Chapter 19, Section(s):
Age related changes in structure and function
Common cardiovascular problems
Chapter 20, Section(s):
Age related changes in structure and function
Factors affecting lung function
Chapter 21, Section(s):
Age related changes in structure and function
Chapter 22, Section(s):
Age related changes in structure and function
Prevalence of urinary incontinence
Chapter 23, Section(s):
Age related changes in structure and function
Chapter 24, Section(s):
Structural age-related changes of the neurologic
system Chapter 25, Section(s):
Endocrine physiology in older adults
Ch. 17: Integumentary Function
Age-related changes in skin structure and function:
● Loss of thickness, elasticity, vascularity, and strength that may delay the healing
process and increase the risk of skin tears and bruising
● Increased lentigines (brown-pigmented spots, or age spots)
● Loss of subcutaneous tissue causing wrinkling and sagging of the skin, which
may affect self-esteem, temperature control, and drug efficacy
● Loss of hair follicles along with thinning and graying
● Increased hair density in the nose and the ears, particularly in men, which may clog
external ear canals and impair hearing
● Thicker nails with longitudinal lines
● Decreased sebaceous and sweat gland activity, which affects thermoregulation and
decreases sweating
● Higher incidence of benign and malignant skin growths
➔ The primary function of the skin is to serve as a barrier against harmful bacteria and other
threatening agents, which makes the skin the first line of defense for the immune system.
Other major functions of the integumentary system include (1) preventing fluid loss or
dehydration, (2) protecting the body from ultraviolet (UV) rays and other external
environmental hazards, and (3) protecting underlying organs from injury. In addition,
the skin provides thermal regulation of body temperature. Radiation, conduction,
convection, and evaporation are facilitated by sensory perceptions that occur in the
skin’s nerve endings. The skin also assists in the regulation of blood pressure through
“local regulation of
,cutaneous blood flow and salt and water metabolism” (Johnson, Titze, & Weller, 2016, p. 1).
The integumentary system reveals emotions such as anger, fear, or embarrassment through
vasodilatation, which reddens the skin tissue. In the presence of the sun’s UV rays, the
skin synthesizes vitamin D, which is then used by other parts of the body. Subcutaneous fat,
the deepest layer of the integumentary system, provides insulation and acts as a caloric
reservoir.
➔ The epidermis is the outermost layer of the skin. The replacement rate of the stratum
corneum, the first layer of epidermis, declines by 50% as a person ages. This decline
results in slower healing, reduced barrier protection, and delayed absorption of medications
and chemicals placed on the skin. The area of contact between the epidermis and dermis
decreases with age, which results in easy separation of these layers. Therefore skin tears
occur from harmless activities such as removing a bandage or pulling an older patient
up in the bed.
➔ The dermis decreases in thickness by approximately 20% with aging. It consists of
strong connective tissue that contains the sweat glands, blood vessels, and nerve
endings. These changes lead to diminished thermoregulatory function and inflammatory
responses, decreased tactile sensation, reduced pain perception, and development of
wrinkles and sagging skin because of loss of underlying tissue. Collagen, a fibrous
protein that provides tensile strength within the dermis, stiffens and becomes less
soluble.
➔ Aging results in a decreased amount of subcutaneous tissue and a redistribution of fat to
the abdomen and thighs. Breast tissue also changes and becomes more granular and
atrophic. Because of a loss of padding supplied by subcutaneous tissues, the risk for
hypothermia, skin shear, and blunt trauma injury is greater. The loss of this protective
padding increases vulnerability of pressure points. Topical medication and dermal
medication patch absorption may increase because of the changes in the
subcutaneous tissue.
➔ With aging, fewer eccrine glands (sweat glands of the palms, feet, and forehead) and
apocrine sweat glands (sweat glands of the axilla, scalp, face, and genital areas) exist,
resulting in decreased body odor and reduced evaporative heat loss because of
decreased sweating. The need for antiperspirants and deodorants is reduced. However,
older adults are at greater risk of heat stroke because of a compromised cooling
mechanism. Sebum oils the skin and provides an antimicrobial property. The sebaceous
glands and pores become larger with aging. Nevertheless, many older adults experience dry
skin, which places them at a greater risk of infection because of an impaired immune
response.
, ➔ Hair thins, and its growth declines. A progressive loss of melanin occurs, resulting in graying
of the hair. Heredity influences the onset of the graying process. Changes in the patterns
of hair growth and distribution as a person ages are thought to be hormone related.
Nails grow more slowly with age and become thicker, brittle, and dull, developing
longitudinal striation with ridges.
➔ Nearly 35% of older adults experience chronic skin fragility. This fragile skin is called
dermatoporosis. The identifying features of dermatoporosis include atopic changes,
actinic purpura, and white pseudoscars. The skin appears nearly translucent. It occurs
on sun-exposed areas of the extremities. Individuals with dermatoporosis frequently
experience skin lacerations associated with increased bleeding and delayed healing.
In a skin assessment of darkly pigmented skin, prioritize the assessment of:
● Skin temperature
● Edema
● Change in tissue consistency in relation to surrounding tissue
Cherry angiomas are common, bright red, 1- to 5-millimeter (mm) superficial vascular lesions that
begin around age 30 and increase in number with age. The cause of these lesions is unknown.
They are red or deep purple dome-shaped papules.
Seborrheic keratoses are benign lesions more commonly seen in the older adult. These are scaly
growths that have a “stuck-on,” crumbly appearance that varies in color from tan to brown to
black. The lesions may be elevated and range in diameter from 2 to 3 mm. Characterized by
slow growth, these lesions begin to appear later in life. The borders may be round and smooth or
irregular and notched. If the lesion is “picked off,” it will recur. Patients should be reassured that
the growths are benign and are a commonly occurring skin manifestation.
Skin tags are common stalk-like, benign tumors often found on the neck, axilla, eyelids, and groin,
although they may occur anywhere on the body. Beginning as early as age 20, these are tiny,
flesh-colored or brown excrescences that develop into a long, narrow stalk (up to 1 centimeter [cm]).
As they mature, they can be easily removed with scissors, electrocautery, or liquid nitrogen. Skin
tags are usually excised only on the request of the patient, usually for cosmetic reasons.
Seborrheic dermatitis is a common, chronic inflammation of the skin. The scalp, ear canals, eyebrows,
eyelashes, nasolabial folds, axilla, breasts, chest, and groin are common sites.The usual pattern
of distribution begins with
, the scalp and moves down toward the eyebrows, progressing to the chest with a bilateral,
symmetric presentation. It is more common in patients who have Parkinson’s disease or who have
suffered a stroke.
Intertrigo is a superficial inflammatory dermatitis occurring on two closely opposed skin
surfaces because of moisture, friction, and lack of ventilation. Bodily secretions, including
perspiration, urine, and feces, often exacerbate skin inflammation. It is usually found in the
armpits, inner aspects of the thighs, skin folds of the breasts, and abdominal folds. The area is
erythematous and may itch. Intertrigo occurs more often in aging patients who are obese or have
diabetes. Medical management includes appropriate use of an antimicrobial agent (antifungal or
antibacterial), a low potency topical steroid, and keeping the skin clean and dry.
Psoriasis is an autoimmune condition that affects 2% to 3% of the world’s population and
approximately 2.2% of the U.S. population. The condition may affect persons of any age,
although it often begins during early adulthood. Psoriasis is often associated with other diseases
such as cardiovascular disease, metabolic syndrome, hypertension, dyslipidemia, and Crohn’s
disease. Obesity and tobacco use are independent risk factors for developing psoriasis. Once
psoriasis begins, there are periods of remission and relapse with varying degrees of intensity.
Currently, no known cure exists. Clinically, psoriatic lesions are typically seen as well-
circumscribed, pink plaques covered with silver-white, loosely adherent scales. These scaly
plaques result from the accelerated replication of the dermis and epidermis over certain parts of
the body. Psoriasis frequently affects the skin of the elbows, knees, scalp, lumbosacral areas,
intergluteal cleft, and genitals. There are multiple forms of psoriasis including plaque, nail,
guttate, pustular, inverse, erythrodermic, and psoriatic arthritis.
The goal of nursing management is control of the inflammatory process with maintenance
therapy using topical agents and shampoo, as prescribed. Patient comfort is evidenced when
medical treatment is done according to advice. Expected outcomes include the following:
1. Skin lesions will remain free from infection.
2. The patient will experience resolution of the inflammatory process.
3. The patient will demonstrate increased knowledge of the condition, as evidenced by:
• Verbalizing the rationale for regular and consistent skin care.
• Verbalizing knowledge of maintenance therapy.
• Verbalizing triggers to inflammatory dermatitis.
• Demonstrating accurate application of topical medications.
Pressure injuries were previously referred to as pressure ulcers. In 1930, Landis determined that
the average capillary pressure before which ischemia occurs is below 32 mm Hg. In the 1950s,
Kosiak (1958) found that pressure applied to rabbits’ ears over 2 hours would result in ulceration.
Thus the universal recommendation of
Age related changes in structure and function
Common cardiovascular problems
Chapter 20, Section(s):
Age related changes in structure and function
Factors affecting lung function
Chapter 21, Section(s):
Age related changes in structure and function
Chapter 22, Section(s):
Age related changes in structure and function
Prevalence of urinary incontinence
Chapter 23, Section(s):
Age related changes in structure and function
Chapter 24, Section(s):
Structural age-related changes of the neurologic
system Chapter 25, Section(s):
Endocrine physiology in older adults
Ch. 17: Integumentary Function
Age-related changes in skin structure and function:
● Loss of thickness, elasticity, vascularity, and strength that may delay the healing
process and increase the risk of skin tears and bruising
● Increased lentigines (brown-pigmented spots, or age spots)
● Loss of subcutaneous tissue causing wrinkling and sagging of the skin, which
may affect self-esteem, temperature control, and drug efficacy
● Loss of hair follicles along with thinning and graying
● Increased hair density in the nose and the ears, particularly in men, which may clog
external ear canals and impair hearing
● Thicker nails with longitudinal lines
● Decreased sebaceous and sweat gland activity, which affects thermoregulation and
decreases sweating
● Higher incidence of benign and malignant skin growths
➔ The primary function of the skin is to serve as a barrier against harmful bacteria and other
threatening agents, which makes the skin the first line of defense for the immune system.
Other major functions of the integumentary system include (1) preventing fluid loss or
dehydration, (2) protecting the body from ultraviolet (UV) rays and other external
environmental hazards, and (3) protecting underlying organs from injury. In addition,
the skin provides thermal regulation of body temperature. Radiation, conduction,
convection, and evaporation are facilitated by sensory perceptions that occur in the
skin’s nerve endings. The skin also assists in the regulation of blood pressure through
“local regulation of
,cutaneous blood flow and salt and water metabolism” (Johnson, Titze, & Weller, 2016, p. 1).
The integumentary system reveals emotions such as anger, fear, or embarrassment through
vasodilatation, which reddens the skin tissue. In the presence of the sun’s UV rays, the
skin synthesizes vitamin D, which is then used by other parts of the body. Subcutaneous fat,
the deepest layer of the integumentary system, provides insulation and acts as a caloric
reservoir.
➔ The epidermis is the outermost layer of the skin. The replacement rate of the stratum
corneum, the first layer of epidermis, declines by 50% as a person ages. This decline
results in slower healing, reduced barrier protection, and delayed absorption of medications
and chemicals placed on the skin. The area of contact between the epidermis and dermis
decreases with age, which results in easy separation of these layers. Therefore skin tears
occur from harmless activities such as removing a bandage or pulling an older patient
up in the bed.
➔ The dermis decreases in thickness by approximately 20% with aging. It consists of
strong connective tissue that contains the sweat glands, blood vessels, and nerve
endings. These changes lead to diminished thermoregulatory function and inflammatory
responses, decreased tactile sensation, reduced pain perception, and development of
wrinkles and sagging skin because of loss of underlying tissue. Collagen, a fibrous
protein that provides tensile strength within the dermis, stiffens and becomes less
soluble.
➔ Aging results in a decreased amount of subcutaneous tissue and a redistribution of fat to
the abdomen and thighs. Breast tissue also changes and becomes more granular and
atrophic. Because of a loss of padding supplied by subcutaneous tissues, the risk for
hypothermia, skin shear, and blunt trauma injury is greater. The loss of this protective
padding increases vulnerability of pressure points. Topical medication and dermal
medication patch absorption may increase because of the changes in the
subcutaneous tissue.
➔ With aging, fewer eccrine glands (sweat glands of the palms, feet, and forehead) and
apocrine sweat glands (sweat glands of the axilla, scalp, face, and genital areas) exist,
resulting in decreased body odor and reduced evaporative heat loss because of
decreased sweating. The need for antiperspirants and deodorants is reduced. However,
older adults are at greater risk of heat stroke because of a compromised cooling
mechanism. Sebum oils the skin and provides an antimicrobial property. The sebaceous
glands and pores become larger with aging. Nevertheless, many older adults experience dry
skin, which places them at a greater risk of infection because of an impaired immune
response.
, ➔ Hair thins, and its growth declines. A progressive loss of melanin occurs, resulting in graying
of the hair. Heredity influences the onset of the graying process. Changes in the patterns
of hair growth and distribution as a person ages are thought to be hormone related.
Nails grow more slowly with age and become thicker, brittle, and dull, developing
longitudinal striation with ridges.
➔ Nearly 35% of older adults experience chronic skin fragility. This fragile skin is called
dermatoporosis. The identifying features of dermatoporosis include atopic changes,
actinic purpura, and white pseudoscars. The skin appears nearly translucent. It occurs
on sun-exposed areas of the extremities. Individuals with dermatoporosis frequently
experience skin lacerations associated with increased bleeding and delayed healing.
In a skin assessment of darkly pigmented skin, prioritize the assessment of:
● Skin temperature
● Edema
● Change in tissue consistency in relation to surrounding tissue
Cherry angiomas are common, bright red, 1- to 5-millimeter (mm) superficial vascular lesions that
begin around age 30 and increase in number with age. The cause of these lesions is unknown.
They are red or deep purple dome-shaped papules.
Seborrheic keratoses are benign lesions more commonly seen in the older adult. These are scaly
growths that have a “stuck-on,” crumbly appearance that varies in color from tan to brown to
black. The lesions may be elevated and range in diameter from 2 to 3 mm. Characterized by
slow growth, these lesions begin to appear later in life. The borders may be round and smooth or
irregular and notched. If the lesion is “picked off,” it will recur. Patients should be reassured that
the growths are benign and are a commonly occurring skin manifestation.
Skin tags are common stalk-like, benign tumors often found on the neck, axilla, eyelids, and groin,
although they may occur anywhere on the body. Beginning as early as age 20, these are tiny,
flesh-colored or brown excrescences that develop into a long, narrow stalk (up to 1 centimeter [cm]).
As they mature, they can be easily removed with scissors, electrocautery, or liquid nitrogen. Skin
tags are usually excised only on the request of the patient, usually for cosmetic reasons.
Seborrheic dermatitis is a common, chronic inflammation of the skin. The scalp, ear canals, eyebrows,
eyelashes, nasolabial folds, axilla, breasts, chest, and groin are common sites.The usual pattern
of distribution begins with
, the scalp and moves down toward the eyebrows, progressing to the chest with a bilateral,
symmetric presentation. It is more common in patients who have Parkinson’s disease or who have
suffered a stroke.
Intertrigo is a superficial inflammatory dermatitis occurring on two closely opposed skin
surfaces because of moisture, friction, and lack of ventilation. Bodily secretions, including
perspiration, urine, and feces, often exacerbate skin inflammation. It is usually found in the
armpits, inner aspects of the thighs, skin folds of the breasts, and abdominal folds. The area is
erythematous and may itch. Intertrigo occurs more often in aging patients who are obese or have
diabetes. Medical management includes appropriate use of an antimicrobial agent (antifungal or
antibacterial), a low potency topical steroid, and keeping the skin clean and dry.
Psoriasis is an autoimmune condition that affects 2% to 3% of the world’s population and
approximately 2.2% of the U.S. population. The condition may affect persons of any age,
although it often begins during early adulthood. Psoriasis is often associated with other diseases
such as cardiovascular disease, metabolic syndrome, hypertension, dyslipidemia, and Crohn’s
disease. Obesity and tobacco use are independent risk factors for developing psoriasis. Once
psoriasis begins, there are periods of remission and relapse with varying degrees of intensity.
Currently, no known cure exists. Clinically, psoriatic lesions are typically seen as well-
circumscribed, pink plaques covered with silver-white, loosely adherent scales. These scaly
plaques result from the accelerated replication of the dermis and epidermis over certain parts of
the body. Psoriasis frequently affects the skin of the elbows, knees, scalp, lumbosacral areas,
intergluteal cleft, and genitals. There are multiple forms of psoriasis including plaque, nail,
guttate, pustular, inverse, erythrodermic, and psoriatic arthritis.
The goal of nursing management is control of the inflammatory process with maintenance
therapy using topical agents and shampoo, as prescribed. Patient comfort is evidenced when
medical treatment is done according to advice. Expected outcomes include the following:
1. Skin lesions will remain free from infection.
2. The patient will experience resolution of the inflammatory process.
3. The patient will demonstrate increased knowledge of the condition, as evidenced by:
• Verbalizing the rationale for regular and consistent skin care.
• Verbalizing knowledge of maintenance therapy.
• Verbalizing triggers to inflammatory dermatitis.
• Demonstrating accurate application of topical medications.
Pressure injuries were previously referred to as pressure ulcers. In 1930, Landis determined that
the average capillary pressure before which ischemia occurs is below 32 mm Hg. In the 1950s,
Kosiak (1958) found that pressure applied to rabbits’ ears over 2 hours would result in ulceration.
Thus the universal recommendation of
