Despite a plethora of recommendations, protocols and dictums in the nursing literature, no research studies have defined the basic elements of preventive skin care for incontinent patients, and the prevalence of skin problems associated with incontinence is unknown. Yet the importance of skin care for incontinent elderly or immobilized patients has long been acknowledged. This literature review sought to determine current practices and principles for skin care of frail, elderly, dependent, incontinent patients. Protocols vary widely. And although there is mounting evidence that incontinence, particularly fecal incontinence, is a primary risk factor for pressure ulcer development, most preventive efforts focus on pressure relief, repositioning, and nutrition, rather than incontinence care. More clinical trials are needed in this area. The design and analysis of these trials should take into account the frequency and manner in which skin is cleansed, products used for skin care, risks and benefits of absorbent products and devices, the presence of infection, and patients' concomitant medical conditions and degree of immobility.

Activities of Daily Living↗

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Bioelectrical impedance as a discriminator of pressure ulcer risk.

In an effort to identify objective measures of tissue structure and function associated with pressure ulcer risk, bioelectrical impedance analysis (BIA) was measured in three progressively larger zones over the trochanter and coccyx in patients assessed at high risk for pressure ulcers (HR group) and age-matched normal controls (CONT group). Local BIA measures were significantly lower in the HR group for each individual site and zone (p < .01). Full-thickness tissue biopsies obtained from each measurement zone did not differ between groups. However, additional nutritional and metabolic parameters were significantly different (p < or = .05). These results suggest that local BIA may be useful in assessing pressure ulcer risk.

Aged↗