Skin tears in older adult residents of long-term care facilities: prevalence and associated factors.

OBJECTIVE: To determine the prevalence of skin tears, and demographic and clinical factors associated with their presence in older adult residents of long-term care facilities. METHOD: This observational, quantitative, cross-sectional, epidemiological study was conducted with older adult residents of three long-term care facilities in São Paulo, Brazil. For data collection, four instruments were used: a questionnaire assessing sociodemographic and clinical characteristics of the residents; and the Brazilian-Portuguese versions of the Mini-Mental State Examination, Skin Tear Audit Research (STAR) Skin Tear Classification System, and the Katz Index of Independence in Activities of Daily Living. RESULTS: A total of 69 residents took part in the study. The prevalence of skin tears was 11.6%. Skin tears were significantly associated with the presence of haematoma (odds ratio, OR=9.159; p=0.017) and actinic purpura (OR=6.265; p=0.033), which increased the odds of skin tear development nine-fold and six-fold, respectively. CONCLUSION: The findings agree with the international literature. Considering that this was the first epidemiological study on skin tears carried out in long-term care facilities for older adults in Brazil, its contribution lies in the systematisation of data collection and making data available on a field that has not yet been studied in this country.

Incidence of Skin Tears and Risk Factors: A Systematic Literature Review.

Skin tears are traumatic wounds resulting from friction and shearing forces. Clinical practice strongly indicates that skin tears are a prevalent problem but their incidence is not well established in the literature. This systematic literature review identified and evaluated the available literature on the incidence and risk factors for skin tears in adults and the elderly. Inclusion criteria were epidemiological studies published in English, Spanish, or Portuguese languages from January 1990 through June 2014 and available in full text. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Guidelines for Critically Appraising Studies of Prevalence or Incidence of a Health Problem. Five studies reporting incidence of skin tears met the selection criteria. Reported incidence rates of skin tears ranged from 2.23% to 92% in long-term care facilities and varied from 2.1% among men to 4.6% among women living in the community. The most prevalent risk factor for skin tears was old age, followed by impaired mobility, falls and accidental injuries, previous skin tears, cognitive deficit/dementia, dependence in transfers, and upper limbs. Further epidemiological studies on skin tears are necessary to elucidate the cause of these injuries and identify the profile of people at risk for skin tears, contributing to the development and implementation of appropriate preventive interventions.

[Skin tear prevalence and associated factors: a systematic review]. / Prevalência de lesão por fricção e fatores associados: revisão sistemática.

OBJECTIVE: To identify and analyse skin tear prevalence and factors associated with its occurrence. METHOD: Systematic review of literature of studies published until June 2014 including studies published in full in English, Spanish or Portuguese. The studies were analysed according to the Strengthening the Reporting of Observational Studies in Epidemiology and the Guidelines for Critically Appraising Studies of Prevalence or Incidence of a Health Problem. RESULTS: The analysis of eight studies showed skin tear prevalence of 3.3% to 22% in the hospital setting and 5.5% to 19.5% in homecare. Advanced age, dependence on basic activities of daily life, frail elderly, level of mobility, agitated behavior, non-responsiveness, greater risk for concurrent development of pressure ulcers, cognitive impairment, spasticity and photoaging were cited as risk factors. CONCLUSION: Skin tear prevalence ranged from 3.3% to 22% and is mainly associated with advanced age and dependence on basic activities of daily life.

Skin tear prevalence and associated factors: a systematic review / Prevalencia de lesión por fricción y factores asociados: revisión sistemática / Prevalência de lesão por fricção e fatores associados: revisão sistemática

OBJECTIVETo identify and analyse skin tear prevalence and factors associated with its occurrence.METHODSystematic review of literature of studies published until June 2014 including studies published in full in English, Spanish or Portuguese. The studies were analysed according to the Strengthening the Reporting of Observational Studies in Epidemiology and the Guidelines for Critically Appraising Studies of Prevalence or Incidence of a Health Problem.RESULTSThe analysis of eight studies showed skin tear prevalence of 3.3% to 22% in the hospital setting and 5.5% to 19.5% in homecare. Advanced age, dependence on basic activities of daily life, frail elderly, level of mobility, agitated behavior, non-responsiveness, greater risk for concurrent development of pressure ulcers, cognitive impairment, spasticity and photoaging were cited as risk factors.CONCLUSIONSkin tear prevalence ranged from 3.3% to 22% and is mainly associated with advanced age and dependence on basic activities of daily life.

OBJETIVOIdentificar y analizar la prevalencia de lesión por fricción y los factores asociados con su ocurrencia.MÉTODORevisión sistemática de la literatura publicada hasta junio de 2014 con la inclusión de estudios publicados integralmente en inglés, español o portugués. Los estudios fueron analizados según el Strengthening the Reporting of Observational Studies in Epidemiology y el Guidelines for Critically Appraising Studies of Prevalence or Incidence of a Health Problem.RESULTADOSLos análisis de ocho estudios mostraron prevalencia de lesión del 3,3% al 22% en el escenario hospitalario y del 5,5% al 19,5% en el domiciliario. Edad avanzada, dependencia para las actividades básicas de vida diarias, anciano frágil, nivel de movilidad, comportamiento agitado, falta de responsividad, mayor riesgo para el desarrollo concomitante de úlcera por presión, afectación cognitiva, espasticidad y fotoenvejecimiento fueron los factores de riesgo citados.CONCLUSIÓNLa prevalencia de lesión varió del 3,3% al 22%, estando asociada principalmente con la edad avanzada y la dependencia para las actividades básicas de vida diarias.

OBJETIVOIdentificar e analisar a prevalência de lesão por fricção e os fatores associados à sua ocorrência.MÉTODORevisão sistemática da literatura publicada até junho de 2014 com a inclusão de estudos publicados na íntegra em inglês, espanhol ou português. Os estudos foram analisados segundo o Strengthening the Reporting of Observational Studies in Epidemiology e o Guidelines for Critically Appraising Studies of Prevalence or Incidence of a Health Problem.RESULTADOSAs análises de oito estudos mostraram prevalência de lesão de 3,3% a 22% no cenário hospitalar e 5,5% a 19,5% no domiciliar. Idade avançada, dependência para as atividades básicas de vida diárias, idoso frágil, nível de mobilidade, comportamento agitado, arresponsividade, maior risco para o desenvolvimento concomitante de úlcera por pressão, comprometimento cognitivo, espasticidade e fotoenvelhecimento foram os fatores de risco citados.CONCLUSÃOA prevalência de lesão variou de 3,3% a 22%, estando associada principalmente à idade avançada e dependência para as atividades básicas de vida diárias.

Prevalência e fatores associados às lesões por fricção em idosos de instituições de longa permanência / Prevalence and factors associated with skin tears in elderly long-stay institutions

Introdução: Lesão por fricção é uma ferida traumática, que ocorre principalmente nas extremidades de idosos. Objetivo: O objetivo do estudo foi identificar e analisar a prevalência de lesão por fricção e os fatores demográficos e clínicos associados a essa ocorrência, em pessoas idosas residentes em Instituições de Longa Permanência para Idosos. Métodos: Trata-se de um estudo epidemiológico, transversal, analítico, exploratório, com abordagem quantitativa, realizado em três instituições do município de São Paulo que aceitaram participar do estudo, dentre 135 contactadas previamente. Os dados foram coletados mediante consulta ao prontuário, entrevista com o próprio residente e/ou responsável e exame físico do idoso. Os residentes foram entrevistados e avaliados quanto aos aspectos sócio-demográficos e clínicos, condições da pele e quanto às características das lesões encontradas. Para a coleta de dados, empregaram-se os seguintes instrumentos: instrumento de coleta de dados sócio-demográficos e clínicos, Teste Mini Exame do Estado Mental, Escala de Katz e Sistema de Classificação STAR Lesão por Fricção. Os dados foram analisados por meio de: teste exato de Fisher, teste de Wilcoxon-Mann-Whitney e modelo de regressão logística (backwardstepwise). Resultados: A amostra de 69 residentes foi composta predominantemente por mulheres (51/73,91%), da raça branca (50/72,46%), com média de 81 anos de idade (DP=9,30) e mediana 82 anos, com algum problema na marcha (58/84,06%), redução ou ausência na acuidade visual (56/81,16%), dependência para atividades básica de vida diária (52/75,36%), comprometimento cognitivo (51/73,91%), presença de incontinência (45/65,22%) e algum grau de desnutrição (magreza = 26/37,69%).Oito sujeitos apresentaram 13 lesões por fricção, implicando em prevalência global de 11,6% para essa amostra, sendo de 22,22% para homens, 7,84% para mulheres e 10,00% para a raça branca. Onze (84,6%) lesões localizaram-se nos membros inferiores, predominando aquelas de categoria 3 (6/46,1%). Embora os grupos com e sem lesões por fricção tenham diferido quanto à presença de: hipertensão arterial sistêmica, alterações na marcha (principalmente cadeirantes), rigidez, acuidade visual diminuída, edema de membros inferiores, equimoses, hematoma, pele seca e descamativa, púrpura senil, curativos/ adesivos, dependência para as atividades básicas de vida diária e magreza, somente as presenças de hematoma (RC: 9,159 / p: 0,017) e púrpura senil (RC: 6,265 / p: 0,033) permaneceram no modelo final de regressão logíastica. Conclusão: A prevalência de lesão por fricção entre idosos institucionalizados foi de 11,6%, comparável a escassos estudos internacionais realizados com pacientes hospitalizados. Os fatores associados à ocorrência de lesão por fricção, hematoma e púrpura senil, estão de acordo com a literatura sobre o tema. Ao tratar-se de estudo inédito em nosso meio, seus resultados contribuem para o diagnóstico situacional da ocorrência de lesão por fricção em idosos institucionalizados e para a necessidade de implantação de medidas preventivas em grupos vulneráveis como os idosos.

Introduction: Skin tear is a traumatic wound, which occurs mainly in the extremities of elderly. Objective: The study objective was to identify and analyze the prevalence of skin tears and demographic and clinical factors associated with its occurrence in institutionalized elderly. Methods: This is an epidemiological cross sectional analytical, exploratory study with a quantitative approach, performed in three nursing homes of São Paulo who agreed to participate in the study, among 135 ones previously contacted. Data were collected by records consultation, interview with the resident himself and /or care giver and physical examination of the elderly. Residents were interviewed and assessed for socio-demographic and clinical features, skin conditions and skin tears characteristics. The following tools were used for data collection: socio-demographic and clinical data, Mini Mental State Examination test, Katz index and STAR Classification System Skin Tear. Data were analyzed using Fisher's exact test, Wilcoxon-Mann-Whitney test and logistic regression (backward stepwise). Results: The sample of 69 residents was mostly composed by women (51 / 73.91%), Caucasians (50 / 72.46%), mean age 81 (SD = 9.30) and median 82 years old, some problem in mobility (gait) (58 / 84.06%), visual acuity problems (56 / 81.16%), dependence for activities of daily living (52 / 75.36%), cognitive impairment (51/73, 91%), presence of incontinence (45 / 65.22%) and some degree of malnutrition (underweight = 26 / 37.69%). Eight subjects had 13 skin tears, resulting in an overall prevalence of 11.6% for this sample, and 22.22% for men, 7.84% for women and 10.00% for the caucasians.Eleven (84.6%) skin tear were located in the lower limbs, predominantly category 3 skin tears (6 / 46.1%). Although there were statistically significant differences between groups with and without skinj tears related to: arterial hypertension, mobility problems (especially wheelchair users) , stiffness, decreased visual acuity, lower limb edema, ecchymosis, hematoma, dry and scaly skin, senile purpura, dressings / adhesives, dependence for activities of daily living and thinness, just the presence of hematoma (RC: 9,159 / p:0,017) and senile purpura ( RC: 6,265 / p: 0,033) remained after logistic regression analysis. Conclusion: The prevalence of skin tear among institutionalized elderly was 11.6%, comparable to few international studies with hospitalized patients. The factors associated with the occurrence of skin tear, hematoma and senile purpura, are consistent with the literature on the subject. When being unpublished study in our country, our results contribute to the situational analysis of the occurrence of skin tear in elderly nursing home residents and the need to implement preventive measures in vulnerable groups like the elderly.