Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings

• Published in: Cochrane database of systematic reviews 2020-01, Vol.1 (1), p.CD011377-CD011377
• Main Authors: Cowdell, Fiona, Jadotte, Yuri T, Ersser, Steven J, Danby, Simon, Lawton, Sandra, Roberts, Amanda, Dyson, Judith
• Format: Article
• Language: English
• Subjects: Administration, Topical; Aged; Aged, 80 and over; C. DERMATITIS AND ECZEMA; Emollients - therapeutic use; Female; Humans; Hygiene; Male; Patient Satisfaction; Pruritus - prevention & control; Randomized Controlled Trials as Topic; Skin Care - methods; Skin disorders; Soaps - chemistry; Soaps - therapeutic use; Wounds and Injuries - prevention & control
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD011377.pub2

Ageing has a degenerative effect on the skin, leaving it more vulnerable to damage. Hygiene and emollient interventions may help maintain skin integrity in older people in hospital and residential care settings; however, at present, most care is based on "tried and tested" practice, rather than on evidence. To assess the effects of hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL, up to January 2019. We also searched five trials registers. Randomised controlled trials comparing hygiene and emollient interventions versus placebo, no intervention, or standard practices for older people aged ≥ 60 years in hospital or residential care settings. We used standard methodological procedures as expected by Cochrane. Primary outcomes were frequency of skin damage, for example, complete loss of integrity (tears or ulceration) or partial loss of integrity (fissuring), and side effects. Secondary outcomes included transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema, and clinical scores of dryness or itch. We used GRADE to assess the quality of evidence. We included six trials involving 1598 residential care home residents; no included trial had a hospital setting. Most participants had a mean age of 80+ years; when specified, more women were recruited than men. Two studies included only people with diagnosed dry skin. Studies were conducted in Asia, Australasia, Europe, and North America. A range of hygiene and emollient interventions were assessed: a moisturising soap bar; combinations of water soak, oil soak, and lotion; regular application of a commercially available moisturiser; use of two different standardised skin care regimens comprising a body wash and leave-on body lotion; bed bath with "wash gloves" containing numerous ingredients; and application of a hot towel after usual care bed bath. In five studies, treatment duration ranged from five days to six months; only one study had post-treatment follow-up (one to eight days from end of treatment). Outcomes in the hot towel study were measured 15 minutes after the skin was wiped with a dry towel. Three studies each had high risk of attrition, detection, and performance bias. Only one trial (n = 984) assessed frequency of skin damage via average monthly incidence of skin tears during six months of treatment. The emollient gro