Geriatric dermatology: optimising care in frail older adults

Contains fulltext : 169252.pdf (publisher's version ) (Open Access)Healthcare providers are expected to be increasingly confronted with the growing population of older adults. In the Netherlands, the frailest and most dependent older adults live in nursing homes. Skin problems are common in this patient population and they can result in a high level of morbidity, causing a significant impact on quality of life. Management decisions in frail older adults may be challenging since several factors should be taken in consideration, such as a limited life expectancy, immobility, and dementia. A major group of skin disorders resulting in these challenges in frail older adults is skin cancer. The most common subgroup of skin cancer is nonmelanoma skin cancer (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) and its precursors. NMSC has a relative low-malignant natural course compared to many other types of cancer, however the impact on quality of life in the longer term may be significant. Balancing the risk of under-and overtreatment in older adults with NMSC, together with patient- and tumor characteristics is therefore not easily performed. The aims of the studies presented in this thesis were to obtain insight in the current need for, provision of, and quality of general dermatologic care among nursing home patients (Part A of this thesis), and to study current skin cancer care among older adults and provide guidance in medical-decision making (Part B of this thesis). Important challenges and limitations in dermatologic care among frail older adults were found and suggestions to optimize dermatologic care in these populations were provided.Radboud University, 3 mei 2017Promotor : Kerkhof, P.C.M. van de Co-promotor : Gerritsen, M.J.P