Prevention and Care for Incontinence-Associated Dermatitis Among Older Adults: A Systematic Review

Samoraphop Banharak,1 Ladawan Panpanit,1 Suttinan Subindee,1 Patcharawan Narongsanoi,2 Panisara Sanun-aur,3 Walaiporn Kulwong,4 Pachareeporn Songtin,5 Wanida Khemphimai6 1Department of Gerontological Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand; 2Nursing Department, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand; 3Nursing Department, Bungkla Hospital, Buengkan, Thailand; 4Nursing Department, Banmuang Hospital, Sakon Nakhon, Thailand; 5Nursing Department, Nong Han Hospital, Udon Thani, Thailand; 6Nursing Department, Phimai Hospital, Nakhon Ratchasima, ThailandCorrespondence: Samoraphop BanharakDepartment of Gerontological Nursing, Faculty of Nursing, Khon Kaen University, 123 Moo 16 Friendship Road, Khon Kaen, 40002, ThailandTel +66 61-930-8118Fax +66 43-424-809Email sbanharak@kku.ac.thBackground: The prevalent rate of incontinence-associated dermatitis (IAD) trends upward in older populations. Skin breakdown from IAD impacts the quality of life of older adults and reflects the quality of care in hospitals and long-term care facilities. Specific and appropriate interventions for prevention and care are needed. This systematic review aims to review optimal strategies for prevention and care for older adults with IAD.Methods: PubMed, CINAHL, SCOPUS, Medline, ProQuest, ThaiLIS, ThaiJo, and E-Thesis were searched for articles published between January 2010 and December 2020. Only articles focusing on older adults were included for the review.Results: Eleven articles met the inclusion/exclusion criteria. Interventions for the prevention and care of IAD among older adults were categorized as assessment, incontinence management/causative factors management, cleansing, application of medical products for both skin moisturizing and skin barrier, body positioning, nutrition promotion, health education and training, and outcome evaluation. Specific prevention and care strategies for older adults with IAD included using specific assessment tools, applying skin cleansing pH from 4.0 to 6.8, body positioning, and promoting food with high protein. Other strategies were similar to those reported for adult patients.Conclusion: The systematic review extracted current and specific prevention and care strategies for IAD in older adults. The prevention and care strategies from this systematic review should be applied in clinical practice. However, more rigorous research methodology is recommended in future studies, especially in examining intervention outcomes. Nurses and other health professionals should be educated and trained to understand the causes of IAD in older adults and the specific prevention and care strategies for this population. Because older adults are prone to skin damage, and this type of skin breakdown differs from pressure ulcers, the tools for assessment and evaluation, and the strategies for prevention and care require special attention.Prospero Registration Number: CRD42021251711.Keywords: incontinence-associated dermatitis, moisture-associated skin damage, skin barrier function, skin breakdown, older adults, systematic revie