Aging affects various systems of the body, including the skin. Key factors that contribute to changes in the skin are as follows:

1. Intrinsic factors: These refer to the natural aging process of cells over time. As we age, cell division slows down, and the ability to repair cells to produce new ones decreases. Additionally, the accumulation of free radicals increases, leading to the buildup of waste products and triggering mechanisms that damage cells.
2. Extrinsic factors: These include environmental influences such as sunlight and pollution. Sunlight contains ultraviolet A (UVA) and ultraviolet B (UVB) rays, both of which can damage the DNA of skin cells. This, combined with an increased production of free radicals, leads to skin cell deterioration. Furthermore, smoking (which causes the breakdown of elastin fibers in the skin, similar to the effects of sunlight, affecting both the superficial and deeper layers), excessive alcohol consumption, and poor nutrition are external factors that contribute to the premature aging of the skin.

As a result of the factors mentioned above, aging has significant effects on the skin, leading to common skin problems in older adults, which include:

1. Changes in Skin Color and Age Spots: Age spots, also known as senile lentigo, occur due to the abnormal accumulation of pigment (melanocytes) in the skin. The pigment-producing cells decrease in function, resulting in spots that range from light to dark brown in color. These spots are typically less than 5 millimeters in diameter and increase in number with age, particularly in areas exposed to sunlight, such as the neck, face, and backs of the hands. The accumulation of pigment cells forms brown spots scattered across the skin. Additionally, older adults may develop seborrheic keratosis, which are non-cancerous, rough, scaly growths that may appear on the skin.
2. Reduced Function of Sebaceous and Sweat Glands: This leads to wider pores, dry and flaky skin, itching, and increased susceptibility to allergic reactions. Dry skin (xeroderma) can develop, and if left untreated, it may lead to xerotic eczema, causing redness, peeling, and increased itching. Scratching can result in skin lesions, increasing the risk of infection.
3. Thinning Skin: With a reduction in collagen and elastin, the skin loses its elasticity, resulting in wrinkles, sagging around the cheeks and under the eyes. The skin becomes more fragile and prone to cuts and tears, which heal more slowly compared to younger skin.
4. Dermatitis (Allergic Rashes): This condition is common in older adults with chronic diseases such as allergies or asthma. It can result from various triggers such as dust, chemicals, seafood, pets, temperature changes, or regular medications. The rash typically appears red, raised, and itchy, often disturbing sleep.
5. Senile Purpura (Bruising): This occurs due to fragile blood vessels, leading to easy bruising or blood accumulation beneath the skin. It commonly appears as purple spots, especially in areas prone to bumps or impacts. It is more frequent in older adults who take blood-thinning medications.
6. Skin Cancer: Skin cancer occurs due to abnormal cell repair or division in skin cells. It is more commonly seen in individuals with a genetic predisposition or faulty genes, along with prolonged exposure to ultraviolet (UV) radiation. Abnormal skin cells may appear as raised moles, thickened scars, or persistent, non-healing sores. Areas most prone to skin cancer include the face, sun-exposed areas, and the scalp, especially in men with thinning or bald hair who are regularly exposed to sunlight.
7. Stasis Dermatitis (Skin Problems from Varicose Veins): This condition occurs on the ankles and is caused by poor blood circulation, particularly in individuals with varicose veins. It manifests as thickened, dry, flaky skin, uneven pigmentation, and dark spots around the ankles.
8. Chronic Ulcers: Chronic ulcers are common in older adults due to slower wound healing. Bedridden individuals or those unable to move on their own are at higher risk of pressure ulcers, particularly in areas like the buttocks. Additionally, stasis eczema and scratching may lead to blood-stasis ulcers that heal slowly, often leaving thickened, rough scars.
9. Increased Risk of Infections: Due to reduced immunity in older adults, the skin is more prone to infections. Scratching may lead to infection at wound sites, and there is also a higher risk of shingles, warts, or fungal infections on the skin.
10. Reduced Sensation in the Skin: As skin sensitivity decreases with age, older adults are at a higher risk of accidents and injuries.
11. Thick and Brittle Nails: Nails in older adults may become thicker and darker in color. However, they are often more brittle, prone to splitting, and can break easily.

1. Choose appropriate skin care products that are gentle, fragrance-free, and provide moisture.
2. Take warm showers with moderate water temperature; avoid hot water.
3. Avoid harsh scrubbing on the skin.
4. Pat the skin dry and apply a moisturizer or nourishing cream immediately after drying.
5. Use a humidifier when the air is dry.
6. Wear gloves, hats, and long-sleeved clothing, especially those that protect against ultraviolet rays. Apply sunscreen with at least SPF 30 when necessary. If spending time in the sun for extended periods, seek shade and avoid sun exposure during peak sunlight hours, such as 10:00 to 14:00.
7. Avoid smoking and excessive alcohol consumption. Eat a nutritious diet.
8. Regularly check your skin for any changes. If you notice suspicious changes, consult a doctor.

Bedsores, also known as pressure sores, are injuries to the skin or subcutaneous layer caused by prolonged pressure, friction from bedding or clothing, and skin tears caused by rubbing against surfaces, such as during movement from the bed. These sores typically occur in areas with bony prominences that are subject to prolonged pressure. Bedsores are common in older adults who are bedridden or have mobility issues, such as those who have to sit in a chair or wheelchair for extended periods. Other risk factors that may worsen pressure sores include unclean or damp skin, friction that can cause more sores, and an increased risk of infection and inflammation.

 

1. Frequently change positions. If older adults are unable to do this themselves, caregivers should assist with repositioning every 2 hours or more frequently if pressure sores are present.
2. Choose an appropriate mattress or cushion, such as an air mattress or mattress pad specifically for preventing pressure sores. However, avoid using certain types of cushions, such as donut-shaped or ring cushions, which may worsen pressure sores. These cushions can apply pressure to the skin around the sore, restricting blood flow and potentially causing the existing pressure sore to worsen or expand.
3. Regularly check the skin, particularly around bony prominences or areas prone to pressure, to identify early signs of pressure sores.
4. Look for any skin abnormalities, such as unusual redness or discoloration that does not fade when pressed. This differs from typical rashes. The skin may feel warm, hard, or raised. There may also be pain or itching in areas with prolonged pressure.
5. Use medications to prevent skin irritation and inflammation, such as:

• Cavilon™
  • Cavilon™ Durable Barrier Cream: Apply to the skin after toileting to protect the skin, keeping it soft and moisturized. It can be reapplied more frequently if there is frequent toileting to prevent rashes.
  • Cavilon™ No Sting Barrier Film (spray form): A spray used to prevent inflammation and skin abrasions. It should be applied to areas exposed to urine or fecal matter every 24–72 hours, or more frequently (every 12 hours) if skin irritation or frequent toileting occurs.

                      ** Both Cavilon™ products should not be used on infected wounds.

• Zinc Paste: Apply to the skin where pressure sores are present.
• Duoderm Hydroactive Gel: Apply to areas affected by pressure sores.

6. Maintain a balanced and nutritious diet, particularly foods rich in protein and vitamins, such as eggs and meats. For bedridden individuals or older adults, it may be necessary to adjust food choices and forms to prevent malnutrition.

Cellulitis is an infection of the skin or subcutaneous tissue that causes swelling, redness, pain, or warmth in the affected area. Some individuals may experience a fever or other related symptoms. In severe cases, the infection can spread into the bloodstream, which may be life-threatening. This condition can occur anywhere on the body but is most commonly found on the legs. The infection is typically caused by bacteria that enter the body through cuts, cracks, or broken or sensitive skin.
The symptoms of cellulitis include swelling, redness, and a tendency for the infection to spread to a larger area. Other associated symptoms may include:

1. Fever
2. Pain within the first 1-2 days of onset, and tenderness when the affected area is touched or pressed
3. Warmth or heat in the affected area
4. The appearance of sores or rash in the infected area, which may rapidly expand
5. Indentation or dimpled skin in the affected area
6. Muscle pain

If any of the following symptoms occur along with the above, it is important to consult a doctor immediately, as the infection may spread to other areas or enter the bloodstream, which can be life-threatening.
 

• UpToDate. Prevention of pressure-induced skin and soft tissue injury. Available from: https://www.uptodate.com/contents/prevention-of-pressure-induced-skin-and-soft-tissue-injury [Accessed 2 December 2024].
• National Library of Medicine. Aging changes in skin. Available from: https://medlineplus.gov/ency/article/004014.htm [Accessed 2 December 2024].
• Walston JD. Common clinical sequelae of aging. In: Goldman L, Schafer AI, editors. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020. p. 220-30.