Skin Tear Prevalence, Incidence and Associated Risk Factors in the Long-term Care Population

Abstract

Background: Skin tears (STs) are among the most prevalent wounds found in long-term care (LTC) settings. Given our aging population, the burden related to STs will further increase. Skin tears are often misunderstood as expected outcomes of normal skin changes associated with aging and as a result are frequently under-recognized and under-treated. While many factors have been purported to be associated with ST development, there is little evidence to corroborate their roles in ST risks. The primary purpose of the present study was to establish the prevalence and incidence of STs and examine the risk factors associated with ST development in the Ontario LTC population.

Methods: A prospective study design was used to explore the risk factors associated with ST development. Prior to the study, a systematic literature review was conducted to identify previously reported risk factors to inform the study. A total of 380 individuals 65 years of age and over from 4 LTC facilities in Ontario were followed over 4 weeks. The participants were examined for STs at the beginning of the study and at week 4 to determine if STs had occurred and to record the ST type, location, and associated patient-related factors.

Results: The study found a ST prevalence of 20.8% and an incidence of 18.9% within a month. History of a ST at baseline (RR 1.84, 95% CI (1.25-2.70), p=.002), the presence of skin changes associated with aging (RR 1.60, 95% CI (1.43-1.79), p<.001), chronic disease (RR 1.17, 95% CI (1.03-1.32), p=0.018), requiring assistance with activities of daily living (RR 1.13, 95% CI (1.08-1.18), p<.001) and displaying aggressive behaviour (RR 1.06, 95% CI (1.02-1.10), p =.001) were identified as key risk factors associated with ST development at 4 weeks post baseline assessment.

Conclusion: These results provide much needed Ontario data on the burden of STs in the LTC population. By identifying risk factors, healthcare professionals can establish prevention programs targeted at reduction of modifiable risks for ST development. The present study is an important first step towards developing a prevention program targeting individuals at risk for STs in LTC.