Caregiving: Skin Care for Immobile Adults
As we get older, our skin gets thinner and drier, so it is easier to damage. The chance of skin damage is higher for people who can't move much, or who spend most of their time in bed or in a wheelchair. The skin can develop rashes and sores, especially pressure injuries (also called pressure sores). These injuries are caused by constant pressure, which can limit the blood supply to the skin.
Skin also can be damaged by sweat, feces, or urine, making pressure injuries more likely and harder to heal.
You can help protect the skin of the person you're caring for by checking it every day and by being careful when cleaning it.
Checking the skin for problems
Check the person's skin every day for pressure injuries, especially around bony areas. It's easiest to do this when you help the person bathe and dress. The most common places for these problems are the back of the head and ears, the shoulders, the elbows, the lower back and buttocks, and the hips. Pressure injuries also can form on the inner knees and the heels.
When a pressure injury forms, the skin temperature can be different than nearby skin. It might be warmer or cooler. The skin can also feel either firmer or softer than the rest of the skin.
Also look for rashes, especially in the groin area. This is very important for people who have problems controlling their bladder or bowels, or who wear adult protective underwear.
Let the person know why you're checking the skin. Keep their body covered except for the area you are checking. This will help them stay warm and also may help them feel more comfortable.
- As people age, their skin becomes thinner.
- Rashes can develop in folds of skin on the torso, and in the creases of the armpits, elbows, and groin.
- Rashes can develop in the areas around the knees, ankles, and toes.
- Rashes can develop in the groin and anal areas.
Preventing pressure injuries
You can help prevent pressure injuries by carefully turning the person every 2 hours. It relieves the pressure that can be placed on an area of the body when a person doesn't move for a long time.
Let the person's doctor know if you see pressure injures. The doctor or nurse may give you some advice about how to treat minor sores at home. Serious sores need more medical treatment.
You may be able to use devices that help prevent pressure injuries. These include special cushions and mattresses. But they don't take the place of turning the person.
Keeping the skin healthy
Keeping the person's skin clean and moisturized can help keep their skin healthy.
- Help them bathe as often as needed to be clean and comfortable. When helping someone bathe:
- Use gentle soap.
- Use warm (not hot) water.
- Wash gently with a washcloth.
- Pat the skin dry rather than rubbing. You also can offer the person a terry cloth robe. Terry cloth is a type of fabric often used for towels. It can help gently dry the skin.
- Use moisturizing creams or lotions to keep the skin soft. If the skin is very dry, use a protective barrier cream, lotion, or ointment. These include over-the-counter lotions such as CeraVe and TriCeram. Some lotions are available by prescription.
- Don't put moisturizers in creases and folds, such as those under the breasts and in the groin or on the stomach. These areas are already moist. More moisture can lead to rashes and infections.
- A humidifier may help prevent dry skin. Make sure to clean the humidifier as directed. This can prevent mold, fungus, or bacteria from forming in the machine.
- Good nutrition and plenty of fluids can also help the skin stay healthy and heal if it's damaged. Provide a healthy diet, with lots of protein and fruits and vegetables. Offer the person plenty of water.
- When washing clothing and sheets, use mild detergents. Don't use fabric softeners. And try to have the person wear clothing made with soft fabrics, such as cotton (rather than wool).