Management of skin conditions in the older population 2.

This is the second of two papers covering assessment and management of elderly skin. Part 1 of this clinical review focused on the importance of a comprehensive assessment of the skin and a detailed clinical history of the patient (Bianchi and Cameron, 2008). This second paper considers some common dermatological conditions seen in the older adult and explores suitable management strategies.

Assessment of skin integrity in the elderly 1.

Intrinsic changes to the skin are a normal part of the ageing process. Careful assessment of the skin for any abnormalities should be included in any patients' holistic assessment. It is essential that all health care professionals have a fundamental knowledge of the structure and function of the skin in order to be able to assess any changes to normal skin; identify existing skin problems and potential risk factors. Only by carrying out a detailed and systematic examination, we can implement effective strategies of management. This is the first of two papers. This paper will describe the structure and functions of the skin and explore skin assessment. The second paper will describe some of the more common skin conditions seen in ageing skin and their management.

Exudate and care of the peri-wound skin.

A moist environment provides the optimum conditions for wound healing, but maintaining control of exudate and preventing its contact with the surrounding skin remain a challenge to carers. An essential part of management is identifying the underlying pathology of the wound. Correct diagnosis of the cause of increased exudate production is necessary for the implementation of appropriate interventions. Continual assessment of the wound and surrounding skin, together with evaluation of dressing performance, are integral to manage the different stages of wound healing.

Woundcare Research for Appropriate Products (WRAP): validation of the TELER method involving users.

Woundcare Research for Appropriate Products (WRAP) is a novel collaboration WRAP between industry and clinicians, funded by the Engineering and Physical Research Sciences Council. WRAP objectives included the development and testing of methodologies to identify patients' and clinicians' needs with respect to wound dressings for exudate management. The management of exudate was the focus because it was demonstrated to be the pivotal problem for patients and clinicians in a study of malignant wounds, and is a recurring problem in other wound types. A clinical note-making system (Treatment Evaluation by Le Roux's method--TELER) was validated as a method of collecting observational data of dressing performance in the context of total patient care, thereby involving the users of dressing products. The validation process was a form of consensus where multiple sources of data were used to define patient problems, within the TELER indicators, to measure a change or lack of change in the problems during a period of treatment and care and to draw conclusions about dressing performance and patient experiences.