- Skin tears are the most common wound type in aged care residents in Australia, affecting a significant proportion of residents at any given time
- The primary cause is age-related decline in sebum production, which thins the lipid layer of the skin barrier and makes it fragile
- Standard moisturising protocols often fail because they use water-based products that do not address the oil deficit
- Twice-daily application of a lipid-replenishing product is the most evidence-supported approach to reducing skin tears in older adults
- Mac Pure Oil and Calm+ are formulated around macadamia oil, which contains 17-22% omega-7 (palmitoleic acid), the same fatty acid the skin produces naturally and that declines sharply with age
Skin tears are not inevitable. They are very common in aged care, but the physiology behind them is well understood, and the main intervention is straightforward.
What is less straightforward is why standard moisturising protocols often do not prevent them. The answer has to do with which part of the skin barrier is actually failing.
Why aged care skin becomes so fragile
As we age, the skin changes at every level. The epidermis thins. The junction between the epidermis and dermis flattens, reducing the mechanical grip between layers. The dermis loses collagen. Circulation to the skin surface slows.
Underneath all of this is a change that receives less attention in clinical settings: sebum production declines significantly from around age 60 onwards. The sebaceous glands produce less oil. The fatty acids that form the structural lipid layer of the skin barrier, particularly palmitoleic acid (omega-7), are present in declining quantities.
Without adequate lipid, the skin barrier becomes less flexible and less able to absorb mechanical stress. The skin that was once resilient becomes fragile. Minor contact, a brush against bed linen, contact with a chair arm, the removal of an adhesive dressing, creates tears that would not have occurred in younger skin.
Why many moisturising protocols do not fully work
The most common moisturisers used in aged care are sorbolene-based or water-based emollients. These products are appropriate in many ways: they are fragrance-free, affordable, and easy to apply. Their limitation is that they address the water component of the skin barrier.
When the barrier is failing because of oil depletion, adding water does not restore flexibility. The skin may feel softer immediately after application, but the underlying structural deficit remains. Skin that is moisturised with a water-based product twice daily but not given adequate lipid replenishment continues to tear.
The distinction between replacing water and replacing oil matters clinically. Products that contain lipid-replacing ingredients, particularly oils rich in palmitoleic acid, address the structural component of the barrier that standard emollients do not reach.
What effective skin tear prevention looks like in practice
The evidence consistently supports twice-daily application of an appropriate moisturiser as the most effective preventable measure for skin tears. Timing and technique matter alongside product choice.
Apply after bathing while the skin is still slightly damp, which allows the product to seal in the skin's own moisture alongside the lipid it provides. Apply with minimal mechanical force, patting rather than rubbing. Focus on high-risk areas: shins, forearms, the backs of hands, bony prominences where skin is thinnest.
Clothing and handling practices matter alongside moisturising. Long sleeves to protect forearms, non-adhesive dressings where contact with medical tape is unavoidable, and care with repositioning all reduce the mechanical forces that cause tears.
Products suited to aged care use
Mac Pure Oil is a single-ingredient pure macadamia oil that can be applied directly to fragile skin areas. For residents with particularly severe oil depletion on specific areas (forearms, shins), a direct oil application in addition to a lotion provides intensive lipid support.
Calm+ is the daily lotion formulation, suited to whole-body use morning and evening. It contains macadamia oil as its active ingredient and is designed for the kind of consistent, programme-level application that an aged care skin care protocol requires.
Both products are fragrance-free, vegan, and Australian made. Neither contains active ingredients that require prescriber involvement.
For facilities developing or reviewing a skin care protocol
The most common gap in existing protocols is product specificity. "Apply moisturiser twice daily" is correct guidance that fails in practice when the product chosen is not designed for the specific barrier deficit affecting aged skin.
Mac Pure is used in aged care facilities and hospital settings across Australia. For procurement enquiries, sample requests, or information about wholesale pricing, contact the team at hello@macadamiapure.com.
Frequently Asked Questions
What causes skin tears in elderly residents?
Skin tears in older adults result from the combination of skin thinning, reduced elasticity, and declined sebum production. The oil layer of the skin barrier deteriorates with age, leaving skin fragile and less able to withstand minor mechanical stress.
How can skin tears be prevented in aged care?
Consistent twice-daily moisturiser use with a lipid-replenishing product is the best-supported preventive measure. Protective clothing on high-risk areas, careful handling, and non-adhesive dressings where adhesive contact is unavoidable also reduce incidence.
What is the best moisturiser for aged care residents?
Fragrance-free products that include lipid-replacing oils alongside humectants address both the water and oil components of the skin barrier deficit. Products based on oils rich in palmitoleic acid (omega-7), such as macadamia oil, replenish the specific fatty acid that the skin's sebaceous glands produce less of with age.
Does sorbolene prevent skin tears?
Sorbolene reduces surface dryness and is widely used in aged care settings. Its limitation is that it is primarily a water-based product and does not replenish the oil layer of the barrier. For residents with significant skin fragility, it may need to be supplemented with a product that addresses the lipid component.
Can Mac Pure products be used in aged care facilities?
Yes. Both Calm+ and Mac Pure Oil are suitable for aged care use, fragrance-free, and require no prescriber involvement. For wholesale pricing or sample requests, contact hello@macadamiapure.com.
Skin that tears regularly in aged care is not an inevitable feature of advanced age. It is a sign that the barrier is not receiving the support it needs. The intervention is available, simple to implement, and meaningfully reduces one of the most common wound types in the sector.
For facilities that want to improve outcomes in this area, the starting point is reassessing what the moisturiser in the protocol is actually providing.