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Skin failure for hospice patients—can you prevent it?

By Lauri Weiss, CRNP

Lauri Weiss is a Certified Registered Nurse Practitioner (CRNP) with Holy Redeemer Hospice in Pennsylvania. She is also a certified Wound, Ostomy, Continence Nurse (WOCN). In her role with Holy Redeemer Hospice, Lauri provides expert consultation regarding pain and symptom management in addition to providing assessment and recommendations regarding wound care and other complex issues that our patients may experience.

This is part one of a three part series on skin care.

People with advanced illness are at increased risk for skin failure. The skin is the largest organ in our body, and just like our other organs, its function can be altered in severely ill people. As a hospice/palliative care nurse practitioner and wound specialist, I often speak with patients and families about how the normal functions of the skin are altered in people with advanced illness, common causes of skin breakdown at end of life, strategies for preventing skin breakdown and treatments that promote dignity when skin breakdown occurs.

How do physical changes from advanced illness alter skin function at end of life?  Any one of these issues could compromise skin:

  • Weakness and limited mobility
  • Suboptimal nutrition from loss of appetite
  • Impaired immune function
  • Incontinence
  • Reduced blood flow to the tissues
  • Decreased tolerance to external insults

These changes alter the ability of the skin to perform two of its important functions – protection and sensation. When the skin’s strength and ability to detect painful stimuli is decreased, the risk for skin damage and infection is increased.

For these reasons, skin breakdown at end of life is common. There is little information about the exact number of people with advanced illness who develop wounds at the end of life. The National Hospice and Palliative Care Organization reports that approximately 1/3 of hospice patients suffer from wounds. The majority of these wounds are pressure wounds, but other common causes of wounds at end of life are trauma, lack of circulation, malignancy and moisture.

It can be very disturbing when, in spite of our best preventive efforts, skin breakdown occurs at end of life. Many caregivers feel guilty, believing that skin breakdown occurred as a result of poor care giving. I explain to caregivers that skin failure, resulting in skin breakdown, occurs because of the progression of the life-limiting illness, not something we did or did not do.

It’s important to understand that all cases of skin breakdown at end of life are not preventable. However, certain prevention strategies are often effective. My next post will discuss common causes of skin breakdown and things that can be done to prevent skin breakdown for people with advanced illness.

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