You were helping your father out of the car and grabbed his forearm to steady him. When you let go, there was a flap of skin hanging loose and blood running down his wrist. He barely felt it. You felt terrible. Skin tears like this are common in older adults, especially those who are frail, on blood thinners, or have been on steroids.
This guide explains how to care for a skin tear and how to prevent the next one. It's general information; call a doctor or nurse for wounds that are large, deep or not healing.
Why older skin tears so easily
MedlinePlus describes how aging skin becomes thinner, paler and more translucent, with more fragile blood vessels and less of the protective fat layer1. As a result, older adults are at increased risk for skin injury, and rubbing or pulling on the skin can cause skin tears1. Bruises and collections of blood under the skin may form after even a minor injury1.
Other things raise the risk further: long-term steroid use, blood thinners, dry skin, poor nutrition and dehydration, limited mobility, confusion that leads to bumping into things, and needing help with bathing, dressing or transfers. People who've had skin tears before are likely to get them again. Very old age, being underweight, and having trouble seeing or moving around the home all add to the risk, which is why skin tears are so common among nursing home residents.
Where and how they happen
- During transfers. Grabbing an arm or leg to help someone move from bed to chair, into a car or onto a toilet.
- Bumps and scrapes. Against furniture edges, wheelchair parts, bed rails or doorframes.
- Bandages and tape. Pulling adhesive off fragile skin can strip it away.
- Dressing and bathing. Tugging on tight sleeves or rubbing dry with a rough towel.
- Falls. Even a minor fall can cause tears along with bruises. See fall prevention.
First aid for a skin tear
- Stay calm and wash your hands. MedlinePlus advises washing hands with soap before caring for a cut2.
- Stop the bleeding. Use gentle, direct pressure with a clean cloth or gauze2. Older adults on blood thinners may bleed longer.
- Clean the wound gently. Rinse with mild soap and water or saline2. Don't scrub.
- Lay the skin flap back. If there's a flap of skin, gently ease it back into place with a damp cotton swab or gloved finger. Don't stretch it.
- Cover it. Use a non-stick dressing. Avoid ordinary adhesive bandages and tape on the skin itself; secure the dressing with a light wrap or tubular bandage instead.
- Mark the dressing. Draw an arrow on it showing the direction the flap lies, so whoever removes it pulls the right way and doesn't lift the flap.
- Watch it over the next days. Look for signs of infection and change the dressing as instructed.
When to get medical care
Call 911 if bleeding is severe or doesn't stop after about 10 minutes of pressure2. Contact a doctor or nurse promptly if:
- The tear is large or deep, or the skin flap is missing or dark.
- It shows signs of infection, such as warmth, redness, increasing pain, swelling, fever, a red streak or pus2.
- It isn't healing after a week or two.
- Your parent hasn't had a tetanus shot in 10 years. A tetanus vaccine is generally recommended every 10 years2. See vaccines for seniors.
- Your parent has diabetes or poor circulation, which slow healing. See diabetes in older adults.
A nurse or wound care clinic may use special dressings or skin glue strips designed for fragile skin. Ask for written instructions on how often to change the dressing.
How to prevent skin tears
Most skin tears are preventable with gentler handling and a safer environment.
- Handle gently. Support under the arm and shoulder blade or use a transfer belt instead of gripping forearms or wrists.
- Use lifts and slides properly. Draw sheets and slide sheets reduce friction when repositioning in bed.
- Pad hard edges. Cover bed rails, wheelchair arms and leg rests, and sharp furniture corners.
- Clear the path. Good lighting and fewer obstacles mean fewer bumps.
- Protect the skin. Long sleeves, pants and knee-high socks act as a barrier. Shin guards or arm protectors help people who bump often.
- Moisturize daily. Apply a gentle lotion twice a day, especially on arms and legs. Dry skin tears more easily.
- Bathe gently. Use warm, not hot, water and mild soap, and pat dry instead of rubbing.
- Keep nails short. Both your parent's and caregivers'. Remove rings and watches before giving care.
- Avoid tape on skin. Use silicone-based products or wraps instead.
Nutrition, fluids and skin health
Skin needs protein, calories and fluids to stay as strong as possible and to heal. An older adult who isn't eating or drinking well is more likely to get skin tears and slower to heal from them. See when an elderly parent isn't eating and dehydration. Ask the doctor whether a dietitian or a nutritional supplement makes sense, especially after a hospital stay or illness.
If your parent has dementia
People with dementia may not notice or report injuries, may resist care in ways that lead to bumps and grabs, and may pick at dressings. Approach calmly from the front, explain what you're doing in simple words, and avoid rushing. If your parent becomes agitated during care, stop and try again later. See when a parent with dementia refuses to shower for gentle bathing tips. Check skin regularly during dressing and bathing, since your parent may not tell you about a new wound.
Skin tears vs. pressure sores
Skin tears are caused by friction, shearing or a bump, and usually happen suddenly on the arms, hands and legs. Pressure sores, also called bed sores, develop over time where bone presses against skin, such as the tailbone, hips and heels, in people who sit or lie in one position for long periods. Both are more common in frail older adults, and both are largely preventable. See bed sores in the elderly.
In a nursing home or assisted living
Federal rules require nursing homes to provide care that meets professional standards and keeps residents as healthy as possible3. If your parent gets frequent skin tears in a care community, ask how staff are trained to transfer and reposition residents, whether protective sleeves or padding are being used, how wounds are tracked, and what changes are planned. Bring it up at the care plan meeting. A pattern of unexplained skin injuries, especially with bruises in unusual places, should be reported and investigated; see signs of elder abuse.
Teaching helpers at home
If aides, relatives or friends help with your parent's care, show them how to transfer and reposition without gripping, and where you keep dressings. Post a short note in the bathroom or bedroom: support, don't grab; pat, don't rub; no tape on skin. When you hire help through an agency, ask how aides are trained in safe transfers and skin care. Our guide to questions to ask a home care agency includes this and more.
Medicines that affect the skin
Some medicines make skin more fragile or slow healing. Long-term steroids, whether pills, inhalers at high doses, or creams, thin the skin. Blood thinners and some pain relievers make bruising and bleeding more likely. Don't stop these medicines on your own, but tell the doctor if skin tears are becoming frequent. Sometimes a dose can be adjusted or a different option chosen. A medicine review is a good idea if your parent takes many prescriptions; see polypharmacy in older adults.
How healing usually goes
Small skin tears often heal in one to three weeks when kept clean, covered and protected from further injury. Healing is slower in people with diabetes, poor circulation, poor nutrition or those taking steroids. Keep the dressing in place as instructed rather than peeking often, since each removal risks lifting the flap. When you change it, remove it slowly in the direction of the arrow, and soak it with saline or water first if it sticks. Let the area air briefly, check it, and apply a fresh non-stick dressing.
Watch for changes: a wound that's getting larger, redder, more painful or starting to smell needs a nurse or doctor to look at it. Once healed, the new skin is still fragile, so keep protecting the area with long sleeves or a sleeve protector and continue daily moisturizing. Write down when and how each tear happened. A simple log helps you and your parent's care team spot patterns, such as a particular chair, a tight jacket or a hurried morning routine, and fix them.
An example
After two skin tears in a month, Helen's mother's home care nurse showed the family how to help her stand by supporting under her arm instead of pulling her hand. They padded the arms of her wheelchair, switched her to long-sleeved cotton shirts, and started moisturizing her arms every morning and evening. Helen kept non-stick dressings and a soft wrap in the bathroom. Her mother went months without another tear, and the family felt much more confident helping her every day. Helen also kept a small first aid kit with nonstick dressings in the kitchen drawer. This is an illustration.
