Caring for Dry Skin in the Elderly

Skin is our largest organ. The skin of the average adult, if laid flat, would cover about two square yard and weigh about nine pounds. Skin acts as a barrier, protecting the network of bones, muscles, nerves, blood vessels, and everything else inside.

The outer layer of skin is called the epidermis. The next layer of skin is called the dermis. This layer is made up of blood vessels, nerve endings, and connective tissue. There are two types of fibers in the dermis, collagen and elastin. Collagen is tough and hard to stretch and helps skin hold its shape, while elastin, as the name suggests, is elastic. As we age, some of the elastin-contain fibers degenerate, and this leads to wrinkles. The dermis also contains sebaceous glands, which are glands that produce an oily substance that lubricates the skin and hair. As we age, these glands produce less oil, causing skin to dry out.

Because our skin becomes drier and less elastic as we age, it tears more easily. Especially in dry winter weather, we are at risk for cracked skin on our hands and feet. When the skin barrier is broken, we are at risk for infection. This is especially a concern for the elderly, whose immune systems may be compromised.
When I worked as a home health caregiver in Cincinnati, Ohio, I saw many clients with skin problems. The worst problems occurred when clients were confined to bed. When a person is unable to get out of bed, or when they sit in a wheelchair all day, they are at risk of developing decubitis ulcers, which are better known as pressure sores or bed sores. These sores are most likely to occur on the buttocks and/or on the heels, where there is constant pressure on the skin.

Lee Brooks (all names have been changed to protect the privacy of the patients and their families) was one such client. He was terminally ill and his mother Elaine had been caring for him at home. She was an older woman and had difficulty turning him in bed. The resulting pressure of his buttocks against the mattress all day and night caused bed sores, which soon became infected. Once bed sores develop, it is very difficult to cure them. It is far better to prevent them.