The effectiveness of treatments of skin tears in older people: a systematic review protocol

Abstract

<jats:title> <jats:bold>Review question/objective</jats:bold> </jats:title> <jats:sec> <jats:title /> <jats:p>The objective of this systematic review is to identify and establish the effectiveness of treatments for skin tears in older people.</jats:p> <jats:p>More specifically, the objectives are:</jats:p> <jats:p>This systematic review will address three specific questions across the healthcare contexts listed above:</jats:p> </jats:sec> <jats:sec> <jats:title>Background</jats:title> <jats:p>Skin tears are common injuries that frequently occur in the older adult population.1-4 For the purposes of this review, older adults have been defined as men and women aged 60 years and older as this age group seems to be affected by the greatest number of skin tears, according to a previous literature review.5 This age group has also been chosen in line with the position of the United Nations and the World Health Organization who note that chronological age may be unsuitable when considering the health experiences of all populations.6 One of the major factors that leads to such a high incidence and prevalence of skin tears among older adults is the aging process and the effects that this has on the skin. These effects include thinning and weakening of the epidermis due to atrophy which in turn causes a reduction in the cohesiveness between the layers of the skin.5 Aging skin is also at an increased risk of skin tears due to reduced blood supply and a decrease in subcutaneous fat. The reduction in the number of nerve endings in the skin also lessens the ability of the older adult to perceive tactical (and temperature) stimulation which may result in an increased likelihood of incidental injuries that directly cause skin tears.7 These physiological changes are further exacerbated in people aged 80 and above, and may also be compounded by the increased prevalence of chronic conditions and other predisposing factors for skin tears that lead to this group of older adults being at a particularly high risk of experiencing skin tears.8 </jats:p> <jats:p>Skin tears are commonly not considered to be major wounds among older people, potentially due to their prevalence and association with normal aging processes.3 Despite this, it must be recognized that skin tears cause significant associated pain and discomfort, prolonged hospital stays and reduced mobility.8,9 Skin tears can lead to infection and compromized vascular status which can then increase secondary morbidity and mortality risks for sufferers.10 Payne and Martin also point out that there is an increased cost associated with poor or untimely management and treatment of skin tears.11 </jats:p> <jats:p>The International Skin Tear Advisory Panel (ISTAP) defines skin tears as wounds caused by shear, friction and/or blunt force that result in the separation of skin layers. Recent research with 1127 health care providers from 16 countries indicates that equipment injury during patient transfer, such as bumps on wheelchairs, side-rails and beds as well as falls, are the main causes of skin tears.12 Separation may be "partial thickness" in reference to the separation of the epidermis from the dermis, or "full-thickness" defined as the separation of the epidermis and the dermis from underlying skin structures.13,14 While the prevention of skin tears is generally a primary focus of nursing care - the prevalence of skin tears is equal to or higher than pressure ulcers14 - it is also important that health care professionals are prepared to treat and manage skin tears.15 Prior to the treatment of skin tears, adequate wound assessment is vital as coexisting factors such as patient nutrition, pain management and wound conditions are all involved in the selection of the most appropriate dressing and care.15,16 </jats:p> <jats:p>Many types of skin and wound care interventions can be employed to manage, treat and promote healing for skin tears. Often, product selection will depend upon not only wound assessment but also upon the particular institution.15 A recent survey indicates that current treatment and management options for skin tears are diverse and include steri-tape/strips, film dressings, hydrogel and hydrocolloid dressings, foam dressings, petroleum gauzes, skin glue and liquid bandages, tape and gauze, and topical ointments.12 Non-adhesive dressings are the most popularly used types of dressing.12 Current best practice suggests that certain dressing types such as hydrogel, alginate, lipido-colloid-based mesh, foam dressing, soft silicone, absorbent clear acrylic dressing or non-adhesive impregnated gauze be considered, dependent upon the characteristics of the wound bed.15 Dressings such as hydrocolloids and transparent films are not recommended due to the risk of additional injury to the skin.15 At this stage however, these best practice recommendations are based upon consensus rather than evidence derived from a systematic review.</jats:p> <jats:p>The review authors have conducted a preliminary search of the JBI COnNECT+ database, the Cochrane and, Embase, CINAHL and MEDLINE via PubMed and Prospero and found no preceding or in-progress systematic reviews addressing the effectiveness of treatment interventions for skin tears among older adults. Research with healthcare providers has also indicated a significant need for clear evidence-based resources for the treatment of skin tears.12 Due to this absence, this systematic review is vital and will provide healthcare professionals and researchers with up-to-date, evidence-based information and guidance.</jats:p> </jats:sec>