Influx of older patients provides growth opportunities for derm practices

Rancho Mirage, Calif. - The 65-and-older population grew at a faster rate than the total population between 2000 and 2010, according to the U.S. Census. And if they haven’t already started, nearly all of these patients will be flooding dermatologists’ offices soon, says Wendy Roberts, M.D., who is in private practice, Rancho Mirage, Calif.

“It’s all about the longevity of the 65-plus person. They’re living longer, so the skin has to last throughout the course of life. Dermatologic needs are going to increase,” Dr. Roberts says.

Dr. Roberts says she sees the older generation as so important to the specialty that she coined and trademarked a new term to define their care: “generational dermatology.” She also developed the Generational Dermatology Summit, which holds meetings on the topic (www.gdermsummit.com).

Generational dermatology is a transition from the word geriatric. Generational dermatology encompasses every stage of evolving skin over the course of a lifetime, with a lens on optimizing the health and condition of the 65-plus skin, she says.

What to expect

Among the many non-cancer-related medical dermatology issues of the generational patient, are barrier disorders such as solar purpura and solar lentigenes, as well as conditions affecting the lower extremities, Dr. Roberts says.

“We have to pay special attention to the lower extremities, because when you evolve into the seventh and eighth decades, lower-extremity disorders related to circulation and gravity ensue,” she says. “I won’t say that we (dermatologists) ignore the lower extremities, but it’s not something that may come to our mind if the patient does not have a lower-extremity complaint, and it should.”

 Lower-extremity conditions common among the 65 plus set may include dryness, foot and leg ulcers and hyperkeratotic nail disorders and onychodystrophy, Dr. Roberts says. “For 65-plus people, nails are an important area of concern.”

Management issues

One of the most important services a dermatologist can offer to the 65-and-older patient is a full-body skin examination, according to Dr. Roberts.

“You can’t really address what you don’t see,” she says. “Many of the life-threatening skin cancers occur on non-exposed sites such as back and lower leg. Not only can you save a life by detecting skin cancer, but you can improve the quality of a life, by having answers to disorders that this group thinks they have to live with, such as a dry foot disorder.”

Pay attention to the lower extremities while performing the full-body exam, she says.

“A thorough examination of older patients’ skin requires they take off their clothes and shoes, which can be not only embarrassing for elderly patients but also difficult because of mobility issues,” she says. “That’s what I see as my role - supervising my staff to encourage and help our patients to get undressed so I can look all of their skin over and address all of the issues.”

 Another important dermatologic service to this patient population: skin barrier care, according to Dr. Roberts.

“Disturbances in the patient’s skin barrier will be causative in some of the skin disorders that we’re seeing. So, we have to focus on optimizing the skin barrier as we age,” she explains. 

Still another management issue in the care of the 65-and-older patient is knowing what medications and supplements they take, as well as understanding how what they take might be affecting their skin. “Statins, for example, may wreak havoc on patients’ skin,” Dr. Roberts says, “And then you have the supplements, which can cause skin allergies and drug interactions. When reviewing medications, I don’t just call it a medication list anymore, I call it a medication and supplement list.”

 Education counts

Older patients tend to think their skin conditions are a consequence of aging. What they don’t often realize is that dermatologists can treat most, if not all, of their concerns, says Dr. Roberts, adding that that’s what makes caring for the generational patient an opportunity.

“That’s why I love geriatrics. It really puts you in every area of dermatology, and there is so much educational opportunity. It’s also something that dermatologists are uniquely trained to do. You can help your patients on both the medical side and cosmetic side. You can really make a difference,” she says.

Disclosure: Dr. Roberts reports no relevant financial interests.