Registered Nurses' Association of Ontario

Consensus Statement Skin Changes at Life’s End (SCALE)

  • Not to be considered or used as a skin assessment tool
  • It provides10 valuable consensus statements which discuss changes of the skin as a result of the dying process
  • The following statements have specific relevance:
    • Statement 1: Physiologic changes that occur as a result of the dying process (days to weeks) may affect the skin and soft tissues and may manifest as observable (objective) changes in skin color, turgor (integrity), or as subjective symptoms such as localized pain
    • Statement 4: Skin changes at life’s end are a reflection of compromised skin (reduced soft tissue perfusion, decreased tolerance to external insults, and impaired removal of metabolic wastes)
    • Statement 6: Risk factors may include weakness and progressive limitation of mobility, suboptimal nutrition including loss of appetite, weight loss, cachexia and wasting, low serum albumin/pre-albumin, and low hemoglobin as well as dehydration; diminished tissue perfusion, impaired skin oxygenation, decreased local skin temperature, mottled discoloration, and skin necrosis; loss of skin integrity from any of a number of factors including equipment or devices, incontinence, chemical irritants, chronic exposure to body fluids, skin tears, pressure, shear, friction and infections; and impaired immune function
    • Statement 7: A total skin assessment should be performed regularly and document all areas of concern consistent with the wishes and condition of the patient


Clinical Management
Risk Assessment and Prevention of Pressure Ulcers
Sample Tools