How can we improve skin care in residential care homes?

Skin problems, ranging from generalized skin dryness to pressure ulcers, are common in older, care-dependent people. Care workers attempting to improve skin health face an array of good practice recommendations. A study led by Charité – Universitätsmedizin Berlin is now investigating whether the sundry treatment standards currently in use ought to be replaced by a structured skin care program capable of addressing the full range of skin conditions seen. The project has been awarded approximately €975,000 in funding by the Federal Ministry of Education and Research (BMBF).

The skin care needs of elderly people in residential care are governed by a range of specific guidelines and standards. These range from the prevention of pressure ulcers to treating skin itching and inflammation. “However, the more recommendations are added, the more difficult it becomes for care workers to implement them,” explains the project’s lead researcher PD Dr. Jan Kottner of Charité’s Department of Dermatology, Venereology and Allergology on Campus Charité Mitte. Many of the problems encountered are caused by age-related changes in the skin. As people age, they develop dryer, thinner skin which is more vulnerable to injury. The skin also loses its protective barrier and its ability to regenerate naturally.

Led by PD Dr. Kottner, the team of researchers started by analyzing the array of good practice recommendations currently in use. Commonalities and parallels were then used to develop a new skin care guidance, which offers a standardized, step-by-step approach to evaluating the patient’s skin (Is the skin mostly dry or weeping? Is the patient overweight?). In addition to (and separate from) this standardized assessment, this guidance also includes recommendations on how to clean and care for skin. This enables care workers to treat a range of skin problems simultaneously.

The recently-launched ‘SKINCARE study’, which involves a total of 500 residents from 20 care homes in the Berlin area, will run for three years. It will investigate whether the implementation of the new care program leads to improvements in both skin structure and function and quality of life. “Study-specific training will be provided to ensure that care workers know how to use the skin care program correctly,” explains PD Dr. Kottner. “In this way, the new guidance will also increase staff competency.”

The SKINCARE study is one of 15 projects receiving funding under the BMBF ‘Gesund – ein Leben lang’ (healthy – for life) initiative. The aim of this funding initiative is to fill existing gaps in knowledge and evidence pertaining to older and very old adults, and to help advance clinical research in this field. To support this aim, the BMBF plans to provide approximately €10 million in funding. The program started in 2017 and is expected to run until 2023. The SKINCARE study includes men and women aged 65 and over. All participants have considerable care needs (‘Pflegegrad 2’ or higher) and live in residential care homes in Berlin. The new skin care program will be introduced in 10 out of 20 participating care homes (intervention group), while the other 10 homes will continue to follow current skin care protocols (control group).

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