OT 504 Week 9 Large Group 2: Skin Concerns & Lower Extremity Amputation in Older Adulthood.

What are the four major functions of the integumentary system?

Maintains barrier to water/electrolyte loss, protects against external injury, serves as a sensory organ (touch, temperature, pain, vibration), and performs self-maintenance and wound repair (epithelialization).

What age-related structural skin changes occur?

Thinning of epidermis, dermis, and blood vessels; decreased collagen; decline in lipid content; reduced inflammatory response; reduced allergic/irritant reactions; reduced superficial pain perception; increased deep tissue pain; fewer melanocytes but larger size (age spots/moles); seborrheic keratosis.

What skin conditions are older adults at increased risk for?

Dermatitis, pruritus ('winter itch'), xerosis (dry skin), bruising (senile purpura), skin infections, and pressure sores, with risks compounded by comorbidities.

Why are skin concerns important in older adults?

Poor management increases risk for skin injury, disease, wounds, occupational performance problems, and health complications.

What history should an OT obtain during a skin assessment?

Medical history, previous skin problems, medications, skin care routine, psychological well-being, bowel/bladder function, and body image concerns.

What should you LOOK for during a skin assessment?

Edema, color changes, bruising, inflammation, scratch marks, jaundice, swelling, breaks in skin, ulcers, lesions, and skinfold condition.

What should you FEEL during a skin assessment?

Texture, moisture, swelling, and temperature.

What should you SMELL during a skin assessment?

Body odor, infection, and incontinence.

What five common skin concerns were discussed?

Dry skin, sun damage/skin cancer, skin tears, diabetic foot ulcers & pressure ulcers, and incontinence-associated dermatitis.

Why is dry skin a concern?

It can be painful, embarrassing, and increases the risk of cracks, skin tears, and wounds.

What is OT's role for dry skin?

Screening, patient education, and referral.

What are emollients?

Products that soften and increase skin flexibility. Examples: Oils, lipids, colloidal oatmeal, shea butter.

What are humectants?

Substances that pull water into the skin and retain moisture. Examples: Glycerin, urea, aloe vera, hyaluronic acid.

What are occlusives?

Physical barriers that trap moisture. Examples: Petroleum, beeswax, lanolin.

What are protein rejuvenators?

Ingredients marketed to improve skin: collagen, keratin, elastin.

What is the ABCDE mnemonic?

A = Asymmetry, B = Border, C = Color, D = Diameter, E = Evolution.

How can sun damage be prevented?

Cover skin, wear sunglasses, avoid tanning, wear sunscreen, and refer suspicious lesions to dermatology.

What is a skin tear?

An acute wound caused by shear, friction, or blunt force causing separation of skin layers.

Where do most skin tears occur?

On hands and arms (70–80%).

Common causes of skin tears?

Bumping into objects, transfers, falls, and wheelchairs.

Risk factors for skin tears?

Advanced age, immobility, use of assistive devices, ADL dependence, cognitive impairment, cardiac disease, vascular disease, vision impairment, malnutrition, falls, edema, corticosteroid use, and senile purpura.

What are the three skin tear types?

Type 1 = No tissue loss; Type 2 = Partial tissue loss; Type 3 = Complete tissue loss/no epidermal flap.

Treatment priorities for skin tears?

Control bleeding, clean wound, approximate edges (Types 1 & 2), cover/protect, promote moist healing, and manage pain. Debridement if flap is nonviable.

OT interventions for skin tears?

Restore routines, prevent role loss, prevent wounds, modify environment, educate on skin care and risk reduction.

What is a diabetic foot ulcer?

A foot skin injury caused by impaired blood flow.

Where do diabetic foot ulcers commonly occur?

On the heel, ball of foot (metatarsal heads), and tips of toes (especially 1st & 2nd).

Why do diabetic foot ulcers develop?

Due to foot deformity, peripheral neuropathy, peripheral arterial disease, long-standing diabetes, prior ulcers or amputations, smoking, HbA1c >9%, visual impairment, and chronic kidney disease (CKD).

Types of diabetic foot ulcers?

Neuropathic, ischemic, and neuroischemic (highest amputation risk).

Wagner Classification of diabetic foot ulcers?

Grade 0 = Normal foot; Grade 1 = Superficial ulcer; Grade 2 = Deep ulcer; Grade 3 = Infected foot; Grade 4 = Partial gangrene; Grade 5 = Extensive gangrene.

Treatment for diabetic foot ulcers?

Prevention education, proper foot care, blood sugar control, activity restriction (NWB), wound care, surgery/debridement, antibiotics, and hyperbaric oxygen.

Daily diabetic foot care education?

Inspect feet daily, wash/dry feet, lotion (not between toes), never go barefoot, wear proper shoes, check inside shoes, wear socks, trim nails straight across, don't remove corns yourself, improve circulation, and exercise safely.

What causes pressure ulcers?

Prolonged pressure leading to reduced blood flow, usually over bony prominences, with friction/shear contributing.

Common pressure ulcer locations?

Sacrum, ischium, trochanters, elbows, and heels.

What signs should be used for pressure ulcers in darker skin?

Discoloration, itching, warm/cool temperature, swelling, tenderness, open sore, hard/soft tissue, and drainage (odor may or may not be present).

OT interventions for pressure ulcers?

Weight shifting, skin inspection, turning/repositioning, keeping skin clean/dry, ensuring proper nutrition/hydration, appropriate clothing, using air mattresses, and wheelchair cushions.

What causes IAD?

Skin irritation from prolonged exposure to urine or stool.

Symptoms of IAD?

Redness/darkening, inflammation, warm skin, firmness, lesions, pain, burning, and itching.

Treatment for IAD?

Cleanse, moisturize, protect skin barrier, and use medical topical treatments if indicated.

Most common cause of lower-limb amputation in older adults?

Peripheral vascular disease complications, with diabetes increasing risk up to 10-fold.

Consequences of lower-limb amputation?

Pain, depression, altered body image, mobility limitations, frailty, high mortality, and high healthcare cost.

Phantom sensation vs. phantom pain?

Phantom sensation: Feeling the missing limb (itching, tingling, asleep). Phantom pain: Burning, cramping, twisting, aching pain.

What treatment options are available for phantom pain?

Desensitization, gentle tapping, vibration, retrograde massage (after healing), medication, and shrinker sock.

Red flags indicating possible amputation risk?

Pain/numbness, slow-healing wounds, gangrene, shiny/smooth skin, thick toenails, weak/absent pulse, and infection not responding to antibiotics.

What occurs during pre-prosthetic training?

Balance/body control, wheelchair management, ADL training, safety education, and home modifications.

What balance skills are emphasized during pre-prosthetic training?

Positioning, bed mobility, sitting balance, sit-to-stand, and standing balance.

ADL skills taught after amputation?

Transfers, dressing, toileting, bathing, activity adaptation, and caregiver training.

Safety interventions after amputation?

Fall prevention, home assessment, removal of barriers, home adaptations, and assistive device selection and training.

Lifestyle interventions following prosthetic fitting?

Community walking, outdoor mobility, and managing chronic diseases (diabetes, PVD, cancer, poor circulation).

Residual limb care?

Inspect skin after prosthesis removal, wash daily with mild soap, and dry thoroughly while managing perspiration.

Prosthesis care?

Clean socket daily, follow manufacturer maintenance recommendations, and train patient in maintenance and care.