The skin characteristics of older adults increase the risk of skin damage, due to slower replacement of skin cells and fewer blood vessels, which results in slower healing.
Hormone changes also lead to thinner skin, which is more easily damaged. In addition, there is a decrease in lipid content of the skin, which affects the acid protection mantle and the epidermis. Sweat and sebum play a very important role in preventing the skin from drying out and the entrance of pathogenic bacteria and fungi. As a person ages, malnutrition with fewer essential fatty acids in the diet and a lower metabolism leads to a slower regeneration process. Furthermore, the pH of the skin increases with age, resulting in less sweat and sebum, causing the skin to become porous, and thinner.
Incontinence exposes the skin to continual wetness and the wearing of an incontinence product can increase perspiration and thereby increase the exposure to moisture. Moisture leads to swelling of the skin cells, which become softer and break down more easily. This results in patients developing skin rashes and skin damage. The pH value – shown in the pH colour scale – is the measure of whether a liquid is acidic or alkaline. The natural skin surface is acidic. A pH skin environment that is too alkaline can be unhealthy. The contact of alkaline urine with the skin, breaks the acid mantle, allowing the entrance of pathogenic bacteria and the loss of moisture. Incontinence-associated skin damage (ISAD) is a form of inflammation of the skin that may be accompanied by redness, blistering, erosion and secondary infection, caused by prolonged exposure to urine and/or stool:
- Urine overhydrates exposed skin, increasing the risk for friction injury.
- Ammonia in urine elevates skin pH, impairing its barrier function.
- Fecal enzymes weaken epidermal integrity.
- Liquid stool is particularly irritating to the skin.
By eliminating and reducing or containing incontinence, IASD can be prevented. Keeping skin dry is essential to avoid bacterial growth; a skin friendly pH value 4.5 – 5.5 (slightly acidic), inhibits the growth of bacteria. Skin damage is a common problem of incontinence and older adults are at high risk for developing IASD. Thus, skin pH has an important role in keeping skin healthy and preventing IASD.
In June 2016, the Bliss study was announced, which demonstrated that absorbent incontinence products containing curly fibre, have the potential to prevent IASD, reduce IASD severity and promote IASD healing in older nursing home residents. Furthermore, the study found that the curly fibre technology significantly lower/acidify skin pH, reducing the risk for IASD and the acidity of the product remained over time.
In conclusion, findings support the use of absorbent incontinence products with curly fibre, as a new strategy for combating IASD and maintaining skin health during incontinence episodes.