Aging affects every part of our bodies. For example, as individuals age, the skin undergoes some changes. Not necessarily bad things but changes that can affect your skin, particularly its ability to protect you from pressure injury and other issues.

Changes to the skin include decreases in collagen, the connective tissue in the body, which is made up of a protein that forms strands. If you imagine how a rope is made up of strands of fiber to increase strength, that would be similar to how collagen creates strength, through strands of proteins in the body. Collagen is found in the skin but also in cartilage, bones, tendons, and ligaments. Decreases in collagen affect the outer surface of the skin as well as the supporting structures within the body.

It is a double issue when external skin tissue is affected and the underlying structures that support it. The decrease of collagen increases the risk of pressure injury as there is not a good balance in internal support to disperse pressure from boney prominences or skin elasticity to accommodate the change. Unfortunately, you will not know when this decrease in collagen will occur. It is a culprit in individuals who do not have pressure injuries in youth but suddenly do.

Other issues occur to aging skin, again for some but not so much for others. This includes dry skin, which can develop from a variety of sources. Dehydration is one. As we age, we might not recognize the need to drink fluid, especially water. This can dehydrate the body subtly, without awareness.

Other causes of dry skin are being in the sun too much or in dry air, especially in the wintertime with the heat drying the environment. Smoking robs the cells of oxygen and nutrients (including fluid). Slower functioning of sweat and oil glands with age does not create moisture on the skin to develop a protective barrier. This is especially an issue with the Autonomic Nervous System (ANS), which may have affected sweating for years. Health problems can also lead to dry skin, especially diabetes and kidney disease. Skin cleansers and medications can lead to dry skin. Soap that is used frequently or without thorough rinsing is a ringleader for dry skin. Many medications can have the side effect of itching. Medications for reducing cholesterol called statins are particular culprits.

Itchy skin leads to scratching, which can create openings on the surface of the skin. This can be an entry point for bacteria. The reduction of collagen makes the skin more susceptible to scratches. Internally, bruising can occur more easily from decreases in collagen inside the body.

Medications can increase your risk. The most common are important medications that thin the blood, including low and high-dose daily aspirin, coumadin, Plavix, and heparin. These types of blood thinners or anticoagulants are most frequently used, but there are other blood-thinning medications as well. These are required for some individuals to prevent blood clots, stroke, and other serious vascular complications.

Some foods and dietary supplements can affect blood clotting as well. They should never be substituted or used without consulting your healthcare professional. Food cannot thin your blood effectively as prescribed medication, but it can interfere or over-thin your blood when combined with medication. Be sure to read the medication information that comes with your prescription to ensure you are not counteracting the medications efficiency. Foods that contain high levels of vitamin K will counteract your blood-thinning medication. Green leafy vegetables, brussels sprouts, broccoli, fish, meat, and eggs are sources of vitamin K. Foods that can over increase the effectiveness of blood-thinning medications include garlic and turmeric, to name but a few.

Wrinkles appear as we age. This is another collagen issue of the skin and supporting structures. Wrinkles will increase with too much time in the sun or ultraviolet rays and smoking. Gravity is another factor in the development of wrinkles as the skin sags when the underlying structure becomes less able to support it.

Age spots, skin tags, and skin cancer can all be increased with age. Age spots are brown areas on the skin of various sizes. They are flat on the surface of the skin. Skin tags are little growths on the skin, usually the same pigment of your skin, that just sort of hang there. Both age spots and skin tags are benign (non-cancerous). However, skin cancer is a very serious issue. Have your dermatologist evaluate age spots, skin tags, and skin cancer. A once a year skin check by a healthcare professional is beneficial as you age because a little something on your skin can develop into something big or dangerous. Catching skin cancer early greatly increases your chance of getting early treatment and a significantly better outcome. Do not guess. Find out and get treatment. You should be checking your skin frequently for pressure injury, so a new spot should be easy to catch.

The CDC offers these symptoms of skin cancer:

• “A” stands for asymmetrical. Does the mole or spot have an irregular shape with two parts that look very different?
• “B” stands for border. Is the border irregular or jagged?
• “C” is for color. Is the color uneven?
• “D” is for diameter. Is the mole or spot larger than the size of a pea?
• “E” is for evolving. Has the mole or spot changed during the past few weeks or months?

How to protect your skin from issues with aging is a question that is frequently asked. Protection begins in your youth. However, if you are like me, we did not have the knowledge about protecting our skin as we do now, so start protecting your skin today, no matter your age.

Limit your time in the direct sun, use sunscreen, wear protective clothing (wide-brimmed hat, rash guard clothes, cooling cloths), and avoid tanning in the direct sun or in a tanning booth.

Use protective eyewear such as sunglasses with UV protection. The eyes are not skin but if you are protecting your body, protect your eyes as well. Sun rays are much stronger than they were in years past. Avoid eye issues in later life by protecting them starting today.

Follow a healthy diet that is rich in vitamins, nutrients, and essential minerals. Most individuals can easily obtain these elements from a healthy diet. Remember to work toward your goals, including all the food groups in moderate portions. This will help you keep your collagen in shape.

Drink water as you are able. You may have some restrictions due to a bladder management program. If you are without restrictions due to bladder or cardiac issues, increase your fluids just a bit, slowly over time, not quickly. This helps your body adjust. Avoid alcohol, sugary drinks, which will rob the nutrients needed by your cells. The extra fluid will pump up your skin as well as to possibly create that moisture barrier on the surface of your body unaffected by the ANS.

As you age, decrease your time in the shower or bath. Rotate a full shower by taking a ‘bird bath’, washing the essential areas underarms, groin, and rear. Use a mild soap and rinse thoroughly. Dry completely. Use warm or body temperature water. Hot water dries out the skin quickly. When showering, get in, get out. Do not linger in the water. Use an emollient-based lotion to rehydrate the skin’s surface.

Quit smoking or do not start. That includes all inhalants except prescribed medication, like an asthma inhaler. Ecigs, recreational drugs are just as dangerous as tobacco cigarette smoking due to the inhalants. Do not let advertisements or peer pressure make you think differently. Avoid secondhand smoke as well. The scientific evidence is quite clear. If you do smoke or use these products, the time to stop is now. There are treatments that can help you. Perhaps you have tried before, do not give up. For some individuals, it may take several attempts, but you can do it. Smoking anything or inhaling products into your lungs creates an inability for needed nutrients to reach your cells, affecting your skin and those underlying structures, including collagen and other cellular needs. Smoking also wrinkles your skin and creates an environment in your body where healing is much slower.

Check your pressure dispersing equipment to ensure it is still the correct option for you. Older equipment may need to be replaced due to use and changes in your body that require different support for your skin. If you have not had pressure mapping to see if your equipment is up to your requirements, ask for a referral, or your physical therapist may be able to do this assessment at a session.

Avoid injury to your body. Perform your skin checks. Younger or newly injured individuals tend to check their skin, finding over time nothing is wrong, so they become less rigorous in checking. Do not let this happen to you. We never know when our skin and bodies will change, so you must be vigilant today and in the future. If you have become complacent in your skin checks, restart your skin check campaign. Finding a change in pigmentation early saves a world of trouble later.

Pediatric Consideration:

Teaching your child or teen to check their skin is a parental duty, just like teaching your child to eat a healthy diet, exercise, read, all the life’s tasks that children need to learn. Start out by doing skin checks together, then move into more independence with your child or teen. Create an environment where skin checks are just a part of life, not a chore. Have equipment such as a long-handled mirror located where the child can easily get to it, like at the bedside. Teach them to look at their skin as they dress, toilet, turn, all of these or whatever is appropriate for your child.

Skincare in the early years can prevent issues in the later years. Today, the world is more conscious of skin issues which is a benefit to everyone. Skin issues are more in conversations today. More children and especially teens, are aware of skin conditions and how to prevent them, which helps in being cautious at an earlier age. Skin protection is consistent with what other kids are doing, protection from the sun, not smoking and other strategies, just add in pressure releases and skin checks as a part of daily life. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.