Why skin deserves a regular look

Skin checks for older adults matter because older skin is thinner, drier and slower to repair. Add limited mobility, diabetes, swelling or incontinence, and a red spot can become an open wound in a short time. The best time to find a problem is before the skin breaks.

A skin check is a simple habit. Someone looks at the skin on a regular schedule, knows what is normal for that person, and reports changes. A primary care clinician does this at routine visits, and families and caregivers can do a version of it at home in between.

Where problems usually start

Pressure injuries form where bone sits close to the skin and body weight rests for long periods. Other trouble spots are places that stay damp or get rubbed.

  • Tailbone and buttocks
  • Heels and ankles
  • Hips
  • Shoulder blades, elbows and the back of the head
  • Skin folds under the breasts, belly and groin
  • Between the toes and on the soles of the feet
  • Under oxygen tubing, braces, splints and compression garments
  • Shins and forearms, where thin skin tears easily

People with diabetes need extra attention to their feet, because nerve damage can hide an injury. See the guide on daily foot checks for people with diabetes.

What to look for

Look, and with clean hands, feel gently.

  • Redness that is still there after pressure has been off the area for a while
  • On darker skin, an area that looks darker, purple, bluish or simply different from the skin around it
  • A spot that feels warmer, cooler, firmer or softer than nearby skin
  • Blisters, peeling, cracks or any open area
  • A rash or raw skin in folds or wherever moisture collects
  • Swelling, weeping, pain or itching in one place

Our guide to pressure injury stages explains the terms clinicians use, but you are not expected to stage anything. Describe what you see and where.

Skin checks as part of primary care

During a primary care visit, the clinician can look at high-risk areas, ask about mobility, continence, nutrition and sensation, and judge how much risk a person carries. That shapes the plan: how often to check, whether a different mattress or cushion should be considered, and whether a wound care clinician should be involved.

Because primary care looks at the whole person, it can also address what lies behind skin breakdown: a poor appetite, a medication that causes drowsiness, a fall that has left someone afraid to move, or unmanaged incontinence. See mobility and fall risk and nutrition and healing.

Building a routine at home

Tie the check to something that already happens every day, such as bathing or getting ready for bed, and use good light.

  1. Use a long-handled mirror, or ask for help, to see the heels, back and bottom.
  2. Look under braces, tubing and garments if the clinician has said they can be moved.
  3. Note anything new, with the date and location, and compare it the next day.

Checking is half of prevention. The other half is taking pressure and moisture away. Ask the clinician about a repositioning schedule, support surfaces, and skin protection with incontinence. In assisted living or skilled nursing, ask staff how often skin is checked and how the family hears about changes.

What Gateway arranges

Gateway arranges primary care follow-up and wound care with Gateway clinicians and coordinates between them. If a skin check turns up a concern, we help get it in front of the right clinician, follow up on orders for supplies or equipment, and keep the existing physician and the family informed.

For people at high risk, see how pressure injury prevention is coordinated among home health, facility staff and the treating clinician, who makes the assessment and writes the orders.

What to report, and how fast

Call the treating clinician promptly for any open area, a blister, a red or discolored spot that is still there the next day, or skin that is warm, swollen or painful. For people with diabetes or poor circulation, report any foot wound, however small.

Call 911 for a wound with fever and confusion, redness that is spreading quickly in someone who looks very unwell, or a foot or leg that suddenly turns cold, pale or blue.

How to start

Call 314-325-0126 or fill in the request care form with a name and phone number. Keep health details for the call. It helps to know where the person spends most of the day (bed, recliner or wheelchair) and who helps with bathing and dressing.

Common questions

How often should an older adult’s skin be checked?

Someone who walks, shifts position and has normal sensation may need only a look during routine care. A person who spends most of the day in a bed or chair, has diabetes or cannot feel their feet usually needs a daily check. Ask the treating clinician what schedule fits.

What does an early pressure injury look like?

Often it is a patch of unbroken skin over a bony area that stays red after pressure is removed. On darker skin, feel for warmth, firmness or tenderness and compare with nearby skin. Report any such spot, and keep weight off it while you wait for advice.

Does a primary care visit include a full skin exam?

Not automatically. A clinician may check high-risk areas for pressure and moisture damage, and look at the feet, without examining all of the skin. A full-body exam for skin cancer is a different service, often done by a dermatologist. Say so if you want a particular area checked.

Should I put cream or a bandage on a red spot?

Ask the treating clinician before applying anything, since the right step depends on the cause. In the meantime, take pressure off the area, keep the skin clean and dry, and note the size and color so you can describe it. Do not rub or massage the spot.

Related pages

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.