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Greener Journal of Medical Sciences
Vol. 11(1), pp. 94-99 2021
ISSN: 2276-7797
Copyright ©2021, the copyright of this
article is retained by the author(s)
https://gjournals.org/GJMS
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Skin Health Seeking Behaviour amongst Admitted Seniors
1Amadi, ES*, 2Otike-Odibi, B, 3Pepple, EF, 4Bell-Gam,
HI
1-Dermatology Unit,
Department of Internal Medicine, Rivers State University, Nkpolu-Oroworukwo, Rivers
State, Nigeria
2- Dermatology Unit,
Department of Internal Medicine, University of Port Harcourt Teaching Hospital,
Rivers State, Nigeria
3-Department of Community
Medicine, Rivers State University, Nkpolu-Oroworukwo, Rivers State, Nigeria
4-Geriatrics Unit, Department of
Internal Medicine, Rivers State University, Nkpolu-Oroworukwo, Rivers State,
Nigeria
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ARTICLE INFO
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ABSTRACT
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Article
No.: 070721061
Type: Research
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Background: Older adults who
are considered to be aged 60 years and above according to the United Nations
for developing nations are increasing in number. This brings concerns with
regards to developing healthcare services that covers all round care
including skin care. It is a misconception that older adults are not bothered
about their skin but studies have shown that skin disorders clearly affect
the quality of life of seniors. There may be varied factors why an older
adult might not seek skin care services. This study aims to find out if older
adults on the wards for various ailments have actually sought for care with
regards to their skin problems.
Method: A purposive
cross-sectional sampling of 126 elderly patients aged 60 years and above that
were admitted to the different wards of the hospital within a 3-month period
were interviewed using a pro forma and
were examined for skin lesions. Those with a previous skin complain were included
in the study. Data collection sheet was used to collate demographic
information, dermatological conditions, care sought, point of care and
diagnosis, treatment received and outcome of treatment.
Result: There was no
significant relationship found between the complaint of having a dermatological
lesion with occupation, educational status, marital status or area of
residence. Only 9.5% (12) had a previous skin complaint that required them to
seek for care. Females are more likely to seek for treatment with regards to
dermatologic disorders.
Conclusion: Skin health
seeking behaviour amongst the admitted elderly is poor despite a greater
number with dermatoses.
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Accepted: 08/07/2021
Published: 12/07/2021
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*Corresponding
Author
Amadi,
ES
E-mail:
ekechiamadi@ yahoo.com
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Keywords: Skin;
health seeking behaviour.
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INTRODUCTION
As life expectancy is increasing, the health of the senior’s skin is becoming an increasingly
more important phase of total health care.1The
aged skin is prone to a lot of dehydration and dryness which predisposes it to
pruritus, skin excoriations and ulcers.1, 2The older adult may be
reluctant to seek care for a variety of reasons which may include poor
perception about how others would regard their complaints, poor attitude of
healthcare workers during previous
visits, distance to health care facility, the perceived effectiveness of
treatment, financial constraints and other prevailing health issues that may
make them physically constraint to seek care.2, 3, 4 Older people
just like in any other age group are also concerned about how their skin looks.5
Studies have shown that they can also be significantly burdened by cutaneous
lesions.6 This study looks at the socio-demographics of those
who were admitted with a prior skin
complaint and what care was received.
METHOD
Study area
The study took place in the University of Port
Harcourt Teaching Hospital (UPTH). The hospital is a 700-bed tertiary hospital
located in Port Harcourt, Rivers state, Nigeria. The hospital plays host to a
variety of medical specialists and serves as a referral center for other health
care facilities in the state and neighbouring states as well.
The study population
The study population included persons aged 60 years
and above presenting to UPTH for medical attention who were admitted to the
wards after presentation.
Sample and Sampling
A purposive cross-sectional sampling of 126 elderly
patients that were admitted to the different wards of the hospital within a
3-month period was carried out.
Data Collection
A pro forma data collection sheet was used to collate
demographic information, dermatological conditions, previous skin complaints, care
sought, point of care and diagnosis, treatment received and outcome of
treatment.
Data Analysis
The data collected was analysed using the Statistical
Package for Social Sciences (SPSS) v25 software. At a 95% confidence interval
and a p-value less than
0.05 was considered significant. The socio- demographic characteristics,
clinical details and dermatological complains were presented in tables for
better visualization.
RESULTS
A sample of 126 patients who were admitted at the
University of Port Harcourt Teaching Hospital into different wards was examined
for dermatological lesions. Out of this number a pro forma data collection
sheet was used to collate demographic information, dermatological conditions,
previous skin complaints, care sought, point of care and diagnosis, treatment
received and outcome of treatment. The top ten dermatological diagnoses seen
within this group is as listed in the table below, however only 9.5% (12) had
had a previous skin complaint that required them to seek skin care. The male: female ratio seen was
1.3: 1 with regards to the general group however with regards to those with a
previous skin complaint that necessitated intervention was 1:2 showing that
more females sought for skin care with regards to their skin complaints.
Table 1- Top ten commonest
skin lesions
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Dermatological
condition
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Frequency
(Number of persons)
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IGH
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72
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DPN
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67
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WRINKLES
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59
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NEVI
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58
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XEROSIS
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53
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HYPERPIGMENTATION
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35
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SURGICAL SCAR
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32
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ITCHING
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26
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ULCER
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26
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RASH
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19
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IGH-Idiopathic guttate
hypomelanosis, DPN- Dermatosis papulosa nigrica
There was no
significant relationship found between dermatological lesion with occupation,
educational status, marital status or area of residence. The most frequent
occupation seen amongst them was peasant farming. The age range was 61-87 years.
The mean age was 70.25±4.7 at 95% confidence interval; the median was 66.25 and
the mode 65. Out of these older adult patients, 8.3% (1) patient practiced
self-medication and bought drug from a patent medicine dealer. The rest visited
various health care settings and consulted a medical doctor; out of which 25%
(3) visited general practitioners in different
health care centres of which, (1)
was referred to a dermatologist. A greater number, 50 % (6) visited a
dermatologist in a tertiary hospital inclusive of the referral to admitting
hospital from a primary health care centre. One of those who visited a
dermatologist couldn’t recall treatment given however the dermatitis resolved
after treatment. A physician who wasn’t a dermatologist was consulted by 8.3% (1)
of these patients in a tertiary setting and 16.6% (2) had seen a surgeon.
Majority of the patients, 75% (8) had resolution of symptoms as at when seen
while 16.6% (2) were on admission for the persistence of the skin complaint.
These were the cases of the chronic ulcer and bullous pemphigoid. Two others
were admitted for other reasons but still complained of recurrent cases of skin
lesions. These were the cases of two females with tinea incognito plus
pityriasis rosea; and the intertriginous fungal infection. Out of these patients
with persistent skin lesions, 75% (3) had diabetes mellitus. Fungal infection
was seen in 41.6% (5) of patients in this study. In two cases the diagnoses
were in their case notes as they sought for care in the same hospital where
they are been admitted. 25% (3) of the patients had biopsies of which two were
skin biopsies and one an excisional biopsy to confirm diagnoses.
DISCUSSION
Dermatoses are common within the elderly age group as
seen in studies done within the same region and in other developing nations
with varying prevalences.7-10This study showed a smaller percentage
of older adults who have actually sought help for skin problems as older adults
when compared to the general sample of the older adult population which had a
greater prevalence of dermatoses on skin examination. The actual prevalence of
the elderly that visit the dermatology outpatient clinics has been noted to be
smaller as against those who were actually examined on admission or institutionalized.
It was noted that Ayanlowo et al reported that older adults constituted a
prevalence of 4.8% of cases that visited the
dermatology out-patient clinic within a 5 year time frame while Amadi et
al reported a prevalence of 3.1% over a 10 year period.11, 12 This
may be influenced by the way older adults perceive the seriousness of skin
diseases.3-6,13 However a self-reported study amongst advanced
African Americans had a higher percentage of participants(45.5%) who had visited the physician for a skin concern in the past; with more females
seeking skin care as seen also in this study.13 This study showed
that fungal infections were a common reason to visit a physician or skin
doctor. Fungal infections are one of the prevalent diseases found amongst the
elderly both in urban and rural settlements regardless of socio-economic
status.1-4; 7-13 Just one patient did self-medication which did not
resolve symptoms. Self-medication is a common practice worldwide as seen amongst
different age groups as noted in other studies. The complications are enormous
and often the ailment doesn’t get cured as seen in this case in this study.14This
study showed persistent skin disorders despite treatment which necessitated
admission and skin biopsies. This might
be a reflection of the particular skin
disorder prognosis such as in case of
bullous pemphigoid which is chronic and needs proper investigations, prolonged
treatment and care. It might also be a reflection of poor adherence to therapy
and the use of chemicals such as skin lightening creams and wrong medication in
the treatment despite visiting the dermatologist. It can also be due to
persistent risk factors such as diabetes mellitus or any other cause of
immunosuppression which is noted to predispose the elderly to fungal infections
of the skin as seen in this study.
Greater majority of skin disorders will be managed on out-patient basis
but occasionally would require a multidisciplinary approach requiring both
medical and surgical interventions necessitating admissions. It could also be
life threatening as in the case of blistering disorders where a greater portion
of the skin has been lost predisposing to internal infection and dehydration.15Dermatological
surgeries are mostly still done by surgeons within the area of study thus
having more patients visiting them first for lumps and bumps which they would
want to get rid of. Biopsies are
required for confirmation of diagnosis and can be done in the clinic or on
admission. Skin health seeking behaviour of the elderly in this group was low
and those who sought care had no particular or peculiar socio demographics
different from those who did not. The reasons may be due to the lack of awareness
of the availability of dermatologists within the treatment facility to take
care of their skin ailment or not perceiving the dermatologic disorder as a
problem worth visiting the hospital.4, 16
CONCLUSION
Dermatoses in the elderly are common and can be a
concern necessitating outpatient or inpatient care. Skin health seeking
behaviour amongst the elderly may be impaired for a variety of reasons.
Recommendations
It is important the doctor or healthcare worker fully
examines the patient holistically noting skin disorders which may be a pointer
to other systemic diseases even when the older adult presents for a different
complaint in order to make timely referral to the dermatologist. Failing to do
so presents a missed opportunity to totally care for the older adult thus
promoting increased morbidity and mortality. Patients are encouraged to examine
their skin as much as they can noting any abnormal disorder and are encouraged
to visit the dermatologist yearly for a thorough examination. Self-medication
should be discouraged at all levels.17
Consent and ethical approval
Ethical approval to carry out the study was obtained
from the Research and Ethics Committee of the University of Port Harcourt
Teaching Hospital before commencing the study. A willing written informed
consent was obtained from each participant before they were included into the
study.
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