How to Improve Dermatologic Care of Older Adults

WASHINGTON, DC — Whole-person, age-friendly dermatological care for older adults considers the 5Ms of geriatrics — medications, mobility, what matters, mentation, and multi-complexity — and can be optimized through “simple steps you can take in your practice this month,” geriatrician Christina Prather, MD, told dermatologists at the ElderDerm 2025 conference on dermatology in the older patient.

For medication adherence and safety, for instance, possible steps include changing your practice’s pre-visit call center script to prompt patients to bring in “everything they take — the supplements, the eye drops, the ointments, the pills,” Prather said, and then doing “a plastic bag biopsy” before the visit ideally, or afterward if necessary.

“The MAs [medical assistants] in my clinic know what to do with these plastic bags of medications, and yours can too,” said Prather, director of the Division of Geriatrics and Palliative Medicine, and associate professor of medicine at the George Washington School of Medicine and Health Sciences, Washington, DC, which hosted the conference.

Other steps include using the real-time “teach-back” method that asks patients to tell you in their own words what they need to do for their care, and having an MA or nurse call the patient 4-7 days after the visit to check for questions and ensure understanding of the care plan. “Or maybe you’re scheduling a follow-up visit 2 weeks later to make sure patients are implementing the plan,” said Prather, also clinical director of the GW Institute for Brain Health and Dementia, Washington, DC.

“With treatment plans, you always have to pause and ask [yourself] what makes sense for this patient?” she said. If it appears that the patient is not fully understanding the care plan, “just [appreciate] that it won’t happen without significant support and follow-up,” she said.

When necessary, she noted, “you can order home health to have a nurse go out and implement the medication care plan that you’ve enacted,” she said, noting that his is available through Medicare. Printed copies of care plans — done in large print for readability and with specificity — can be helpful in reducing barriers to medication adherence, as can specific suggestions for compound pharmacies. “A lot of our older adults may not be as savvy with the internet in finding a pharmacy,” Prather said.

“Another handout you can have on your wall ready to give people is information about bubble packing and online packaging pharmacies that will package your medications based on what you need to take and when,” she said, citing PillPack as an example.

Considering Possible Cognitive Impairment

These actions apply to the “mentation” component of geriatric care as well, Prather said, noting that pre-visit call center scripts can also prompt/remind patients to bring a family member or companion — in addition to their medications.

By 2030, 20% of the population will be older than 65 years, noted dermatologist Freba Z. Farhat, MD, in another presentation at the meeting. People older than 85 years are the fastest growing segment of the US population and are expected to number 9.6 million by 2030 and 20 million by 2060. Of consequence for dermatologists is the significant number of people who have cognitive impairment, Farhat said.

According to a cross-sectional nationally representative study led by researchers at Columbia University Irving Medical Center, New York City, published in 2022, almost 10% of US adults aged 65 years or older have dementia, and another 22% have mild cognitive impairment.

Consideration of cognition and other factors such as functional mobility, social support, and polypharmacy are guiding principles in geriatric medicine and can all “factor into what treatment plan we recommend,” said Farhat, assistant professor of dermatology at Georgetown University School of Medicine and director of the Inpatient Dermatology Consultation Service at Georgetown University Hospital/Washington Hospital Center, Washington, DC.

Prather suggests that practices with a large senior population consider training their MAs to administer a Mini-Cog, a fast and simple screening test to detect possible cognitive impairment. “You don’t have to take ownership of it, but it might really help you think about how you communicate your care plans,” she said, noting that patients whose results suggest possible cognitive impairment can be referred back to the primary care physician.

Mobility, Multi-Complexity, What Matters

Other considerations for older patients include whether chairs in the clinics have arm rests, Prather said, noting that “some older patients need those armrests to push up.”

For older patients who need more time to move from place to place and more support overall, “consider not double-booking these patients, or maybe schedule them at the end of the clinic block,” or, if possible, schedule them for a longer visit, she advised. Telemedicine visits for medication checks — to check on possible side effects, for instance — may be especially valuable for these patients, she noted.

Regarding the multi-complexity often involved in the health of older adults, Prather encouraged dermatologists to “embrace nutrition” by telling patients, for instance, “your nutrition is really important to your skin health…and I’m not going to judge but I just want to get a general sense of your dietary intake.” She then asks patients what they ate for breakfast that morning, how many glasses of water they had that day, and what they ate for dinner the prior night. By asking such questions, “you’ll know if nutrition is contributing to your patient’s skin health,” she said.

(During her presentation, Prather said that she saw cases of scurvy in three patients in 2021 “related to the lack of nutritional access during COVID in individuals who were homebound.”)

Nutritional/meal support and other services are sometimes available through local offices on aging — and handouts that list these offices and other local community-based services can be valuable in the dermatology practice. “In DC, we have the Department of Aging and Community Living,” which can facilitate free meal delivery for seniors who are dually eligible for Medicare and Medicaid, she said, “and there are similar programs elsewhere.”

To understand what matters most to patients, Prather suggested asking questions like these: “What concerns you most about your health? What is the most important thing I need to know about how this [condition] impacts your quality of life? What are the things that bring you joy or make you happy most days, and are you able to do those things now? And what is going to make this treatment challenging for you?”

Prather reported having no financial relationships with commercial interests and no conflicts of interest. She serves as a consultant for the Alzheimer’s Association, Innovation Horizons, and AffinityCED, and has active federal research funding. Farhat reported having no relevant disclosures.