Geriatric dermatology

San Francisco

- Respect is a right for patients of any age, and physicians have a duty to bestow even-handed demeanor and care to all, says Robin A.C. Graham-Brown, M.D., a consultant dermatologist and director of services for older people at the Leicester Royal Infirmary, Leicester, England.

However, she says, aging populations do not always receive the same care and attention as younger patient populations. Though doctors’ behaviors may not stem from any malicious or direct hurtful intent, older and aging patients may, nevertheless, sometimes feel cast out, obsolete and less important.

Medical professionals have a tendency not to treat older patients with the same degree of fervor or at times. Dr. Graham-Brown says that just because a patient is old and/or physically or mentally lethargic, it does not give the medical professional the right to treat them with any less respect or dignity than they would a bright and quick thinking younger patient.

"Medical professionals do not take any cognizance of the fact that older patients may be retired nuclear physicists, doctors, teachers or any line or work for that matter.

"The problem is that we do not look at old people as if they were still the young person that the old person feels themselves to be," Dr. Graham-Brown says.

According to Dr. Graham-Brown, there are four main areas of dermatology where clinicians fail to adequately address and serve the aging population, namely, pruritus, ulcers and sores, inflammatory dermatoses and solar dermatoses.

The ravages of the sun commonly affect older people, more so than any other patient population, as the effects of chronological and environmental aging are significant and are most evident in older patients.

Older patients can be bothered by the numerous benign keratoses, actinic keratoses, fine lines and wrinkles, sagging skin and the whole gamut of cosmetic issues that go hand in hand with solar and chronological skin damage. Clinicians should not minimize their efforts just because these patients are old.

Similarly, inflammatory dermatoses are often less investigated in older patients. Doctors do not investigate the contact allergy to the same extent as they would in younger patients.

No matter what the skin affliction, older patients can suffer just as much from dermatoses as younger patients, if not more. The capacity for older patients to handle and cope with skin disease is diminished, and it can be more challenging for them to comply with a given treatment regimen, such as the application of a cream or the mindset to take daily medication several times a day.

"It is important that younger dermatologists are more aware and more conscious that they need to treat their older patients with exactly the same rigor and exactly the same fervor as they would younger patients," Dr. Graham-Brown tells Dermatology Times.

"I think we should make it explicitly clear to all medical professionals, whether in private practice or hospitals, that older patients have the right to stand up for themselves and we should give them the voice that they sometimes require and deserve," she says. DT