Subcutaneous fat below the dermis consists primarily of adipose tissue, and it provides mechanical protection and insulation. Loss of subcutaneous fat during aging results in parallel losses in these protective functions. 4 Subcutaneous tissue undergoes site-specific atrophy in the face, dorsal aspect of the hands, shins, and plantar aspects of the foot, increasing the energy absorbed by the skin during trauma to these areas. A concomitant decrease in pain perception may make the elderly person more vulnerable to traumatic environmental insults. Turning or lifting, which can cause friction and shearing, may injure the skin.
Delicate skin can tear when adhesive dressings or tape are removed.
Even ambulating or transferring patients may present a problem if they bump into objects such as chairs, beds, or tables. Nearly half have no apparent cause. Those that appear on the back and buttocks may be mistaken for Stage II pressure ulcers. In the late 1980s, a pilot study by Payne and Martin 8 led to the development of the Payne-Martin Classification System for Skin Tears, which addresses assessment, prevention, and treatment of skin tears. Although relatively new and not well-known, this classification tool presents the health care practitioner with a system to enhance documentation and track outcomes of care.