:

• Gerontology
• Dermatology
• Evidence-based Practice

Background:

• Aged individuals in nursing care experience high rates of skin conditions like xerosis cutis, intertrigo, pressure ulcers, and skin tears.
• Effective skin care strategies are crucial for maintaining skin health and integrity in this population.

Purpose of the Study:

• To systematically review evidence on non-drug topical skin care interventions for promoting and maintaining skin integrity and barrier function in the aged.
• To identify outcome domains and measurement instruments used in this research area.

Main Methods:

• An updated systematic review of primary intervention studies published between 1990 and 2018.
• Inclusion of experimental study designs, including randomized controlled trials and quasi-experimental designs, focusing on individuals aged 50 years and older.
• Quality assessment of randomized controlled trials using the Cochrane Collaboration's Tool for assessing risk of bias.

Main Results:

• Sixty-three studies reported on interventions for dry skin, pruritus, skin barrier improvement, incontinence-associated dermatitis, skin tears, and pressure ulcers.
• Syndet or amphoteric surfactant cleansers improved skin dryness; lipophilic leave-on products with humectants reduced dryness and pruritus.
• pH 4 products enhanced skin barrier function, while skin protectants and structured protocols reduced incontinence-associated dermatitis severity. Glycerin and petrolatum formulations decreased skin tear incidence.

Conclusions:

• Substantial heterogeneity exists in study designs, interventions, and outcomes.
• Basic skin care, including low-irritating cleansers and humectant-rich leave-on products, benefits aged skin barrier function and dryness.
• Standardizing critical outcome domains is recommended for future research to improve comparability of skin care intervention results.