Did you know that the skin is the largest organ in the human body? It too can have changes and deteriorate at end of life.


Skin integrity, color, and elasticity can be affected due to the natural homeostatic and metabolic changes during end of life. When the heart can no longer adequately pump and circulate the blood to the extremities, the blood is shunted from the skin to the internal vital organs leading to decreased soft tissue perfusion. In addition, weight loss and the loss of subcutaneous fat tissue beneath the skin can cause it to thin and be at risk to break down faster. Even minor injuries can lead to hemorrhage, gangrene, infection, skin tears, and pressure ulcers. Skin breakdown may be an unavoidable complication at end of life so our best efforts at prevention are crucial.


Common sites of skin breakdown are over bony prominences such as ankles, heels, hips, elbows, shoulders, tailbone, and spine.

Prevention Measures:

– Ensure incontinence brief is changed often and a barrier cream is used. Urine or feces on the skin can cause further irritation.

– When using a barrier cream, you do not have to wipe it away completely or scrub hard to get down to the skin and re-apply every time you change the brief!! Wipe away the messy parts and the top layer. Clean the mess as best you can to get the obviously dirty parts off. It is meant to be a barrier and does not have to come completely off before re-applying a bit more. Scrubbing the skin to take it completely off with every brief change can cause further tissue irritation.

– Reposition at least every 2 hours to alleviate pressure.

– Place a pillow beneath the lower legs, ensuring that the heels are ‘floating’ and not touching the bed or the pillow.

-More pillows! In hospice care centers, we tend to use a lot of pillows with repositioning. They can be placed in a variety of ways and places to take the pressure off the areas of concern.


While the skin and soft tissues can be compromised as a person is nearing end of life, it is important to do the best we can to reduce pressure to the skin and prevent breakdown.