Our skin can need more TLC as we get older, so it's important to keep it fresh, supple, and free of pressure risks.
Loss of moisture and changes to skin structure can lead to problems such as dryness and itchiness. The skin also thins and becomes more fragile with age. This can be caused by medications as well, such as long term use of prednisone. A healthy diet and good fluid intake is vital for healthy older skin.
Here are other ideas to avoid common skin problems.
Use warm water, not hot, for bathing and showering. Moisturising body wash products are more soothing for skin than soap. They also glide across the skin more easily, which is better for older and sensitive skin.
Rinse properly to avoid skin irritation. If there is a skin problem, your doctor may prescribe Aqueous Cream BP. This is used instead of soap for washing and bathing, and can also be used as a moisturiser.
Invest in soft, fluffy flannels and towels. Use two different flannel colours and keep them separate. One colour can be used to wash the face, body and limbs, and the other colour can be kept for washing the perineum (anal area) and buttocks. (This is important for some cultures, but it’s a good habit for everyone.)
Blot the skin (don’t rub) with a soft towel. Gentle blotting will avoid tearing fragile skin, a common problem for the elderly and people who are immobile.
Use moisturisers immediately after drying. This will keep skin supple, reduce moisture loss, and help to prevent skin tears. Special barrier creams are available for people who use continence products – they can prevent skin irritation and minimise infection risks.
Non-irritating moisturisers in the anal and buttock areas will also help to prevent skin breakdown. Do not use essential oils at all, or other highly scented hygiene products.
Wash eyes first from inner eye to the outer eye. One gentle wipe, then change cloth position, wipe gently again, etc.
Then wash the face and ears. Heed the old saying: nothing bigger than an elbow should go into your ear.
Next wash the front of the body. Pay careful attention to body folds and under breasts. Look for any redness or broken skin. If red, dust the area lightly with cornstarch-based baby powder or cornflour after drying. The powder will absorb moisture, preventing friction and skin breakdown. (In some cultures, use of cornflour is inappropriate, as it is a food source.) These areas may need to washed and dried twice a day.
Special attention should be given to the arms and hands of those who have had a stroke, especially if the fingers are closed into a fist. Fungal infections can thrive in the warm moisture of a closed hand, damaging nails and skin. Open the fingers and thoroughly wash and dry nails, between fingers, palms, etc. Be aware that this can be very painful for your family member, so be as gentle as possible!
Now wash the legs, observing the condition of the feet, skin, area between the toes etc. Look for any signs of infection or breaks in the skin. This is especially important for people with diabetes, as skin breaks can lead to infections that cause unstable blood sugars, and in turn to other health problems. Dry thoroughly between toes with a soft cloth.
Wash the back, repeating steps above. Then gently clean the perineum, anal and buttock areas (using the different coloured flannels).
Potential areas for pressure sores are elbows and hips, and the spine, sacrum, shoulder blades, heels, or ankles. In fact, any skin over a ‘bony prominence’ has the potential to break down if the person is not moving well, or if their diet is inadequate. Refrain from rubbing these pressure points.
It is best to have the bathroom set up well before a shower. Place flannels, toiletries, and towels nearby, and warm the room. More than two towels may be needed for drying.
Ideally the shower should not have any steps, be easy to enter, and there should be a shower chair or seat to sit on. There should also be a rail for your family member to hold onto.
The shower head should be on a flexible hose attachment; this makes hair washing less stressful, and ensures the perineum and buttocks can be washed properly.
It can be hard to accept help with bathing and showering from support workers or from family members. If your family member uses a shower chair, it may be easier to undress and re-dress in the bedroom. Dignity can be maintained while moving between rooms by using a towelling wrap that covers them and their chair.
Cover a comfortable seat with a large, soft towel. Maintain dignity by covering the body with another towel while you wash your family member’s face, back, perineum and buttocks.
After drying, powdering and moisturising, put on underwear and a singlet. Then follow routine for legs and feet.
You could put on underwear and outer lower clothing, socks and shoes while the person is seated so it is easy to pull up clothing all at once, avoiding the need to get up and down unnecessarily.
Talking throughout, and quietly explaining what you are doing when washing breasts, perineum, and buttocks, and checking penises (you need to gently pull back the foreskin and wash this area), will minimise nervousness and embarrassment (theirs and yours).
If the person is capable of doing these areas themselves, then they should!
Photo: Shutterstock.com, KacsoSandor