Dermatological Disease in the Older Age Group: A Cross-sectional Study in Aged Care Facilities

Background: Older people living in aged care facilities face multiple potential barriers to accessing dermatological care including physical and/or cognitive disability. This group is therefore at risk for undiagnosed and untreated dermatological disease including inflammatory dermatoses and skin cancer. Methods: Two large aged care facilities providing both low level (residential) and high level (hospital) care were selected for this cross-sectional study. Each participant underwent a full dermatological examination. In addition, functional and cognitive status were assessed using the Rehabilitation Complexity Scale and Abbreviated Mental Test score. Results: 88 participants were recruited and 81.8% were found to have at least one significant condition. Inflammatory disease was more common in those with little physical disability compared to those with serious physical disability (odds ratio 3.69; 95% CI 1.1-12.6, p=0.04). No significant association was found between skin disease and cognitive impairment. Conclusion: A high rate of dermatological disease was found. Findings ranged from frequent but not lifethreatening conditions (e.g. onychomycosis), to those associated with a significant morbidity (e.g. eczema, lichen sclerosus and bullous pemphigoid), to potentially life-threatening (e.g. squamous cell carcinoma, melanoma and breast cancer). Those with less significant physical impairment were found to be at greater risk of inflammatory dermatoses. This could be because they receive less direct assistance or prompting from staff with regard to managin