Barriers to Care Addressed in Geriatric Dermatology

Adam J. Friedman, MD

A new investigation into geriatric dermatology identified several barriers to care and treatment among the older adult dermatology patient population, with investigators adding that partnerships between dermatologists and geriatricians could be made to address these concerns.

Geriatric dermatology is an emerging field in the world of skin studies, with previous research identifying important principles to consider in older skin including cognition, polypharmacy, mobility, social support, and sleep disturbance.

However, as the population of older patients continues to grow, investigators believed that barrier to care and treatment faced by older patients had not been adequately addressed.

As such, Adam J. Friedman, MD, and Jaya Manjunath, BS, George Washington School of Medicine and Health Sciences, assessed provider perception and attitudes regarding the needs of older adult patients in dermatology clinics.

The Findings

Investigators surveyed members of the Orlando Dermatology Aesthetic and Clinical Conference vie email. Of the 2840 recipients who were made aware of the email, 169 (5.9%) providers completed the survey.

Of those respondents, 92.9% were dermatologists and 6.5% were advanced practice providers.

The 3 most pressing issues affecting the care of older adult patients identified were limited social support systems, difficult in comprehension of treatment plans, and financial barriers.

Similarly, hearing problems and lack of social support systems were selected by 82.9% and 82.8% of practitioners, respectively. These barriers were followed by immobility (74.4%), the ability of the patient to communicate clearly (69.5%), transportation barrier (77.5%), financial barrier (72.2%), Medicare limitations (66.9%), poor psychosocial functioning (77.5%) and telehealth due to the COVID-19 pandemic (71.2%).

When asked of the most common complaint heard from older patient during dermatology visits, 2.3% of respondents answered, “hearing differing advice from providers” and 16.2% of respondents answered, “confusion with billing and insurance”.

Poor psychosocial functioning (89.9%), polypharmacy (87.8%), lack of social support system (88.5%), poor adherence to medications (81.1%), and lack of a primary care physician (72.3%) as barriers to treatment in older adult dermatology patients were also noted.

Investigators believed that partnerships between geriatricians and dermatologists could be established to improve education regarding geriatric topics, and could include lectures provided by geriatricians in dermatology residency programs to improve education and raise awareness about geriatric topics such as polypharmacy, poor psychosocial functioning, and limited social support networks.

Additionally, further studies were recommended to assess the unique needs of older patients during the COVID-19 pandemic, which included issues with telemedicine.

“As many older adults continue to face challenges navigating teledermatology visits, we must develop strategies to optimize teledermatology in older adults,” the team wrote.

The study, "Assessing Dermatology Provider Perceptions and Attitudes About the Unique Needs of Older Adult Patients," was published on JDD Online.