Preventing Skin Tears in Older People Across Care Settings in Viet Nam: Fragile Skin, Safer Daily Assistance and Timely Clinical Assessment
LONG-TERM CARE QUALITYAGE-FRIENDLY CARE QUALITY
Preventing Skin Tears in Older People Across Care Settings in Viet Nam: Fragile Skin, Safer Daily Assistance and Timely Clinical Assessment
An older woman living in a residential care facility is being helped from her bed to a chair. As she moves, her forearm brushes against the edge of nearby furniture. The contact appears minor, but a small area of skin separates, leaving a painful, bleeding wound. She is frightened, and the care worker is surprised that such a gentle impact could have caused an injury.
Similar incidents can happen at home. An older person may scrape an arm against a doorframe, catch fragile skin while getting dressed, or sustain an injury when an adhesive dressing is removed. These are ordinary situations that may receive little attention until someone is hurt.
Skin tears are traumatic wounds caused by mechanical forces, including friction, shear, blunt impact, and the removal of adhesives. They can occur at any age, but older people may be particularly vulnerable because of changes in skin structure, underlying health conditions, and the circumstances in which they receive care.
Although some skin tears heal without major complications, others can cause considerable pain, bleeding, distress, delayed healing, or infection. Even a small wound may make dressing, bathing, movement, or other daily activities uncomfortable. For someone already living with frailty or reduced mobility, the consequences may extend well beyond the injury itself.
In hospitals, residential long-term care facilities, and home-based services across Viet Nam, preventing skin tears requires attention to how everyday care is delivered. The challenge is not simply to recognize fragile skin or treat injuries after they occur. It is to understand where avoidable mechanical trauma arises, adapt assistance to individual needs, and ensure that wounds receive appropriate clinical assessment.
Good prevention should also preserve independence. Protecting fragile skin must not become a reason to unnecessarily restrict an older person's movement, participation, or choices.
Understanding Skin Tears and Why They Need Specific Attention
Skin tears are sometimes confused with pressure injuries, but the two conditions are not interchangeable.
The International Skin Tear Advisory Panel (ISTAP) describes a skin tear as a traumatic wound caused by mechanical forces, including adhesive removal and patient handling. Its depth may vary but does not extend through the subcutaneous tissue layer. A skin flap may remain, although the extent of tissue loss differs between injuries. Deeper traumatic wounds extending through that layer require a different classification and management approach.
Pressure injuries, by contrast, are associated with pressure or pressure combined with shear, often over bony prominences or in connection with medical devices. Some individuals are vulnerable to both conditions, but their causes, classification systems, and preventive approaches are not identical.
Other skin problems may resemble skin tears. Bruising, moisture-associated skin damage, dermatitis, blistering, and deeper traumatic lacerations may require different assessments and management.
This distinction has practical consequences. A care facility may have established procedures for pressure injury prevention, including repositioning and pressure redistribution, yet still overlook injuries caused by contact with furniture, clothing, equipment, or adhesive products.
On May 22, 2025, ISTAP published the second edition of Best Practice Recommendations for the Prevention and Management of Skin Tears in Aged Skin, developed in collaboration with Nurses Specialized in Wound, Ostomy and Continence Canada and the Wound, Ostomy and Continence Nurses Society in the United States.
The updated recommendations bring together available evidence and international expert consensus on risk recognition, prevention, assessment, classification, treatment, and documentation. They also address issues such as skin tone, dementia, and the importance of appropriate wound management.
For organizations caring for older people, skin tear prevention deserves specific attention within a broader approach to skin integrity. It should complement pressure injury prevention rather than be assumed to be covered by it.
Why Some Older People Are More Vulnerable
Skin changes gradually with age. It may become thinner, less elastic, and less resistant to mechanical stress. Changes in the dermis and underlying supporting tissues can also reduce the skin's ability to tolerate pulling, friction, and minor impacts.
However, age alone does not determine who will develop a skin tear. Two people of similar age may have very different levels of vulnerability.
Frailty, previous skin injuries, reduced mobility, certain medical conditions, nutritional concerns, and exposure to mechanical trauma may all be relevant. Some people have visible purpura or bruising associated with fragile skin, while others have a history of recurrent injuries that provides an important warning about ongoing risk.
A systematic review and meta-analysis by Xu and colleagues, published in Geriatric Nursing in 2025, examined 23 studies involving 59,489 older adults. The estimated pooled prevalence of skin tears was 6.5%, with notable associations involving previous skin tears, purpura, and an increased risk of pressure injury.
These findings help identify groups who may need closer attention, but they require careful interpretation. The pooled estimate reflects the populations and methods included in the review. It should not be presented as the prevalence among all older people in Viet Nam or as a reliable estimate for every Vietnamese residential care facility.
These associations also do not establish that any particular individual will develop a skin tear or that every injury can be prevented.
Medications may be relevant to individual assessment. Prolonged corticosteroid exposure can contribute to skin fragility in some circumstances, while anticoagulant and antiplatelet medicines may influence bruising or bleeding after an injury. These effects should not be confused with the mechanical forces that directly cause a skin tear.
Medication changes should not be made solely because a caregiver notices fragile skin. Assessment of treatment-related risks and benefits belongs to appropriately qualified healthcare professionals.
Understanding vulnerability therefore requires more than recording someone's age or medical diagnoses. Previous injuries, skin condition, mobility, ability to communicate discomfort, daily activities, and the surrounding environment all deserve consideration.
Someone who moves independently may still have fragile skin, while another person requiring substantial assistance may have few previous injuries. Prevention should respond to the individual's actual circumstances rather than assumptions about age or dependency.
Safer Daily Assistance Begins With How Care Is Provided
Many opportunities for preventing skin tears arise during ordinary personal care.
Helping someone get dressed, assisting with bathing, changing bedding, repositioning in bed, or supporting a transfer between a bed and chair may involve contact with fragile skin. Problems can arise when an arm is pulled, clothing catches against the skin, or the person brushes against a hard surface during movement.
These events do not necessarily involve excessive force or inappropriate intentions. A routine technique that works well for one person may be unsuitable for another whose skin is particularly vulnerable.
Care workers therefore need to understand not only what assistance is required but how it can be provided without unnecessary friction, pulling, or impact.
For example, a resident who has experienced repeated injuries on the forearms may need a review of how assistance is provided during dressing or transfers. Another person may benefit from adjustments to clothing or the position of equipment. Where specialized moving and handling techniques or equipment are required, assessment and instruction should come from appropriately qualified professionals.
The objective is not to make routine assistance unnecessarily complicated. It is to recognize situations in which modest changes could improve safety without reducing the person's ability to participate.
Skin care itself also matters. Fragile skin may be more susceptible to injury when it becomes excessively dry or irritated. The 2025 ISTAP recommendations emphasize gentle cleansing, avoiding unnecessary rubbing, and maintaining skin hydration with appropriate moisturizing products.
In practice, this may involve using suitable gentle cleansers, avoiding unnecessarily hot water, patting rather than rubbing the skin dry, and supporting regular moisturizing where appropriate. Products should be selected with consideration for the individual's skin condition, tolerance, preferences, and any relevant clinical advice.
There is evidence supporting structured moisturizing as part of skin tear prevention. A cluster-randomized study conducted in Australian residential aged-care facilities by Carville and colleagues, published in 2014, found substantially fewer skin tears among residents receiving a twice-daily moisturizing regimen than among those receiving usual skin care.
The findings support the value of maintaining skin hydration, although the results should not be interpreted as proof that every product, application schedule, or care setting will achieve the same benefit. Moisturizing is one preventive measure, not a substitute for appropriate handling, environmental safety, or clinical assessment.
Care teams should also consider nutrition and hydration as part of overall health and skin integrity. However, supplementation or increased fluid intake should not automatically be recommended for everyone, particularly when medical conditions require individualized dietary or fluid management.
Maintaining skin health, reducing mechanical trauma, and providing suitable daily assistance are connected parts of prevention. Each should be adapted to the individual rather than applied as an inflexible routine.
Making the Care Environment Safer for Fragile Skin
A care environment may appear safe from major hazards while still exposing an older person to repeated minor injuries.
Bedframes, chair arms, walking aids, furniture edges, doorways, and other everyday surfaces can become sources of mechanical trauma. Their position and suitability matter, particularly when someone has impaired balance, reduced vision, limited mobility, or difficulty controlling their movements.
A narrow space between a bed and chair may be manageable for one resident but difficult for another who uses a walking aid or needs assistance. Similarly, furniture that has been familiar for years may become hazardous as a person's functional abilities change.
These concerns apply in private homes as well as residential facilities.
Families and care workers often recognize environmental risks through repeated observations. Someone may regularly brush against the same doorway, struggle to reach a preferred chair, or experience discomfort when using particular equipment.
When injuries recur in a similar location or during the same activity, the environment should be reviewed rather than assuming each event is an unrelated accident.
Practical changes may include improving furniture arrangements, maintaining clear walking routes, ensuring suitable lighting, reviewing equipment placement, or considering protective clothing and padding where appropriate.
However, protective measures should be individualized. A sleeve that reduces minor impacts may be helpful for one person but uncomfortable or restrictive for another. Padding or other modifications should not interfere with equipment safety, hygiene, transfers, or ordinary activities.
The older person's experience is important. A resident may recognize that a particular chair, garment, or piece of equipment causes repeated discomfort long before a formal incident review identifies the problem.
An age-friendly environment should support both safety and independence, rather than treating them as competing priorities.
Adhesive Products Can Cause Avoidable Skin Damage
Adhesive dressings, tapes, and products used to secure medical devices are common in healthcare. They may also be present when an older person returns home or enters residential care after hospital treatment.
For vulnerable skin, applying or removing these products can create additional risks.
Excessive pulling during removal may injure the skin, particularly when an adhesive is unsuitable for the individual's condition or repeated applications have already caused irritation.
This concern overlaps with medical adhesive-related skin injury, commonly known as MARSI. However, not every adhesive-related injury is a skin tear. Adhesives can also cause superficial skin stripping, blistering, dermatitis, and other forms of damage.
Recognizing the distinction matters because these injuries may require different clinical responses.
International skin tear guidance emphasizes selecting suitable wound products and minimizing avoidable trauma during their use. For clinical teams, this includes considering the characteristics of the wound, surrounding skin, and the purpose of the dressing or device.
For residential and home-based care providers, an important responsibility is recognizing when an adhesive appears to be causing discomfort or injury and ensuring that the concern reaches an appropriately qualified professional.
Non-clinical workers should not independently select or change prescribed wound treatment or alter the way a medical device is secured beyond their training, care instructions, and authorized responsibilities.
Care transitions are particularly important. An older person discharged from hospital may arrive with an existing wound, dressing, or attached medical device. The receiving caregiver needs to understand what support is expected, which instructions apply, and whom to contact if a problem develops.
Protecting fragile skin should not unintentionally disrupt treatment that remains clinically necessary.
When Dementia Changes the Experience of Personal Care
Skin tear prevention can become more complicated when an older person lives with dementia or another condition affecting cognition, communication, or behavior.
Someone may not immediately understand why assistance is being offered. They may be frightened by unfamiliar physical contact, withdraw an arm unexpectedly, or resist a particular care activity. If the person's skin is fragile, these movements may increase the possibility of mechanical injury.
Such responses should not automatically be described as difficult behavior. They may communicate discomfort, pain, anxiety, misunderstanding, or an unmet need.
On April 8, 2026, Wounds International published Best Practice Recommendations for Understanding Dementia and Skin Tears, developed by an international expert group. The guidance examines the relationship between skin vulnerability and dementia-related care needs, with attention to individualized assessment, respectful communication, and appropriate management.
Its importance extends beyond the condition of the skin.
A resident who becomes distressed during dressing may respond better when assistance is provided by a familiar worker, when more time is allowed, or when the activity is explained in a way the person can understand. Adjusting the approach or routine may make care more comfortable and reduce unexpected movements.
These adjustments should respond to the person's preferences and observed needs rather than assumptions about dementia.
Not everyone living with dementia has fragile skin, and a diagnosis of dementia should never replace individual assessment.
Distress or refusal of assistance should not be used as a routine justification for physical restraint or unnecessary restrictions. Where immediate safety concerns arise, care providers need to follow applicable legal, clinical, and safeguarding requirements while considering the least restrictive appropriate response.
A sudden or fluctuating change in cognition, behavior, or consciousness may indicate delirium or another acute medical problem. It should receive prompt clinical attention rather than being attributed automatically to dementia.
The goal is to protect the person's skin while preserving trust, communication, and dignity during everyday care.
Recognizing a New Skin Tear and Knowing When to Seek Clinical Help
When a skin tear occurs, the immediate priority is to protect the person from further injury, recognize the seriousness of the situation, and obtain appropriate assistance.
The wound may look small, yet still cause considerable pain, bleeding, or distress. Some older people may have conditions or medications that affect bleeding or healing, while others may be unable to communicate the extent of their discomfort.
The 2025 ISTAP recommendations emphasize timely assessment, appropriate classification, and wound management based on both the injury and the person's overall condition.
Clinical assessment should consider the wound's location, extent, tissue damage, bleeding, pain, surrounding skin, relevant health conditions, and potential complications. Clinicians also need to recognize that signs of inflammation or skin damage may appear differently across skin tones.
The ISTAP classification system provides a recognized approach to categorizing skin tears according to the condition and loss of the skin flap. However, the existence of this system does not mean that every caregiver should independently classify wounds or make treatment decisions.
A deeper laceration, pressure injury, moisture-associated injury, or another skin condition may require a different assessment and management approach.
For non-clinical care providers, the appropriate response is to follow relevant first-aid and escalation arrangements within their competence and authorized responsibilities, avoid additional trauma, communicate relevant information, and arrange clinical assessment when needed.
Substantial or persistent bleeding, severe pain, deep or extensive injury, or other concerning symptoms may require urgent medical attention. Increasing redness, warmth, swelling, discharge, worsening pain, fever, or deterioration in the person's general condition may indicate complications that need prompt professional assessment.
People with diabetes, vascular disease, impaired immunity, or other conditions affecting healing may require additional clinical consideration.
An injury should not be dismissed simply because bleeding is limited or the wound initially appears superficial.
Where wound diagnosis, classification, dressing selection, treatment, or follow-up decisions are required, these must be undertaken within the lawful scope and competence of appropriately qualified healthcare professionals.
Family members and other caregivers can contribute to care according to professional instructions, but they should not be expected to make complex clinical decisions without suitable guidance.
For residential and home-based providers, effective response depends on recognizing the concern and ensuring that appropriate assessment is not delayed.
Recurrent or Unexplained Injuries Need Careful Review
A history of previous skin tears is an important consideration when assessing future risk.
Some older people experience repeated injuries despite careful assistance. Their skin may remain vulnerable because of several interacting factors, including frailty, medical conditions, mobility difficulties, and environmental exposure.
Nevertheless, recurrence should prompt a closer look at the circumstances.
A person who repeatedly develops injuries on the same forearm may be coming into contact with a particular bedframe or piece of equipment. Another may experience injuries during dressing, transfers, or the removal of adhesive products.
Rather than considering each event separately, care providers should look for patterns and determine whether practical changes could reduce further harm.
Unexplained injuries require a similarly careful approach.
An injury without a clear explanation does not automatically establish abuse or neglect. Fragile skin can be damaged during unwitnessed events, and some older people may have difficulty recalling exactly what happened.
However, repeated unexplained injuries, inconsistent accounts, delayed reporting, or concerns about a person's treatment may justify further review and protective action.
Care workers should document what they observed, distinguish facts from assumptions, and avoid premature conclusions about family members, employees, or other caregivers.
Where there are reasonable concerns about mistreatment or neglect, providers should follow applicable safeguarding and reporting arrangements.
Clinical assessment and organizational review may both be necessary, but they address different questions. Clinical assessment establishes the nature of the injury and the care required. Organizational review examines how the event occurred, whether preventable hazards remain, and what actions are needed.
The purpose is to protect the older person, support fair decision-making, and reduce the likelihood of repeated harm.
Responsibilities Differ Across Hospitals, Residential Care, and Home-Based Services
Skin tear prevention involves different responsibilities depending on the care setting.
Hospitals and licensed healthcare establishments may have qualified clinical professionals responsible for assessing skin integrity, identifying wounds, determining treatment, managing complications, and arranging follow-up.
Residential long-term care facilities in Viet Nam are not all organized under the same legal or service model. Some may provide authorized healthcare activities, while others primarily offer accommodation, personal assistance, social support, or care coordination.
Home-based services may involve nurses, personal care workers, family caregivers, or several organizations working together.
These differences matter because the ability to recognize a problem does not automatically confer authority to diagnose or treat it.
Non-clinical care workers can help prevent skin tears by observing skin vulnerability, using safer assistance techniques appropriate to their responsibilities, identifying environmental hazards, reporting injuries, and helping older people access professional care.
They should not be expected to perform clinical activities beyond their competence, training, authorization, or applicable legal requirements.
Organizations also need clear arrangements for communicating concerns, particularly when an older person moves between care settings.
Someone returning from hospital may have a healing wound, fragile skin, previous skin tears, or ongoing treatment instructions. The receiving provider needs enough information to support safe daily care and understand when further clinical assessment is required.
A discharge or transfer is not complete simply because the person has arrived at the next setting. Continuity depends on clear responsibilities, appropriate information sharing, and reliable access to professional support.
For organizations without on-site clinical services, arrangements with appropriately licensed healthcare providers can be particularly important.
Understanding the Vietnamese Legal and Professional Context
Viet Nam's legal framework provides important protections for older people, but it is necessary to distinguish general care responsibilities from regulated clinical activities.
The Law on Older Persons No. 39/2009/QH12, as amended, establishes a foundation for the care, protection, and dignity of older people. Consolidated Document No. 23/VBHN-VPQH, issued by the Office of the National Assembly on February 26, 2026, provides an updated official reference to the consolidated Law.
Its provisions address responsibilities relating to older people's care and protection, including prohibitions against mistreatment, humiliation, and discrimination.
These principles are relevant when preventing avoidable injuries, responding to concerns, and respecting the rights of people receiving care.
However, the Law should not be interpreted as establishing a universal skin tear assessment system, clinical classification requirement, or wound treatment protocol for every organization caring for older people.
On July 1, 2026, the Ministry of Health issued Decision No. 1976/QĐ-BYT, promulgating professional guidance on caring for older people at home and in the community.
The guidance provides relevant professional context for organizing home-based and community care, including appropriate daily assistance and support for older people within its specified scope.
It should not be interpreted as establishing an identical specialist skin tear management program for all residential care providers or making ISTAP classification mandatory across Viet Nam.
Where wound assessment or treatment constitutes regulated medical practice, the Law on Medical Examination and Treatment No. 15/2023/QH15, as amended, and applicable implementing requirements must be considered.
Consolidated Document No. 26/VBHN-VPQH, issued on February 26, 2026, provides an official consolidated reference to this Law. Providers must determine the legal requirements applicable to their services, healthcare professionals, and authorized activities.
A residential care organization should not assume that providing personal assistance automatically authorizes its employees to perform regulated medical procedures. Equally, healthcare establishments providing clinical services must ensure that these activities are carried out by appropriately qualified and authorized personnel.
The regulatory framework for social assistance establishments is also evolving.
Government Decree No. 395/2026/NĐ-CP, issued on October 23, 2026, regulates the operation and management of social assistance establishments and is scheduled to take effect on December 7, 2026.
As of November 4, 2026, the Decree has been issued but is not yet effective. Providers should distinguish requirements currently in force from those scheduled to apply later and review the implications according to their legal classification and services.
The Decree addresses the broader organization and provision of social assistance services. It should not be interpreted as establishing a universal skin tear treatment protocol or independently authorizing non-clinical personnel to perform regulated wound management procedures.
For HLVN, the important distinction is between preventing harm through better organization of daily care and making clinical decisions that require professional authority.
Care providers can strengthen safety by recognizing vulnerability, improving their environment, supporting safer daily assistance, and arranging timely clinical assessment without taking on responsibilities outside their lawful service scope.
Using International Guidance Without Confusing It With Vietnamese Law
International recommendations can help organizations develop safer practices, particularly where local care systems are strengthening structured approaches to older-person care.
The 2025 ISTAP recommendations provide a specialist reference for skin tear prevention, assessment, classification, and management. Their value lies in combining available evidence with expert knowledge and practical approaches developed across healthcare settings.
However, ISTAP is a professional advisory body, not a Vietnamese regulatory authority. Its recommendations should not be presented as compulsory national requirements for all healthcare, residential, or home-based care providers in Viet Nam.
Another relevant international reference is ISO 25557:2026, Ageing Societies — Care Quality for Older Persons at Home and in Care Facilities, published in March 2026.
The standard specifies requirements and recommendations concerning the provision of health and social care services for older people, with attention to individual needs, preferences, self-determination, participation, safety, and workforce responsibilities.
These principles are relevant to skin tear prevention because effective care involves more than the actions of one caregiver. It also depends on suitable environments, communication, staff preparation, access to professional services, and the organization's ability to learn from incidents.
ISO 25557:2026 does not establish a specialist wound classification system or replace clinical guidelines, licensing conditions, or Vietnamese legal requirements.
Organizations may use these international references to inform quality improvement while determining which practices are appropriate and lawful within their services.
The objective is not to reproduce a specialist wound care department in every residential facility or home-care organization. It is to build reliable arrangements for identifying foreseeable risks, reducing avoidable trauma, and connecting older people with qualified professionals when clinical care is required.
Measuring Prevention Through Everyday Care Practices
Skin tear prevention can be incorporated into organizational quality improvement because many relevant risks arise during activities that occur repeatedly.
However, the number of reported skin tears alone provides an incomplete picture of care quality.
An organization may record several injuries associated with transfers, while another may identify problems involving adhesive products or contact with furniture. Without understanding the circumstances, both organizations could reach the same injury count but need different preventive actions.
The 2025 ISTAP recommendations support more consistent approaches to assessment and documentation. A validation study by Holloway and colleagues, published in Advances in Skin & Wound Care in 2025, examined the ISTAP Skin Tear Data Collection Tool as a means of improving standardized information collection.
Such tools can support clinical documentation, research, and quality improvement when implemented appropriately. Nevertheless, standardized forms do not replace professional competence or establish an obligation for every non-clinical caregiver to identify and classify wounds.
A recent implementation project illustrates how structured organizational changes may improve care practices.
Lo and colleagues published a study online in JBI Evidence Implementation on October 8, 2026, describing an evidence-based skin tear prevention and management project in a 120-bed residential long-term care facility in eastern Taiwan.
The project used baseline and follow-up clinical audits, staff education, revised documentation, a local protocol, and changes to procurement and clinical workflows.
Following implementation, compliance with structured risk assessment reached 85%, and compliance with preventive measures reached 90%. The point prevalence of documented skin tears declined from 15.8% at baseline to 4.2% at follow-up.
These findings are encouraging, but they should not be interpreted as definitive proof that the intervention alone caused the reduction.
The project involved one facility and used a before-and-after audit design without a randomized comparison group. The reduction in point prevalence was not a predefined primary audit outcome. Differences in the resident population, reporting practices, and other factors may have influenced the observed results.
It would therefore be inappropriate to promise that Vietnamese care facilities could achieve an equivalent reduction simply by adopting similar activities.
The more transferable lesson concerns implementation. Evidence-informed prevention can be integrated into documentation, staff education, equipment selection, clinical workflows, and ongoing organizational review.
For care providers in Viet Nam, useful quality questions include whether individuals with fragile skin are recognized, whether assistance is adapted to their needs, whether identified environmental hazards are addressed, and whether new injuries receive appropriate clinical attention.
Organizations can also examine recurrent injuries, the completion of agreed preventive actions, and whether lessons from previous incidents have changed daily practice.
Interpretation matters. An increase in reported skin tears may reflect improved recognition and documentation rather than a true increase in injuries. Conversely, a facility with very few recorded incidents may still have weaknesses if wounds are frequently overlooked.
Reliable measurement should consider reporting practices, the characteristics of people receiving care, staff competence, and access to clinical assessment.
HLVN does not propose a universal skin tear incidence target, a mandatory assessment frequency, or a standardized wound classification responsibility for every organization.
Quality measures should be appropriate to the provider's legal responsibilities, services, resident population, and improvement objectives.
Prevention Should Support Independence, Not Restrict It
Older people should be able to participate in daily life as fully as their abilities and preferences allow.
Someone with fragile skin may still wish to dress independently, walk around their home, take part in social activities, or assist with ordinary tasks. These activities may involve some risk, but preventing skin tears does not mean eliminating every opportunity for movement or participation.
Unnecessarily confining someone to bed, discouraging ordinary activity, or imposing uncomfortable protective equipment may create other problems and undermine independence.
Good prevention requires a proportionate response.
For one person, changes to clothing and regular skin care may help reduce common sources of trauma. Another may need assistance with transfers, environmental adjustments, or closer professional assessment because of recurrent injuries.
Older people themselves can often provide valuable information about what makes care comfortable or difficult.
A resident may explain that a particular sleeve catches against the skin, that a chair is awkward to use, or that assistance during bathing causes discomfort. Such observations should influence how care is planned and delivered.
Family members can contribute knowledge about previous injuries, familiar routines, and changes in the person's abilities. However, families should not automatically be expected to identify every risk or provide specialized wound care without appropriate support.
The organization retains responsibility for arranging services and assistance consistent with its actual role and capabilities.
For some providers, meaningful improvement may begin with greater awareness of fragile skin, safer personal care, and more dependable communication when injuries occur.
Others, particularly those supporting people with complex medical needs or substantial dependency, may require more structured clinical arrangements and access to wound care expertise.
What matters is that prevention responds to individual circumstances without treating fragile skin as a reason to unnecessarily reduce a person's freedom, comfort, or dignity.
Making Small Moments of Care Safer
A skin tear may begin with a brief moment of contact during an otherwise ordinary activity. Yet the consequences may last much longer.
Pain, repeated dressing changes, anxiety about movement, delayed healing, or the need for additional clinical appointments can affect an older person's comfort and confidence. For someone already living with frailty or functional limitations, even a relatively small wound may disrupt daily life.
Preventing these injuries is therefore about more than reducing wound counts.
It involves understanding how skin vulnerability interacts with the care environment, how assistance is provided, and whether emerging problems are recognized before they become more serious.
For hospitals, residential care facilities, and home-based providers in Viet Nam, the most useful starting point is to examine the ordinary circumstances in which injuries occur. Staff need to recognize vulnerable skin, provide appropriate assistance, identify environmental hazards, and know when to seek clinical support.
Older people and families should be involved wherever possible because their observations and preferences can make preventive measures more practical and acceptable.
Organizations also need to learn from recurring patterns rather than treating every injury as an isolated event.
Not every skin tear can be prevented, and no single technique or product will be suitable for everyone. Prevention should never be used to justify unnecessary restrictions or to shift specialist clinical responsibilities onto people who are not authorized or competent to perform them.
What care providers can do is make daily assistance more reliable, respond appropriately when injuries occur, and ensure that skin damage is not dismissed as an inevitable consequence of aging.
For someone living with fragile skin, safer care may be reflected in something as ordinary as a comfortable transfer, a thoughtfully arranged room, or a caregiver who recognizes that a small injury deserves attention.
These are modest actions, but together they can make a meaningful difference to safety, independence, and quality of life.
Key References and Regulatory Context
Nokaneng, E., Heerschap, C., Thayer, D., Ousey, K., Holloway, S., LeBlanc, K., et al. (2025). Best Practice Recommendations for the Prevention and Management of Skin Tears in Aged Skin. Second edition. International Skin Tear Advisory Panel, Nurses Specialized in Wound, Ostomy and Continence Canada, Wound, Ostomy and Continence Nurses Society, and Wounds International. Published May 22, 2025.
Ousey, K., Heerschap, C., LeBlanc, K., Samuriwo, R., & Woo, K. (2026). Best Practice Recommendations for Understanding Dementia and Skin Tears. Wounds International. Published April 8, 2026.
Ousey, K., Heerschap, C., Thayer, D., & Nokaneng, E. (2025). The Prevention and Management of Skin Tears in Aged Skin. Wounds International, Made Easy series. Published July 21, 2025.
Xu, J., Xiong, Y., Yan, H., Zhou, Z., Wen, J., & Wang, S. (2025). Prevalence and influencing factors of skin tears in older adults: A systematic review and meta-analysis. Geriatric Nursing, 61, 491–498. DOI: 10.1016/j.gerinurse.2024.12.024.
Lo, S.-F., Hu, Y.-T., Tsay, S.-F., Huang, P.-Y., & Chen, C.-Y. (2026). Skin tear prevention and management among frail older adults in a Taiwanese long-term care facility: A best practice implementation project. JBI Evidence Implementation. Published online October 8, 2026. DOI: 10.1097/XEB.0000000000000651.
Holloway, S., Fourie, A., Bandeira da Silva, C. V., et al. (2025). Development and validation of the International Skin Tear Advisory Panel Skin Tear Data Collection Tool. Advances in Skin & Wound Care, 38(10), 527–533. DOI: 10.1097/ASW.0000000000000372.
LeBlanc, K., & Ousey, K. (2024). Assessment, prevention and management of skin tears in older people. Nursing Older People, 36(5), 22–28. DOI: 10.7748/nop.2024.e1462.
Carville, K., Leslie, G., Osseiran-Moisson, R., Newall, N., & Lewin, G. (2014). The effectiveness of a twice-daily skin-moisturising regimen for reducing the incidence of skin tears. International Wound Journal, 11(4), 446–453. DOI: 10.1111/iwj.12326.
Ministry of Health, Viet Nam. (2026). Decision No. 1976/QĐ-BYT Promulgating Professional Guidance on Care for Older People at Home and in the Community. Issued July 1, 2026.
National Assembly of Viet Nam. (2009). Law on Older Persons No. 39/2009/QH12, as amended.
Office of the National Assembly of Viet Nam. (2026). Consolidated Document No. 23/VBHN-VPQH — Law on Older Persons. Issued February 26, 2026.
National Assembly of Viet Nam. (2023). Law on Medical Examination and Treatment No. 15/2023/QH15, as amended.
Office of the National Assembly of Viet Nam. (2026). Consolidated Document No. 26/VBHN-VPQH — Law on Medical Examination and Treatment. Issued February 26, 2026.
Government of Viet Nam. (2026). Decree No. 395/2026/NĐ-CP on the Operation and Management of Social Assistance Establishments. Issued October 23, 2026; scheduled to take effect December 7, 2026.
International Organization for Standardization. (2026). ISO 25557:2026 — Ageing Societies — Care Quality for Older Persons at Home and in Care Facilities. Published March 2026.
About Healthy Longevity Vietnam
Healthy Longevity Vietnam (HLVN) is an independent initiative focused on advancing quality, safety, and implementation in age-friendly, integrated, and long-term care for older people in Viet Nam. Through evidence-informed approaches, quality improvement, measurement, and collaboration, HLVN supports healthcare and care organizations in developing safer, more coordinated, and person-centered care across settings.
Disclaimer
This article is intended for general education, quality improvement, and organizational development. It does not constitute individualized medical or legal advice, a wound assessment or treatment protocol, an official regulatory interpretation, a mandatory skin tear classification procedure, or an accreditation or certification standard.
Skin tears and other skin injuries require appropriate assessment according to their characteristics and the individual's health condition. Clinical decisions concerning wound diagnosis, classification, treatment, dressing selection, management of complications, and follow-up must remain within the scope of appropriately qualified and authorized healthcare professionals. Non-clinical caregivers should follow applicable care instructions, first-aid arrangements, and escalation procedures without undertaking regulated medical activities beyond their lawful authority, training, or competence.
Substantial or persistent bleeding, severe pain, deep or extensive injury, suspected infection, or other concerning changes may require urgent medical attention. Recurrent or unexplained injuries should be reviewed appropriately. Such injuries do not automatically establish abuse or neglect, but reasonable concerns about mistreatment should be addressed through applicable safeguarding and reporting arrangements.
Preventive measures should be individualized, proportionate, and respectful of the older person's preferences, mobility, independence, dignity, and lawful choices.
The Ministry of Health's Decision No. 1976/QĐ-BYT provides professional guidance for older-person care at home and in the community within its specified scope. It does not establish an identical specialist skin tear treatment protocol for every residential care provider.
Government Decree No. 395/2026/NĐ-CP was issued on October 23, 2026, and is scheduled to take effect on December 7, 2026. Its requirements should not be treated as already effective on the review date.
The ISTAP recommendations, ISO 25557:2026, and other international references are provided for educational and comparative purposes. They do not automatically create Vietnamese statutory obligations or authorize clinical activities outside applicable professional and licensing requirements.
Research findings discussed in this article should be interpreted in light of their study designs, populations, and limitations. They do not guarantee that any specific prevention approach will achieve equivalent results in every care setting.
Healthcare, residential care, and home-based service providers should establish setting-specific arrangements that reflect applicable Vietnamese law, their legal classification, authorized services, workforce competence, individual care needs, and access to appropriately qualified healthcare professionals.
Information and regulatory context reviewed as of November 4, 2026.