Abstract
Background
With the ageing of the global population, it is predicted that the population of older adult patients in hospitals and intensive care units (ICUs) will increase. Because of health conditions, care practices and ageing‐related skin changes, older adult ICU patients are prone to skin integrity problems, including skin tears (STs).
Aim
To determine the prevalence of STs and associated factors in older patients hospitalized in ICUs.
Study Design
The study is a regional, multicentre, point prevalence study conducted in five centres in the five largest cities in terms of population in the Central Anatolia Region of Türkiye. Data were collected simultaneously in each centre on the same day. The list of patients hospitalized in the ICUs on the day of data collection was drawn up, and 200 patients who were 65 years of age or older, were hospitalized in ICUs and agreed to participate in the research were included. The researchers formed an “ST chart” to record patient demographic characteristics, clinical variables and skin assessment.
Results
STs were detected in 14.5% of patients in ICUs, with 72.5% of them having stage 1 ST. A significant relationship was found between individuals' average body mass index (BMI) (p = .043), age (p = .014), length of stay in the ICU (p = .004) and having ST. There was also a statistically significant relationship between skin temperature (p = .002), skin turgor (p = .001) and ST. More STs were observed in patients with cold skin and low turgor. The prevalence of ST was higher in individuals with a history of ST. Additionally, there was a statistically significant relationship between consciousness (p = .014), incontinence (p = .006), the Braden score (p = .004), the Itaki fall risk score (p = .006) and ST.
Conclusions
In this multicentre point prevalence study, the prevalence of ST in older patients in ICUs was 14.5%, and many factors associated with ST have been identified.
Relevance to Clinical Practice
Given the insufficient information and attention to STs in older adults, the study emphasizes the importance of addressing STs. The impact of STs includes increased treatment costs, length of stay and risk of complications. Therefore, understanding the global extent of STs in ICUs and developing effective interventions for prevention and management are crucial.
Keywords: intensive care units, older patients, skin tears, wound care
What is known about the topic
ICU patients often suffer from skin integrity issues.
ICU nurses play an essential role in preventing skin integrity issues.
Although there are many studies on skin integrity issues, there are no studies on skin tears in ICUs.
What this paper adds
The research is the first study to determine the prevalence of skin tears in older patients in ICUs.
In this multicentre point prevalence study, it was determined that the prevalence of skin tears was 14.5% in older patients in ICUs.
The study results may contribute to developing skin tears prevention programmes in older adult patients in ICUs and increase nurses' awareness about skin tears.
1. INTRODUCTION
Patients' health conditions in intensive care units (ICUs) that necessitate close monitoring and follow‐up and the associated treatment and care practices (such as monitoring, nasogastric feeding and defibrillation) contribute to skin integrity issues. Numerous studies have highlighted that skin integrity issues are more prevalent in ICUs compared with other clinical settings. 1 , 2 , 3 The highest prevalence and incidence rates of pressure injuries (PIs) are known to be in ICU patients, confirming that ICU patients are at the most significant risk for developing PIs compared with hospitalized individuals. Lin et al. (2022) found that the prevalence of general hospital‐acquired PIs was 12.2% in ICU patients and 4.3% in non‐ICU patients in a study that included 198 ICUs from 21 provinces in China. 3 Pather et al. (2021) reported that 35.1% of patients with incontinence developed incontinence‐related dermatitis (IAD) in ICUs. 4 In a cross‐sectional study (n = 300), Karacabay et al. (2021) determined that medical device‐related pressure injury (MDRPI) developed in 34% of patients in ICUs. 5 ICU patients are at an elevated risk for skin integrity issues because of their inability to perform self‐care and daily life activities, compounded by their ventilation and sedation. Furthermore, the critical conditions of ICU patients, including hemodynamic instability and oxygenation impairment, can expedite the development of skin integrity problems. 1 , 3 , 6
Despite numerous studies on skin integrity issues in ICUs, there is a noticeable gap in the literature regarding skin tears (STs). STs, defined by the International Skin Tears Advisory Panel (ISTAP) as traumatic wounds caused by mechanical forces like cutting, friction and blunt trauma (including the removal of adhesives), predominantly occur on the extremities and in older adults. If left untreated, STs can lead to infection, pain, prolonged hospital stays, poor quality of life and increased health care costs. 7 Recent studies suggest that the prevalence of STs ranges from 3.0% to 20.8% in older adults. 7 , 8 , 9 , 10 , 11 , 12 , 13 For instance, a retrospective study of six long‐term care facilities in Pennsylvania (n = 1253) found a 9% prevalence of STs. 9 LeBlanc et al. (2020) reported a 20.8% prevalence and an 18.9% 4‐week incidence of STs in four long‐term care centres in Canada, involving 380 older adults. 10 In a prevalence study with individuals aged 65 and over in a Brazilian hospital (n = 148), the prevalence of STs was reported as 12.2%. 11 In view of the global increase in the ageing population, the number of older patients in hospitals and ICUs is expected to rise. 14 Consequently, the importance of studies on STs in older adults in ICUs is growing.
Preventive measures are recognized as a more appropriate approach than therapeutic ones for STs and other skin integrity issues. This approach mitigates physical and emotional/social problems for patients and their families, enhances the quality of life and reduces health care costs. While nurses are primarily responsible for patient care in ICUs, there is a notable lack of knowledge in the existing literature regarding the prevalence, prevention and treatment of STs in ICUs. 7 , 15 , 16 This study aimed to determine the prevalence of STs and associated factors in older patients hospitalized in ICUs.
2. MATERIALS AND METHODS
2.1. Study design and participants
This is a regional, multicentre, point prevalence study conducted in five centres in the five largest cities in terms of population in the Central Anatolia Region of Türkiye. “Supplementary 1” provides information on the hospitals and their ICUs providing tertiary care. Inclusion criteria were as follows: (1) patients were 65 years of age or older, (2) were hospitalized in ICUs and (3) agreed to participate in the research. The exclusion criterion of the study was having a skin problem that would prevent skin evaluation such as burns. On the day of data collection, the number of hospitalized patients was 450 in ICUs at the five hospitals, 225 of whom were 65 years and over. Eleven patients had skin problems such as burns, and 14 patients and legal guardians/family members refused the study and the study was completed with 200 patients.
Because the point prevalence study tries to reflect the current situation of the setting as if it was photographed, in this study, patients who met the inclusion criteria on the study date in the hospitals were included and no power analysis to indicate the required sample size was performed.
2.2. Data collection
First, before starting the data collection, training of approximately 60 min was given to the five research nurses by the wound‐care nurse, who had previously studied STs. Information about the STs, ISTAP classification system and its differences from other wounds were given in the training, as the tools have been introduced because more than one researcher will be involved in the data collection. A consensus was reached among researchers about the data collection process and tools. At each centre, data were simultaneously collected on the same day (20 June 2023). The list of patients hospitalized in the ICUs on the day of data collection was drawn up, and patients who met the inclusion criteria were included in the study.
The researchers formed an “ST chart” to record patient demographic characteristics, clinical variables and skin assessment (Supplementary 2). The chart includes information on the patient, such as gender, age, diagnosis, body mass index, comorbidity, medications, incontinence, independent walking, history of falling, mechanical ventilation and length of stay in the ICUs. Additionally, information on skin assessment, including colour, temperature, moisture, oedema and skin turgor, was recorded from head to toe, anteriorly and posteriorly. STs were evaluated using the ISTAP Classification System. 17 According to this system, an ST is classified as Type 1 (no skin/flap loss), Type 2 (partial skin/flap loss) or Type 3 (complete flap loss). The AVPU scale, which assesses patients' consciousness levels as A (Awake), V (Verbal), P (Painful) or U (Unresponsive), 18 was used to determine the patient's level of consciousness. Risk scales, namely, the Itaki Fall Risk Scale for fall risk and the Braden Scale for pressure injury risk, were employed. The time required for data collection was approximately 15 to 20 minutes per patient.
2.3. Statistical analysis
Analyses were performed using the SPSS software (IBM SPSS Statistics Standard Concurrent User ver. 22). Descriptive statistics were determined as statistical units (n), percent (%), mean (X̄), standard deviation (SD), median (IQR) and percentiles (25–75). The Shapiro–Wilk test was used to determine compliance with normal distribution for continuous variables. In comparisons between patients with and without STs, independent samples t‐test and Mann–Whitney U test were used for continuous data, and chi‐square was used for categorical data. Besides, the ST point prevalence rate was calculated as [(number of participants with an ST/number of participants in a population at a particular time) × 100]. p < 0.05 was considered statistically significant.
2.4. Ethical considerations
The study complied with the ethical principles in the Declaration of Helsinki. Ethics approval was obtained from the institutional review board at a university (IRB Number: IRB‐2022/484, 29.06.2022). Informed consent was received from each participant or legal guardian/family member.
3. RESULTS
The number of participants in the study is 200. The age of the ICU patients in the study was 75.48 ± 7.94 years; 53.0% were women, and 69.5% were treated in internal ICUs. Notably, 84.5% of the participants had chronic diseases, and 39.5% had DM. Of the patients, 66.0% used medication constantly, and 58.5% used regular medications in anticoagulant groups. The body mass index (BMI) score of the participants was 25.01 ± 4.53, and the duration of stay in the ICU was 11.56 ± 15.7 days (Table 1).
TABLE 1.
The characteristics of patients in intensive care units (ICUs) (n = 200).
| Sex | n (%) |
|---|---|
| Female | 106 (53.0) |
| Male | 94 (47.0) |
| Units | |
| Medical | 139 (69.5) |
| Surgical | 61 (30.5) |
| Chronic disease | |
| Yes | 169 (84.5) |
| No | 31 (15.5) |
| DM | 79 (39.5) |
| HT | 122 (61.0) |
| Cardiovascular disease | 60 (30.0) |
| Thyroid disorder | 3 (1.5) |
| Chronic pulmonary disease | 31 (15.5) |
| Chronic kidney disease | 22 (11.0) |
| Cancer | 17 (8.5) |
| Psychiatric disease | 14 (7.0) |
| Regular medication use | |
| Yes | 132 (66.0) |
| No | 68 (34.0) |
| Anticoagulant | 117 (58.5) |
| Steroid | 50 (25.0) |
| Chemotherapy | 6 (3.0) |
| X̄ ± SD | |
| BMI | 25.01 ± 4.53 |
| Age | 75.48 ± 7.94 |
| Length of stay in ICU (day) | 11.56 ± 15.7 |
Abbreviations: BMI, body mass index; DM, diabetes mellitus; HT, hypertension; ICU, intensive care unit.
When the physical characteristics of the individuals participating in the study were examined, it was determined that 51.0% had standard skin colour, 64.0% had dry skin, 70.5% had body temperature within the normal range, 66.0% had low skin turgor, 45.5% had oedema, 60.0% had ecchymosis/haematoma/purpura skin problems, 20.5% had a previous history of ST, 6.0% had a history of falls, 81.5% used assistive devices, 45.0% depended on mechanical ventilation, 36.5% had an alert level of consciousness and 38.0% had faecal incontinence. The mean Braden score used in evaluating pressure injuries of the patients was 15.59 ± 8.08, and the mean ITAKI score used in evaluating fall risk was 13.16 ± 5.09 (Table 2).
TABLE 2.
The physical assessment characteristics of patients in intensive care units (n = 200).
| Characteristics | n (%) |
|---|---|
| Skin assessment | |
| Colour | |
| Normal | 102 (51.0) |
| Pale | 78 (39.0) |
| Cyanotic | 13 (6.5) |
| Yellow | 7 (3.5) |
| Skin moisture | |
| Normal | 66 (33.0) |
| Dry | 128 (64.0) |
| Wet/moist | 6 (3.0) |
| Temperature | |
| Normal | 141 (70.5) |
| Cold | 51 (25.5) |
| Hot | 8 (4.0) |
| Turgor | |
| Normal ≤2 s | 68 (34.0) |
| Decreased | 132 (66.0) |
| Oedema | |
| Yes (hands, arms, legs and feet) | 91 (45.5) |
| Skin problems other than ST | |
| Ecchymosis/hematoma/purpura | 120 (60.0) |
| Pressure injury | 61 (30.59) |
| Incontinence‐associated dermatitis | 58 (29.0) |
| ST history | 41 (20.5) |
| Falling history | 12 (6.0) |
| Use of assistive devices | 163 (81.5) |
| Mechanical Ventilation | 90 (45.0) |
| Consciousness | |
| A‐Alert | 73 (36.5) |
| V‐Verbal | 43 (21.5) |
| P‐Pain | 43 (21.5) |
| U‐Unresponsive | 41 (20.5) |
| Incontinence | |
| Urinary | 13 (6.5) |
| Faecal | 76 (38.0) |
| Faecal and urinary | 49 (24.5) |
| X̄ ± SD | |
| Braden Scale score | 15.59 ± 8.08 |
| ITAKI Scale score | 13.16 ± 5.09 |
Abbreviation: ST, skin tear.
ST was detected in 14.5% of patients in intensive care, and 72.5% of them had stage 1 ST. The most common area where ST is seen is the hand (37.9%) (Table 3). Analysis data comparing the characteristics of individuals with and without ST are presented in Tables 4 and 5. There is a significant relationship between individuals' average BMI (Z = −2.022, p = .043), age (t = 2.486, p = .014), length of stay in intensive care (Z = −2.847, p = .004) and ST (Table 4).
TABLE 3.
Characteristics of skin tears of patients in intensive care units (n = 200).
| Characteristic | n (%) |
|---|---|
| ST | |
| Yes | 29 (14.5) |
| No | 171 (85.5) |
| Type of ST (ISTAP ST Classification) | |
| Type 1 | 21 (72.4) |
| Type 2 | 5 (17.2) |
| Type 3 | 3 (10.4) |
| Area* | |
| Hand | 11 (37.9) |
| Arm | 7 (24.1) |
| Leg | 4 (13.8) |
| Foot | 6 (20.7) |
Abbreviations: ISTAP, International Skin Tears Advisory Panel; ST, skin tear.
TABLE 4.
Patient characteristics with and without skin tears in intensive care units (n = 200).
| Sex a | ST | Non‐ST | Statistical test, p‐value |
|---|---|---|---|
| Female | 16 (55.2) | 90 (52.6) |
X 2 = 0.064 p = .800 |
| Male | 13 (44.8) | 81 (47.4) | |
| Units a | |||
| Medical | 22 (75.9) | 117 (68.4) |
X 2 = 0.648 p = .514 |
| Surgical | 7 (24.1) | 54 (31.6) | |
| Chronic disease a | |||
| Yes | 23 (79.3) | 146 (85.4) |
X 2 = 0.697 p = .409 |
| No | 6 (20.7) | 25 (14.6) | |
| DM a | |||
| Yes | 9 (31.0) | 70 (40.9) |
X 2 = 1.017 p = .313 |
| No | 20 (69.0) | 101 (59.1) | |
| HT a | |||
| Yes | 16 (55.2) | 106 (62.0) |
X 2 = 0.484 p = .487 |
| No | 13 (44.8) | 65 (38.0) | |
| Cardiovascular diseases a | |||
| Yes | 7 (24.1) | 53 (31.0) |
X 2 = 0.555 p = .456 |
| No | 22 (75.9) | 118 (69.0) | |
| Thyroid disorders a | |||
| Yes | 0 (0.0) | 3 (1.5) |
X 2 = 0.517 p = .623 |
| No | 29 (100) | 168 (98.5) | |
| Chronic pulmonary diseases a | |||
| Yes | 5 (17.2) | 26 (15.2) |
X 2 = 0.079 p = .480 |
| No | 24 (82.8) | 145 (84.8) | |
| Chronic kidney diseases a | |||
| Yes | 4 (13.8) | 18 (10.5) |
X 2 = 0.270 p = .534 |
| No | 25 (86.2) | 153 (89.5) | |
| Cancer a | |||
| Yes | 5 (29.4) | 12 (7.0) |
X 2 = 3.332 p = .079 |
| No | 24 (82.8) | 159 (86.9) | |
| Psychiatric diseases a | |||
| Yes | 0 (0.0) | 14 (8.2) |
X 2 = 2.553 p = .110 |
| No | 29 (100.0) | 157 (91.8) | |
| Regular medication use a | |||
| Yes | 19 (65.5) | 113 (66.1) |
X 2 = 0.004 p = .953 |
| No | 10 (34.5) | 58 (33.9) | |
| Anticoagulant a | |||
| Yes | 18 (62.1) | 99 (57.9) |
X 2 = 0.178 p = .637 |
| No | 11 (37.9) | 72 (42.1) | |
| Steroid a | |||
| Yes | 6 (20.7) | 44 (25.7) |
X 2 = 0.336 p = .649 |
| No | 23 (79.3) | 127 (74.3) | |
| Chemotherapy a | |||
| Yes | 0 (0.0) | 6 (3.5) |
X 2 = 1.049 p = .596 |
| No | 29 (100.0) | 165 (96.5) | |
| X̄ ± SD | |||
| BMI c | 23.49 ± 3.38 | 25.26 ± 4.66 |
Z = −2.022 p = .043 |
| Age b | 78.83 ± 7.63 | 74.91 ± 7.87 |
t = 2.486 p = .014 |
| Length of stay in ICU (day) c | |||
| 19.90 ± 28.03 | 10.14 ± 12.11 |
Z = −2.847 p = .004 |
|
Note: Bold indicates statistically significant values.
Abbreviations: BMI: body mass index; DM: diabetes mellitus; HT: hypertension; ICU: intensive care unit.
Chi‐square test;
Independent Samples t‐test;
Mann–Whitney U test.
TABLE 5.
The physical assessment characteristics of patients with and without skin tears (n = 200).
| Characteristic | ST | Non‐ST | Statistical test, p‐value |
|---|---|---|---|
| Skin assessment | |||
| Colour a | |||
| Normal | 9 (31.8) | 93 (54.4) |
X 2 = 14.325 p = .002 |
| Pale | 12 (41.4) | 66 (38.6) | |
| Cyanotic | 6 (20.7) | 7 (4.1) | |
| Yellow | 2 (6.9) | 5 (2.9) | |
| Skin moisture a | |||
| Normal | 7 (24.1) | 59 (34.5) |
X 2 = 1.205 p = .547 |
| Dry | 21 (72.4) | 107 (62.6) | |
| Wet/moist | 1 (3.4) | 5 (2.9) | |
| Temperature a | |||
| Normal | 14 (48.3) | 127 (74.3) |
X 2 = 12.880 p = .002 |
| Cold | 15 (51.7) | 36 (21.1) | |
| Hot | 0 (0.0) | 8 (4.7) | |
| Turgor a | |||
| Normal ≤2 s | 2 (6.9) | 66 (38.6) |
X 2 = 11.103 p = .001 |
| Decreased | 27 (93.1) | 105 (61.4) | |
| Oedema a | |||
| Yes (Hands, arms, legs, feet) | 17 (58.6) | 74 (43.3) |
X 2 = 2.355 p = .125 |
| No | 12 (41.4) | 97 (56.7) | |
| Skin problems other than ST | |||
| Ecchymosis/hematoma/purpura a |
X 2 = 5.270 p = .024 |
||
| Yes | 23 (79.3) | 97 (56.7) | |
| No | 6 (20.7) | 74 (43.3) | |
| Pressure injury a | |||
| Yes | 16 (26.2) | 45 (73.8) |
X 2 = 9.740 p = .004 |
| No | 13 (9.4) | 126 (90.6) | |
| Incontinence‐associated dermatitis a | |||
| Yes | 14 (48.3) | 44 (25.7) |
X 2 = 6.121 p = .013 |
| No | 15 (51.7) | 127 (74.3) | |
| ST history a | |||
| Yes | 18 (62.1) | 23 (13.5) |
X 2 = 35.962 p = .000 |
| No | 11 (37.9) | 148 (86.5) | |
| Falling history a | |||
| Yes | 4 (13.8) | 8 (4.7) |
X 2 = 3.652 p = .077 |
| No | 25 (86.2) | 163 (95.3) | |
| Use of assistive devices a | |||
| Yes | 28 (96.6) | 135 (78.9) |
X 2 = 5.097 p = .020 |
| No | 1 (3.4) | 36 (21.1) | |
| Mechanical ventilation a | |||
| Yes | 15 (51.7) | 75 (43.9) |
X 2 = 0.620 p = .431 |
| No | 14 (48.3) | 96 (87.3) | |
| Skin care/protective measure a | |||
| Yes | 19 (65.5) | 46 (26.9) |
X 2 = 16.855 p = .000 |
| No | 10 (34.5) | 125 (92.5) | |
| Consciousness a | |||
| A‐Alert | 5 (17.2) | 68 (39.8) |
X 2 = 10.680 p = .014 |
| V‐Verbal | 6 (20.7) | 37 (21.6) | |
| P‐Pain | 6 (20.7) | 37 (21.6) | |
| U‐Unresponsive | 12 (41.4) | 29 (17.0) | |
| Incontinence a | |||
| No | 1 (1.6) | 61 (35.7) |
X 2 = 12.517 p = .006 |
| Urinary | 3 (10.3) | 10 (5.8) | |
| Faecal | 14 (48.3) | 62 (36.3) | |
| Faecal and urinary | 11 (37.9) | 38 (22.2) | |
| X̄ ± SD | |||
| Braden score c | 12.83 ± 8.24 | 16.06 ± 7.98 |
Z = −2.846 p = .004 |
| ITAKI score b | 15.5 ± 4.67 | 12.75 ± 5.05 |
t = 2.783 p = .006 |
Note: Bold indicates statistically significant values.
Abbreviation: ST, skin tear.
Chi‐square test;
Independent Samples t‐test;
Mann–Whitney U test.
There is a statistically significant relationship between ST and skin colour (χ 2 = 14.325, p = .002), and ST was most commonly found in individuals with pale skin colour. Additionally, a statistically significant relationship was found between skin temperature (χ 2 = 12.880, p = .002), skin turgor (χ 2 = 11.103, p = .001) and ST. More ST was observed in patients with cold skin and low turgor. There is a statistically significant difference between the presence of ST and ecchymosis/haematoma/purpura (χ 2 = 5.270, p = .024), pressure ulcer (χ 2 = 9.740, p = .004) and IAD (χ 2 = 6.121, p = .013), which are skin problems other than ST. There is a significant relationship between individuals' history of ST and ST (χ 2 = 35.962, p < .001); the prevalence of ST is higher in individuals with a history of ST. Additionally, there is a statistically significant relationship between consciousness (χ 2 = 10.680, p = .014), incontinence (χ 2 = 12.517, p = .006), the Braden score (Z = −2.846, p = .004), the Itaki score (t = 2.783, p = .006) and ST (Table 5).
4. DISCUSSION
With the global increase in the older adult population, there is a corresponding rise in the number of older individuals in hospitals and ICUs. Age‐related physiological changes, including multiple comorbidities, immunosuppression and decreased respiratory capacity, complicate the clinical management of ICU patients. Both ageing‐related alterations and the procedures involved in critical care (monitoring, nasogastric feeding, defibrillation) predispose older patients to skin integrity issues. 8 , 19 It is vital to examine ST, one of the traumatic injuries in which the changes in the skin because of ageing significantly increase the risk in older patients hospitalized in ICUs. Examining STs, a traumatic skin injury exacerbated by age‐related changes, is crucial for understanding the risks in older ICU patients. It has also been reported that there are severe problems in the assessment, classification and documentation of STs at the international level, and failure to diagnose STs correctly negatively affects prevention and management. 7 , 17
Souza et al. (2021) conducted a prevalence study with adults and older adults in inpatient and ICUs in Brazil. All individuals over 18 were included; ST was observed in 18 out of 148 participants and not in ICUs (n = 15). 13 In a point prevalence study (n = 202) that included patients in a hospital in Denmark, two patients in ICUs were included, and no ST was observed in ICU patients. 20 It is thought that ST was not observed in ICU patients in the studies because very few ICU patients and all adults (aged 18 and over) were included. Yüceler Kaçmaz et al. (2022) included 52 ICU patients in a point prevalence study (n = 418) at a tertiary hospital in Türkiye. In this study, the patient group with the highest prevalence of ST was ICU patients (11.7%). 14 In the present study, ST developed in 29 of 200 ICU patients, and the prevalence of ST was 14.5%. According to these findings, it would not be wrong to say that ST is one of the common skin integrity issues in ICU patients.
Age is a widely accepted factor contributing to skin injuries, with changes such as reduced dermal thickness, loss of elasticity and increased dryness making older individuals more susceptible. 21 This study determined a significant difference between age and ST, and the mean age of those with ST was higher than those without ST (78.83 vs. 74.82). The finding that age is an essential factor in the development of ST is consistent with previous studies.
Nutrition, a longstanding factor linked to skin health, is also implicated in skin injuries. Studies have revealed the effects of nutrients on improving skin conditions and preventing skin diseases. 22 It would not be surprising to think that ST, one of the skin integrity issues, will also be affected by nutrition. In the present study, it was found that there was a relationship between BMI and malnutrition, which are nutritional indicators, and ST. A 5‐year cross‐sectional study (n = 2197) in Australia to explain the relationship between malnutrition and ST revealed that malnutrition was a risk factor for ST prevalence and multiple ST. 23 In a point prevalence study (n = 418) in Türkiye, Yüceler Kaçmaz et al. determined a significant relationship between ST and BMI and malnutrition. 14 In a cross‐sectional study (n = 69) to determine the prevalence of ST and demographic and clinical factors associated with their presence in older adult residents of three long‐term care facilities in Brazil, malnutrition was associated with ST but was not retained in the final logistic regression model. 24 The relationship between ST and malnutrition may not have been revealed in the regression analysis due to the small sample size (n = 69). Although the study's relationship between ST and BMI is unclear, it has been stated that BMI is limited in evaluating nutrition and that ST and BMI are unrelated. 13 , 23 The nutritional needs of individuals with an elevated risk of STs should be evaluated, especially using valid and reliable tools; malnutrition should be determined, and the needs should be met. The nutritional status of older adults should be considered in the ST treatment and ST prevention.
Many studies reveal the relationship between the properties and problems of skin and ST. 14 , 15 , 25 , 26 , 27 , 28 , 29 This study observed that skin properties such as skin colour, turgor and temperature were related to STs, and STs developed more in cyanotic, turgor‐decreased and cold skin. In addition, it was determined that there was a relationship between ST and skin integrity issues such as a history of ST, ecchymosis, pressure injury and IAD, and more ST was observed in ICU patients with skin problems. Performing skin assessment in ICU patients and identifying high‐risk patients is one of the most critical steps in ST management.
Independence was one of the main topics addressed in the studies on ST. Therefore, older adults must be able to perform daily living activities independently. ICU patients are highly dependent because of their critical condition. 30 Approximately one in three adults aged 65 and over experiences limitations in activities of daily living (e.g., eating, bathing and dressing). 31 Our study determined that 81.5% of the patients did not walk independently, and ST developed more frequently in patients who could not walk independently. There are results in the literature similar to those of our study. 14 , 15 , 26 , 27 , 28 , 32 , 33 , 34 Especially in dependent ICU patients, patients should be protected from trauma during care practices (transfer, moving, use of adhesives etc.).
In the present study, incontinence, one of the common geriatric syndromes, was among the factors associated with ST. Some studies have reported that incontinence contributes to ST, while others have reported no relationship. 14 , 29 , 32 It is thought that incontinence and ST are observed together in older adult ICU patients, not because they are related, as they are one of the more common problems because of ageing. Consciousness, which has not been the subject of studies on ST before, was evaluated in our research because we worked with ICU patients, and it was observed that STs were seen more frequently in unconscious patients. This situation may be explained by the increase in dependence and exposure to trauma as the state of consciousness deteriorates in ICU patients.
4.1. Implications for practice and further research
Given the inadequate knowledge and interest in STs in older adults in the ICU, the importance of addressing STs in studies is evident. STs are associated with increased treatment costs, prolonged hospital stay and increased risk of complications. Therefore, it is important to perform skin assessment and diagnose ST in ICU patients to understand the global extent of STs. It is necessary to identify high‐risk patients in ICUs and develop institutionally effective interventions for the prevention and management of ST. In addition, it is recommended to plan in‐service training to improve knowledge and practices and raise awareness about ST to ICU nurses.
4.2. Limitations
Limitations include being regional study in a ICU population. For this reason, the results are limited to the hospitals included in the study and cannot be generalized to all ICU patients. The study did not include scales used to evaluate ICU patients, such as Acute Physiology and Chronic Health Assessment (APACHE) II, Sequential Organ Failure Assessment (SOFA) and nutritional assessment scales because of the variation in practice between the five centres.
5. CONCLUSIONS
In this multicentre point prevalence study, it was determined that the prevalence of ST was 14.5% in older patients in ICUs. Many factors can be used to develop risk assessment measurement tools. The study results may contribute to the development of programmes to prevent ST in older patients in ICUs. It can also increase the awareness of health care professionals in ICUs and provide ideas on taking preventive measures. In this context, the quality of care will be increased by providing evidence‐based practices and developing protocols in ICUs where ST cases are seen.
AUTHOR CONTRIBUTIONS
Idea/Concept: HYK. Desıgn And Design: HYK. Supervision/Consultancy: OC, MY. Resources: HYK, HK, Materials:HYK, HK, Data Collection And/Or Processing:HYK, HK, ATH, FU, SG, NK, Analysıs And/Or Interpretation: HYK, HK, NK, Literature Review: HYK, Article Writer: HYK, HK, ATH, FU, SG, NK, Critical Review: OC, MY, ST.
FUNDING INFORMATION
The authors declare that this study has received no financial support.
CONFLICT OF INTEREST STATEMENT
The authors have no conflicts of interest to declare.
Supporting information
Supplementary 1. Information about the hospitals and intensive care units in the study.
Supplementary 2. Skin Tears Chart.
Yuceler Kacmaz H, Kahraman H, Topal Hancer A, et al. Skin tears in older patients in intensive care units: A multicentre point prevalence study. Nurs Crit Care. 2025;30(2):e13131. doi: 10.1111/nicc.13131
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplementary 1. Information about the hospitals and intensive care units in the study.
Supplementary 2. Skin Tears Chart.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.