“It seems the SKIN… that I’m IN… is terribly, terribly… THIN!”
Ever wondered why you never see a loofah brush, exfoliating mitt, nor any other type of abrasive body-scrubbing device in an elderly person’s bathroom? That’s not counting the mandatory piece of dried-up pumice stone once used to file corns and callouses from busy hard-working purposeful feet of a lifetime ago.
Well, there’s good reason for it apparently. Summed up perfectly by 89 year old Lizzy Waterduck as I chatted to her during her shower last week:
“At my age? Crikey, I’d end up skinned alive like a Chinese dog if I used one of those now!”
Understandably, for most of the older adults I visit in their homes, their skin is a fairly pertinent issue. They know only too well that if something new or unusual appears on their outer – there’s a darn good chance that something more threatening may be happening on their inner.
Physiological changes such as connective tissue breakdown, the lessening of elastin and collagen production, a limited ability to retain moisture, plus an increasingly slower metabolism in general – all contribute to the breakdown of our skin’s integrity as we age.
And as a consequence of this dermal deterioration, we then get to watch in despair as the inevitable creases, folds and ridges creep leisurely onto our skin’s surface to create that familiar ‘old person’ look…
Come on, sing it with me now: WRINKLES!
Throw in the exhaustion of the juicy subcutaneous fat layer beneath, too, means the natural oils which once protected us from damage and gave skin it’s firm, voluptuous appearance – are depleted. Leaving elders with a moisture-less, thinned barrier that’s vulnerable to anything untoward.
Oh yes, defences by this stage, are most definitely down!
Understandably, with skin that’s as delicate and translucent as Lizzy Waterduck’s, the last thing she’d ever consider doing as part of her shower routine, even if she might have done regularly in her decadent middle-aged years… is to slough off yet another (possibly the last) layer from her precious epidermal.
Of course, other contributing factors such as lifestyle, genetics and diet can also throw a pensioner’s skin balance out of whack. Interestingly, one of the major roles of our outer dermis is to maintain the body’s natural thermostat. Which explains why so many seniors seem to spend most of their days grumbling how cold they are, even in the height of a summer heatwave.
“Brrrr… shut the dam door, girlie!”
Progressing into our ‘twilight’ years, means we might also get to grow the odd unsightly skin tags, unflattering strangely-shaped moles and, prevalent on the backs of hands, balding heads, ears, arm, noses and necks… are the browny-coloured ‘liver’ or sun spots we immediately associate with ‘being old’.
These annoying tell-tale blemishes are a result of spending entire lives being hat-less and factor-less for long periods exposed to the outside elements. And declaring “but we didn’t know any better”, does nothing to fix the skin damage already caused.
Sadly, it doesn’t matter how much sunscreen grandad coats himself in now, it’s a case of too-little too-late for these old timers.
And there are other less than delightful skin conditions we become more predisposed to as we age. Dermatitis, eczema and pruritis are afflictions which are all identifiable with dry, ageing skin and will continue to drive itchy, older folk to reach for the tried-and-true camomile lotion by the gallon.
But flaky, scaly skin is a bad thing when you’re an older peep because when skin has become so dry that it’s now irritated and cracking open, there is opportunity galore for serious infection to enter and thrive it’s head off.
With immunity already compromised in sick or frail seniors or those suffering with pre-existing health complaints, the skin, whose job as the built-in protection layer stopping the big bad germ-laden world from entering our bodies and making us unwell, becomes weakened and unable to hold ground when it’s really needed most.
A seemingly small injury to a mature-ager’s cutaneal areas (even the slightest scratch), if not treated appropriately, can easily lead to serious complications and a much longer recovery time leaving an elder either in hospital… or in a very, very bad mood!
Indeed, depending on the state of it – our skin can quite literally mean the difference between life and death!
More significantly for an anxious pensioner, it can also mean the difference between remaining at home or being despatched to live in an aged-care facility… ie: the dreaded nursing home.
I get to observe a lot of elderly skin when I visit my clients at this stage of their lives. Assisting them to shower and maintain regular hygiene habits is integral to self-esteem, dignity and indicative to the rest of the world (ie: suspicious adult children) that they’re still capable of living independently.
And although not medically trained, an experienced carer can become quite astute in recognising symptoms of potential health issues, merely by observing the condition or noting even slight changes in a naked senior’s skin – especially at shower time.
Bruises, for example, can be discovered during Personal Care shifts and might be the result of a fall, walking into the coffee table – or possibly from something more sinister? A quick mention here regarding Elder Abuse and that ALL suspicions of such should be reported immediately and without hesitation.
Haematoma (bruising) can look dreadful on pale older skin and thanks to sluggish metabolisms, may take months to totally heal and fade. Not helped by certain medications used to control inflammatory conditions so common in old age (stiff joints, arthritis, COPD, diabetes etc) which, as a pesky side-effect, can leave seniors exceptionally prone to bruising.
Such as one of my clients, 79 year old Hilary Greentree who relies on steroidal drugs to control symptoms of her advancing emphysema. These powerful meds offer a fabulous quality of life and are literally life-saving for someone like Hilary.
More importantly (she informs me), they allow her to be top of her game on the golf course!
BUT… it was discovered recently, that Hilary’s skin had in fact become so thinned and susceptible to even the slightest touch that something as flimsy as the seam on her new golf slacks is enough to cause extensive black and blue marks down both her shins.
I mean, did you EVER?
For obvious reasons, assisting a senior to wash their outer body involves common sense, a good bit of empathy and patience… plus a WHOLE LOTTA care and attention. Jagged fingernails or solid objects such as jewellery, rings etc can inflict catastrophic damage to paper-thin skin – and often with very minimal force applied.
Cringe-worthy is the story about a carer once who, worrying about getting to her next job on time, ripped an enormous gash in her client’s calf while attempting to yank up his support hose (commonly used to control circulation probs in the lower limbs). In her haste, she hadn’t realised the tag on the garment had accidentally embedded itself into the poor old gent’s skin which then sliced deeply all the way up his leg as she pulled.
Ohhhh, THE HUMANITY!
Which explains why some of my more delicate ladies fear using a standard flannel or wash cloth that the rest of us ruffians take for granted. Instead, they prefer to wash with a tiny square of baby muslin or light-weight sponge, both of which seem so floaty and flimsy – you wonder if it’s worth bothering!
There’s certainly no RUBBING or SCRUBBING involved. Just a lot of gentle circles and tender dabbing to ensure their sensitive aged skin is left suitably cleansed, and more importantly – unbroken.
Thankfully, it turns out that the older you get, the less cleansing your skin actually requires. With retirement marking an inevitable slump in physical activity, there are now far less occasions to get a big ‘sweat-up’ like we once might have. Common thought now is that it’s more than adequate for a senior to instead shower every other day (or less), thereby allowing natural oils in the skin a chance to replenish and build resistance against all the nasties.
“And so I can get my GLOW on!”
As one of my lovelies, Gladys Gigglestick, proudly preaches.
Funnily enough, Gladys swears by sweet almond oil as her choice of showertime lather – and NEVER soap.
“Because soap is just too harsh and leaves me dry, rashy and itchier than an old man’s tweed vest”.
Which is fair enough when you’re 95 and you’ve been in this bathing game long enough to know! Admittedly, the almond oil (which smells devinely like Christmas pudding) does leave Gladys’ skin noticeably well-nourished and ever so moisty.
Although, when she holds my arm stepping out of the shower, I have to make sure I plant my feet firmly to keep us both steady… blimmen ‘eck, she’s as shiny and slippery as an eel!