Prevalence and associated factors of skin diseases in aged nursing home residents: a multicentre prevalence study

Elisabeth Hahnel, Ulrike Blume-Peytavi, Carina Trojahn, Gabor Dobos, Irina Jahnke, Vera Kanti, Claudia Richter, Andrea Lichterfeld-Kottner, Natalie Garcia Bartels, Jan Kottner, Elisabeth Hahnel, Ulrike Blume-Peytavi, Carina Trojahn, Gabor Dobos, Irina Jahnke, Vera Kanti, Claudia Richter, Andrea Lichterfeld-Kottner, Natalie Garcia Bartels, Jan Kottner

Abstract

Objectives: The aim of this study was to measure the prevalence of skin diseases in aged nursing home residents and to explore possible associations with demographic and medical characteristics.

Design: Descriptive multicentre prevalence study.

Setting and participants: The study was conducted in a random sample of ten institutional long-term care facilities in the federal state of Berlin, Germany. In total, n=223 residents were included.

Results: In total, 60 dermatological diseases were diagnosed. The most frequently diagnosed skin disease was xerosis cutis (99.1%, 95% CI 97.7% to 100.0%) followed by tinea ungium (62.3%, 95% CI 56.0% to 69.1%) and seborrheic keratosis (56.5%, 95% CI 50.2% to 63.0%). Only few bivariate associations have been detected between skin diseases and demographic and medical characteristics.

Conclusion: Study results indicate that almost every resident living in residential care has at least one dermatological diagnosis. Dermatological findings range from highly prevalent xerosis and cutaneous infection up to skin cancer. Not all conditions require immediate dermatological treatment and can be managed by targeted skin care interventions. Caregivers need knowledge and diagnostic skills to make appropriate clinical decisions. It is unlikely that specialised dermatological care will be delivered widely in the growing long-term care sector.

Trial registration number: This study is registered at https://ichgcp.net/clinical-trials-registry/NCT02216526.

Keywords: Dermatology; Elderly; Nursing Homes; Prevalence; Skin Diseases.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Flow chart of participants.

References

    1. Cohen-Mansfield J, Jensen B. The preference and importance of bathing, toileting and mouth care habits in older persons. Gerontology 2005;51:375–85. 10.1159/000088701
    1. Jafferany M, Huynh TV, Silverman MA, et al. . Geriatric dermatoses: a clinical review of skin diseases in an aging population. Int J Dermatol 2012;51:509–22. 10.1111/j.1365-4632.2011.05311.x
    1. Diepgen TL. [Demographic changes in Germany. Consequences in health policy and dermatology]. Hautarzt 2003;54:804–8. 10.1007/s00105-003-0586-2
    1. Jindal R, Jain A, Roy S, et al. . Skin disorders among geriatric population at a Tertiary Care Center in Uttarakhand. J Clin Diagn Res 2016;10:WC06–8. 10.7860/JCDR/2016/17015.7500
    1. Deo MS, Kerse N, Vandal AC, et al. . Dermatological disease in the older age group: a cross-sectional study in aged care facilities. BMJ Open 2015;5:e009941 10.1136/bmjopen-2015-009941
    1. Hay RJ, Fuller LC. Global burden of skin disease in the elderly: a grand challenge to skin health. G Ital Dermatol Venereol 2015;150:693–8.
    1. Hahnel E, Lichterfeld A, Blume-Peytavi U, et al. . The epidemiology of skin conditions in the aged: a systematic review. J Tissue Viability 2017;26:20–8. 10.1016/j.jtv.2016.04.001
    1. Tseng HW, Ger LP, Liang CK, et al. . High prevalence of cutaneous manifestations in the elderly with diabetes mellitus: an institution-based cross-sectional study in Taiwan. J Eur Acad Dermatol Venereol 2015;29:1631–5. 10.1111/jdv.12664
    1. Hay RJ, Johns NE, Williams HC, et al. . The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol 2014;134:1527–34. 10.1038/jid.2013.446
    1. Shah M, Coates M. An assessment of the quality of life in older patients with skin disease. Br J Dermatol 2006;154:150–3. 10.1111/j.1365-2133.2005.06959.x
    1. Kim EK, Kim HO, Park YM, et al. . Prevalence and risk factors of depression in geriatric patients with dermatological diseases. Ann Dermatol 2013;25:278–84. 10.5021/ad.2013.25.3.278
    1. Patterson SM, Cadogan CA, Kerse N, et al. . Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev 2014;7:CD008165 10.1002/14651858.CD008165.pub3
    1. Stewart D, Mair A, Wilson M, et al. . Guidance to manage inappropriate polypharmacy in older people: systematic review and future developments. Expert Opin Drug Saf 2017;16:203–13. 10.1080/14740338.2017.1265503
    1. Rollason V, Vogt N. Reduction of polypharmacy in the elderly: a systematic review of the role of the pharmacist. Drugs Aging 2003;20:817–32.
    1. Statistisches Bundesamt. Pflegestatistik 2015. Pflege im Rahmen der Pflegeversicherung Ländervergleich - Pflegeheime. Wiesbaden: 2017.
    1. Kottner J, Hahnel E, Trojahn C, et al. . A multi-center prevalence study and randomized controlled parallel-group pragmatic trial to compare the effectiveness of standardized skin care regimens on skin health in nursing home residents: a study protocol. Int J Nurs Stud 2015;52:598–604. 10.1016/j.ijnurstu.2014.11.007
    1. Junkin J. Targeting incontinence-associated dermatitis. 3rd Congress of the World Union of Wound Healing Societies, 2008.
    1. LeBlanc K, Baranoski S, Skin Tear Consensus Panel Members. Skin tears: state of the science: consensus statements for the prevention, prediction, assessment, and treatment of skin tears(c). Advances in skin & wound care 2011;24:2–15. 10.1097/01.ASW.0000405316.99011.95
    1. Serup J. EEMCO guidance for the assessment of dry skin (xerosis) and ichtyosis: clinical scoring systems. Skin Res Technol 1995;1:109–14. 10.1111/j.1600-0846.1995.tb00029.x
    1. Kang BC, Kim YE, Kim YJ, et al. . Optimizing EEMCO guidance for the assessment of dry skin (xerosis) for pharmacies. Skin Res Technol 2014;20:87–91. 10.1111/srt.12089
    1. Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J 1965;14:61–5.
    1. Ayello EA, Braden B. How and why to do pressure ulcer risk assessment. Adv Skin Wound Care 2002;15:125–31 quiz 132-133. 10.1097/00129334-200205000-00008
    1. Statistisches Bundesamt. Pflegestatistik 2013. Pflege im Rahmen der Pflegeversicherung Deutschlandergebnisse. Wiesbaden, 2015.
    1. Scanlan C. Is anticipated consent an acceptable model for a unique Cohort of research participants? commentary on case study of scabies in nursing homes. Public Health Ethics 2017;10:96–9.
    1. Kilic A, Gül U, Aslan E, et al. . Dermatological findings in the senior population of nursing homes in Turkey. Arch Gerontol Geriatr 2008;47:93–8. 10.1016/j.archger.2007.07.007
    1. Gunduz T, Gunduz K, Degerli K, et al. . Epidemiological profile of Onychomycosis in the elderly living in the nursing homes. Eur Geriatr Med 2014;5:172e4 10.1016/j.eurger.2013.11.012
    1. Nakagami G, Takehara K, Kanazawa T, et al. . The prevalence of skin eruptions and mycoses of the buttocks and feet in aged care facility residents: a cross-sectional study. Arch Gerontol Geriatr 2014;58:201–4. 10.1016/j.archger.2013.10.003
    1. Lichterfeld A, Lahmann N, Blume-Peytavi U, et al. . Dry skin in nursing care receivers: a multi-centre cross-sectional prevalence study in hospitals and nursing homes. Int J Nur Stud 2016;56:37–44. 10.1016/j.ijnurstu.2016.01.003
    1. Long MA, Reed LA, Dunning K, et al. . Incontinence-associated dermatitis in a long-term acute care facility. J Wound Ostomy Continence Nurs 2012;39:318–27. 10.1097/WON.0b013e3182486fd7
    1. Zimmaro Bliss D, Zehrer C, Savik K, et al. . Incontinence-associated skin damage in nursing home residents: a secondary analysis of a prospective, multicenter study. Ostomy Wound Manage 2006;52:46–55.
    1. Hoppe C, Pöhler A, Kottner J, et al. . [Pressure ulcers: new data about risk, prevalence and places of development. Results of a study in German nursing homes and hospitals]. Pflege Z 2008;61:90–3.
    1. Kottner J, Dassen T, Lahmann N. Prevalence of deep tissue injuries in hospitals and nursing homes: two cross-sectional studies. Int J Nurs Stud 2010;47:665–70. 10.1016/j.ijnurstu.2009.11.003
    1. Steingass S, Klein B, Hube G, et al. . [New avenues to quality assurance-a model project for recording bedsore incidence]. Gesundheitswesen 2002;64:585–91. 10.1055/s-2002-35520
    1. Lahmann N, Dassen T, Kottner J. [Frequency of pressure ulcers in german hospitals]. Gesundheitswesen 2012;74:793–7. 10.1055/s-0031-1299778
    1. Makrantonaki E, Steinhagen-Thiessen E, Nieczaj R, et al. . Prevalence of skin diseases in hospitalized geriatric patients: association with gender, duration of hospitalization and geriatric assessment. Z Gerontol Geriatr 2016; (Epub ahead of print 28 Jun) 10.1007/s00391-016-1084-3
    1. Brooks J, Cowdell F, Ersser SJ, et al. . Skin cleansing and emolliating for older people: a quasi-experimental pilot study. Int J Older People Nurs 2017;12:e12145 10.1111/opn.12145
    1. Hahnel E, Blume-Peytavi U, Trojahn C, et al. . The effectiveness of standardized skin care regimens on skin dryness in nursing home residents: a randomized controlled parallel-group pragmatic trial. Int J Nurs Stud 2017;70:1–10. 10.1016/j.ijnurstu.2017.02.006
    1. White-Chu EF, Reddy M. Dry skin in the elderly: complexities of a common problem. Clin Dermatol 2011;29:37–42. 10.1016/j.clindermatol.2010.07.005
    1. Kottner J, Lichterfeld A, Blume-Peytavi U. Maintaining skin integrity in the aged: a systematic review. Br J Dermatol 2013;169:528–42. 10.1111/bjd.12469
    1. Shim JH, Park JH, Lee JH, et al. . Moisturizers are effective in the treatment of xerosis irrespectively from their particular formulation: results from a prospective, randomized, double-blind controlled trial. J Eur Acad Dermatol Venereol 2016;30:276–81. 10.1111/jdv.13472
    1. Blume-Peytavi U, Kottner J, Sterry W, et al. . Age-associated skin conditions and diseases: current erspectives and future options. Gerontologist 2016;56(Suppl 2):S230-42. 10.1093/geront/gnw003
    1. Beeckman D, Van Damme N, Schoonhoven L, et al. . Interventions for preventing and treating incontinence-associated dermatitis in adults. Cochrane Database Syst Rev 2016;11:CD011627 10.1002/14651858.CD011627.pub2
    1. Farage MA, Miller KW, Berardesca E, et al. . Psychological and social implications of aging skin: normal aging and the effects of cutaneous disease In: Farage MA, Miller KW, Maibach HI, eds Textbook of Aging Skin. Berlin, Heidelberg: Springer Berlin Heidelberg, 2014:1–14.
    1. Ilkit M, Durdu M. Tinea pedis: the etiology and global epidemiology of a common fungal infection. Crit Rev Microbiol 2015;41:374–88. 10.3109/1040841X.2013.856853
    1. Al Hasan M, Fitzgerald SM, Saoudian M, et al. . Dermatology for the practicing allergist: Tinea pedis and its complications. Clin Mol Allergy 2004;2:5 10.1186/1476-7961-2-5
    1. Röwert-Huber J, Patel MJ, Forschner T, et al. . Actinic keratosis is an early in situ squamous cell carcinoma: a proposal for reclassification. Br J Dermatol 2007;156(Suppl 3):8–12. 10.1111/j.1365-2133.2007.07860.x
    1. Werner RN, Sammain A, Erdmann R, et al. . The natural history of actinic keratosis: a systematic review. Br J Dermatol 2013;169:502–18. 10.1111/bjd.12420
    1. Leiter U, Eigentler T, Garbe C. Epidemiology of skin cancer. Adv Exp Med Biol 2014;810:120–40.
    1. Blumeyer A, Tosti A, Messenger A, et al. . Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men. J Dtsch Dermatol Ges 2011;9(Suppl 6):S1-5710.1111/j.1610-0379.2011.07802.x
    1. Rossaneis MA, Haddad MC, Mathias TA, et al. . Differences in foot self-care and lifestyle between men and women with diabetes mellitus. Rev Lat Am Enfermagem 2016;24:e2761 10.1590/1518-8345.1203.2761
    1. Lubeek SF, van der Geer ER, van Gelder MM, et al. . Current dermatologic care in dutch nursing homes and possible improvements: A Nationwide Survey. J Am Med Dir Assoc 201516:e711–716. 10.1016/j.jamda.2015.04.015
    1. Lubeek SF, van Gelder MM, van der Geer ER, et al. . Skin cancer care in institutionalized elderly in the Netherlands: a nationwide study on the role of nursing home physicians. J Eur Acad Dermatol Venereol 2016;30:e236–e237. 10.1111/jdv.13573
    1. Templier C, Boulanger E, Boumbar Y, et al. . Systematic skin examination in an acute geriatric unit: skin cancer prevalence. Clin Exp Dermatol 2015;40:356–60. 10.1111/ced.12562
    1. Brüggemann J, Coners E, Gerber H, et al. . 4. Pflege-Qualitätsbericht des MDS nach §114A Abs. 6 SGB XI. Qualität in der ambulanten und stationären Pflege. In:Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V. (MDS), ed.,4. asmuth druck + crossmedia gmbh & co. kg, Köln, 2014.

Source: PubMed

3
Subscribe