Many of us take our skin for granted, but as the body’s largest organ, it does far more than just cover us. Skin provides a vital barrier against the environment, helps regulate body temperature, balances electrolytes, and gives us sensations such as pain, touch, heat and cold. It also absorbs shocks and protects what lies beneath.

Like every other part of the body, skin changes as we age. External factors such as air pollution, climate, diet and lifestyle choices all affect its resilience. Internally, natural ageing processes reduce the skin’s ability to perform its protective functions. The layers of skin thin out, circulation slows, and the junction between the epidermis and dermis flattens, which makes it more fragile. Fibroblasts, which produce collagen, also become less effective, leading to a loss of connective tissue and elasticity.

Older skin is often drier, partly due to co-morbidities, reduced fluid intake and less mobility. This dryness, combined with thinning and fragility, increases the risk of wounds, tears, infection and pressure injuries. Even a small knock or bump can cause significant damage. On top of this, illness, fever, sweating, or incontinence add to the strain on ageing skin. For this reason, nurses play an important role in monitoring their patients’ skin condition and identifying any changes early.

In their day-to-day work, nurses often see a wide range of skin conditions. These include irritant reactions to dressings or adhesives, rashes from allergies, blisters linked to diabetes or adhesives, eczema, thickened scaly skin from lymphoedema or venous disease, paper-thin skin and purpura from long-term medications, and excoriation caused by prolonged moisture exposure such as incontinence or stomas. Each of these can compromise skin integrity and increase infection risk, making regular assessment essential.

A skin integrity assessment should begin as soon as a patient is admitted, with particular attention to any existing wounds (especially pressure injuries), vulnerable pressure points, rashes or excoriation. Observations should be documented clearly in the care plan. Nurses should assess colour, temperature, texture, moisture and integrity, as well as noting the location of any breakdown or wounds.

Table 1: Components of skin assessment and what to look for.




For most patients, skin should be checked at least daily, but those at higher risk need inspection once per shift. A solid skin care routine can reduce the chance of infection, tears and pressure injuries.
Basics include:

• Regular inspection – check the skin on admission and at least daily (or more often if the patient is high risk) to spot changes early.
• Encouraging mobility – if a patient cannot reposition themselves independently, interventions are needed. Support patients to move and reposition themselves where possible, or use aids to reduce pressure and improve circulation.
• Providing pressure relief – use equipment such as pressure-relieving mattresses, cushions, heel wedges or offloading boots to prevent skin breakdown.
• Maintaining hydration and nutrition – ensure patients are drinking enough fluids and eating well; involve a dietitian if there are concerns.
• Clear communication between care teams – document all findings, interventions and concerns in clinical notes and handover, and involve allied health where needed.

Daily skin care also matters. Cleansing with non-soap cleansers close to skin’s natural pH (around 5.5), thorough drying and regular moisturising all help protect frail skin. Incontinence care is particularly important, with frequent changes, gentle cleansing and moisturising to prevent painful moisture lesions. Skin barriers may reduce dermatitis caused by incontinence. Gentle handling is essential; too much pressure during cleaning or massage can cause tears and bruising.

Nutrition and hydration are just as vital for skin health as topical care. People come to hospital because they are unwell. In addition to the normal daily nutritional requirements, extra calories and protein are often necessary to assist their recovery and healing from surgery or their wounds. Monitor your patient’s oral intake and, if in doubt, involve dietitians when needed to address these risks.
Equally important is patient and family education. Involving them in skin care empowers patients to continue protecting their skin after discharge. Documentation also underpins safe care: thorough records and handover ensure the whole team is aware of the patient’s needs. Interdisciplinary involvement, from dietitians, physiotherapists and occupational therapists, further supports good outcomes.

Older adults, acutely unwell patients, those with wounds, reduced mobility, or other complicating factors are all at high risk of skin failure. Without proactive care and close monitoring, these patients may suffer avoidable injuries, extended hospital stays, or even readmission and death. With consistent, thoughtful skin assessment and care, nurses can make a significant difference in protecting vulnerable skin and supporting recovery.




By Bonnie Fraser BSc, BNUR, Master of Wound Care, Clinical Nurse Consultant Chronic and Complex Wound Management.

References:
1. Biabchi J, Cameron J. Assessment of skin integrity in the elderly 1. Wound Care, 2008:S26-S32.
2. Varani J, Dame MK, Rittie L, Fligiel SE, Kang S, Fisher GJ, Voorhees JJ.  Decreased collagen production in chronically aged skin: roles of age-dependent alteration in fibroblast function and defective mechanical function. Am J Pathol, 2006: 1861-8. British Journal of Nursing, 2005, 14 (22): 1172-6.
3. McLafferty E, Hendry C, Farley, A. The integumentary system: anatomy, physiology and function of skin. Nursing Standard, 2012: 27 (3): 35-42.
4. Joanna Briggs institute, Recommended Practice. Skin Integrity: Basic Skin Care (older people). The Joanna Briggs Institute EBP Database, JBO@Ovid, 2019; JBI17402.