1.5 Describe pre-disposing factors which may exacerbate risk of impaired tissue viability and skin breakdown

This guide will help you answer 1.5 Describe pre-disposing factors which may exacerbate risk of impaired tissue viability and skin breakdown.

Tissue viability relates to the health of the skin and underlying tissues. Good tissue viability means the skin and tissue are healthy, well-oxygenated, and strong. Compromised tissue viability means skin or tissue is at risk or already damaged.

Skin breakdown is when skin becomes damaged, often leading to sores or ulcers. This damage can range from mild redness to severe open wounds.

People in health and social care settings are often at higher risk. Spotting pre-disposing factors early allows you to provide better support and prevent harm.

Why Tissue Viability Matters

The skin is the body’s largest organ. It acts as a natural barrier to infection, protects internal organs, and helps regulate temperature. When skin breaks down, it creates an entry point for germs. Infections, pain, and longer recovery times can follow.

Good tissue viability means better overall health. Understanding the factors that affect this is a core part of care work.

What are Pre-disposing Factors?

Pre-disposing factors are features or conditions that increase the risk of something happening. In this case, they raise the chance of skin or tissue damage. These factors can be medical, environmental, or lifestyle-related.

Some pre-disposing factors come from within the person. Others are from outside, such as their living conditions.

Knowing these means you can take better action to support people at risk.

Immobility and Reduced Mobility

Not moving for long periods increases the risk of tissue damage. This often affects people who are bed-bound or use wheelchairs. Pressure builds up on certain areas, reducing blood flow. Without enough oxygen, skin and tissue start to break down.

Immobility can result from:

• Long-term illness
• Spinal injuries
• Major surgery
• Progressive conditions like multiple sclerosis or Parkinson’s disease

People who cannot turn or reposition themselves need help. Care workers often use turning charts or pressure-relieving devices to reduce risk.

Poor Nutrition and Hydration

Skin needs nutrients and water to stay healthy. Malnutrition (not enough food or nutrients) weakens the skin. It becomes thin and less able to repair itself.

Not drinking enough water (dehydration) also puts the skin at risk. Dry skin cracks more easily, which can lead to open wounds.

Issues leading to poor nutrition and hydration:

• Difficulty swallowing (dysphagia)
• Poor appetite
• Dementia
• Side effects of medicines

Spotting these issues early helps prevent problems. Encourage regular, balanced meals and plenty of fluids. Dietitians may need to advise on supplements.

Ageing and Changes in Skin Structure

Older skin is more fragile. As people age, the skin loses elasticity and becomes thinner. Blood supply to the skin also reduces with age. This makes it slower to heal after injury.

People over 65, and especially those over 80, often face extra risk. Their skin can bruise or break with very little pressure.

You can help by handling skin gently and using moisturisers to keep skin supple.

Chronic Health Conditions

Some long-term health conditions make skin breakdown more likely. For example:

• Diabetes: Damages blood vessels, slowing healing and reducing sensation in the feet and hands.
• Poor circulation: Conditions like heart failure or peripheral vascular disease reduce the blood flow needed to keep tissues healthy.
• Lung diseases: Less oxygen circulating makes tissue weaker.
• Kidney failure: May lead to toxins building up, which harm the skin.

People with more than one condition are at higher risk. Monitor these closely, and share concerns with the wider health team if needed.

Incontinence

People who cannot control their bladder or bowels are at risk. Skin contact with urine or faeces causes irritation and increases the risk of sores. Wet skin breaks down faster and becomes sore more easily.

Causes of incontinence include:

• Dementia
• Stroke
• Prostate problems
• Immobility

Use of barrier creams and regular continence care can help reduce risk.

High Moisture or Perspiration

When skin is constantly wet, from sweat or other fluids, it becomes softer and more easily damaged. High moisture causes a condition called ‘maceration’.

People who sweat a lot, or those in hot, humid environments, need regular skin checks. Remove wet clothing or bedding, and keep skin dry where possible.

Poor Sensation or Neuropathy

Loss of feeling in the skin is a significant risk factor. People with reduced sensation do not notice pain, pressure, or injuries. For example, those with diabetic neuropathy or spinal cord injuries can develop sores without realising.

Burns, cuts and pressure injuries go unnoticed. By the time you see redness or wounds, the damage may already be severe.

Check areas with reduced sensation often. Use visual checks and involve others if mobility is limited.

Medication Side Effects

Some medicines weaken the skin or slow healing. For example:

• Steroid tablets and creams thin the skin, making it fragile.
• Chemotherapy drugs affect how quickly skin repairs.
• Blood thinners increase bruising and bleeding under the skin.
• Sedatives reduce mobility as people become less able to reposition themselves.

Always report concerns about medication side effects. Pharmacy teams or doctors may be able to suggest alternatives or adjust the dose.

Mental Health and Cognitive Impairment

People who are confused or have learning disabilities might not notice or report discomfort. Those living with dementia may not understand or communicate pain or feeling wet.

Such persons need closer observation and regular checks. You might need to involve family or advocates to gather more information about their risks.

Infection

An existing infection can delay the healing process. Some infections, such as cellulitis, start in broken skin and spread quickly.

A weakened immune system means skin damage lasts longer and is slower to heal. People undergoing cancer treatment or living with HIV/AIDS often experience this issue.

Watch for signs such as increased redness, swelling, or pus. Report these changes quickly.

Poor Personal Hygiene

Dirt and sweat can build up on the skin, leading to irritation and breakdown. People who cannot wash themselves properly need support to keep their skin clean.

Regular showers, clean bedding, and skin checks all help. Pay attention to skin folds, as these areas can trap sweat and bacteria.

Smoking

Smoking narrows blood vessels and reduces oxygen delivered to the skin. This slows down healing and makes the skin more at risk of damage.

Those who smoke need encouragement to cut down or quit. They may also need extra monitoring and support from the care team.

Low Body Weight and Muscle Wasting

People who are underweight or have lost muscle (known as muscle wasting or cachexia) have less padding over bony areas, such as hips, heels, and tailbone. This leads to more pressure on the skin when lying or sitting.

Common in elderly or very ill people, weight loss makes them more prone to pressure ulcers and skin tears.

Monitor weight regularly, and refer to a dietitian for advice if you notice weight dropping.

Obesity

Those with high body weight may face extra challenges. Skin folds are prone to sweat, bacteria growth, and infection. It may be harder to spot sores hidden in folds.

Obesity can limit movement, which adds to the pressure on some areas of the body.

Check hidden areas and folds as part of daily care. Help with movement and good hygiene reduces risk.

Shear, Friction, and Mechanical Stress

Skin and tissues are damaged by ‘shear’ and ‘friction’.

Shear happens when skin stays in one place, but the underlying bone moves in the opposite direction, such as sliding down in a bed or chair. Friction is when skin rubs against another surface, such as bed sheets. Both cause skin layers to stretch or tear.

Reduce this risk by using slide sheets, hoists, or gentle repositioning techniques. Educate staff on correct moving and handling.

Poor Circulation and Oxygenation

Without a good blood supply, tissues become weak. Tissues in feet or lower legs are often affected first by poor circulation.

Signs include cold, pale or blue skin, and slow-healing sores. Encourage people to keep mobile if they can. Medical input may be needed if you spot circulation issues.

Medical Devices and Equipment

Oxygen masks, feeding tubes, splints, and catheters can all cause skin damage. Pressure can build up where equipment touches skin. Check the skin around these areas often, and adjust equipment as recommended.

Use padding, check straps are not too tight, and keep the skin clean and dry.

Prolonged Surgery or Medical Procedures

People who have long operations do not move for hours. This increases pressure on parts of the body, leading to damage.

Alert the care team to heightened risk post-surgery. Monitor skin closely during recovery.

Reduced Mental Alertness and Sedation

People who are drowsy, heavily medicated or have reduced alertness may not realise when they are uncomfortable. This can happen with painkillers, sedatives, or some neurological conditions. These individuals rely on care staff to move and check them.

Other Factors: Cultural and Social

Not everyone recognises or treats skin issues in the same way. Factors such as poverty, housing conditions, or difficulties accessing healthcare can worsen risks.

Language barriers, embarrassment, or social isolation may stop someone from asking for help. Looking out for these signs and taking steps to build trust can improve outcomes.

Preventing Harm and Promoting Good Practice

Spotting pre-disposing factors early allows you to act quickly. Carry out frequent skin checks and know the common risk areas, especially bony parts. Use risk assessment tools like the Waterlow or Braden Scale if your workplace uses them.

Work closely with other professionals and involve the person you support. Good communication ensures better care for those at risk.

Remember:

• Good nutrition and hydration
• Regular repositioning
• Clean, dry skin
• Barrier creams and dressings if recommended
• Support with personal hygiene
• Manage chronic conditions with regular reviews

Always report any changes to the care or nursing team. Early action prevents further damage.

Final Thoughts

By carefully watching for pre-disposing factors in every person, you help protect their skin and dignity. Small changes in care can make a big difference in reducing risk. Remember, your efforts are key to improving the day-to-day lives of those you support.