Epidemiologie und Hautpflege

Einleitung. Aktuell sind etwa 11,5% der Weltbevölkerung älter als 60 Jahre. Aufgrund von altersbedingten Veränderungen der Haut ist diese Population besonders vulnerabel für die Entwicklung dermatologischer Erkrankungen. Es wurden die Epidemiologie von Hauterkrankungen, die Zusammenhänge von Pflegebedürftigkeit, Hautphysiologie und dem Auftreten von Hauterkrankungen untersucht. Weiterhin wurde die Wirksamkeit standardisierter Hautpflegeregimes im Vergleich zur nicht-standardisierten Hautpflege bei Pflegeheimbewohnern in der institutionellen Langzeitversorgung untersucht. Methoden. Es wurde eine systematische Übersichtsarbeit zur Epidemiologie von Hauterkrankungen erstellt. Eine deskriptive Querschnittstudie und eine multizentrische, randomisierte, kontrollierte, prüferverblindete klinische Studie wurden in zehn vollstationären Pflegeheimen durchgeführt. Neben der Erhebung und Messung demographischer Variablen und hautphysiologischer Funktionsparameter (transepidermaler Wasserverlust, Stratum Corneum Hydratation, pH-Wert), wurden dermatologische Untersuchungen durchgeführt. Die Zuteilung der Pflegeheimbewohner zu einer von drei Gruppen für ein achtwöchiges Hautpflegeregime erfolgte randomisiert. Der Endpunkt Hauttrockenheit wurde anhand des Overall Dry Skin Scores diagnostiziert. Die Auswertung der Ergebnisse erfolgte deskriptiv mittels der Darstellung bi- und multivariater Zusammenhänge. Gruppenvergleiche erfolgten mittels Kruskal-Wallis Test und einem Post-hoc-Paarvergleich (Mann-Whitney U-Test). Ergebnisse. Die systematische Literaturrecherche ergab 74 Volltexte, welche Prävalenzund/ oder Inzidenzdaten von mehr als 20 Hautproblemen oder Erkrankungen berichteten. In der Querschnittstudie nahmen n = 223 Pflegeheimbewohner (67,7% weiblich; mittleres Alter 83,6 Jahre (SD 8,0)) teil. Insgesamt wurden 60 dermatologische Diagnosen, darunter Xerosis cutis (99,1%, 95% KI 97,7%-100,0%), identifiziert. Wenige bivariate Assoziationen zwischen Hauterkrankungen und demographischen Charakteristiken konnten dargestellt werden. An der klinischen Studie nahmen n = 133 Pflegeheimbewohner (65,4% weiblich; mittleres Alter 83,8 Jahre (SD 8,3)) teil. Die Hauttrockenheit nahm in allen drei Gruppen ab. Im Gruppenvergleich konnten statistisch signifikante Unterschiede gezeigt werden. Im Vergleich mit den Ausgangswerten waren die hautphysiologischen Funktionsparameter geringfügig verändert. Diskussion. Die Ergebnisse deuten darauf hin, dass Hauterkrankungen in der älteren Bevölkerung sehr häufig sind. Die dermatologischen Befunde reichen von stark prävalenter Xerosis cutis über kutane Infektionen bis hin zu Hautkrebs. Nicht alle Erkrankungen erfordern eine sofortige dermatologische Behandlung. Ein strukturiertes Hautpflegeregime ist effektiv zur Behandlung von Xerosis cutis bei Pflegeheimbewohnern. Pflegekräfte sollten das nötige Wissen und diagnostische Fähigkeiten besitzen, um angemessene klinische Entscheidungen treffen zu können, da eine umfassende, spezialisierte, dermatologische Versorgung im wachsenden Langzeitpflegesektor unwahrscheinlich ist.Introduction. About 11.5% of the world's population is older than 60 years. This population is particularly vulnerable to the development of dermatological diseases. The epidemiology of skin diseases, the relationships between care dependency, skin physiology and skin diseases, as well as the efficacy of standardized skin care regimens compared to non-standardized skin care in nursing home residents were examined. Methods. A systematic review of the epidemiology of skin diseases was conducted. An observational, descriptive, cross-sectional study and a multi-center, randomized, controlled, investigator blinded study were conducted in ten nursing homes. Demographic variables and skin physiology (transepidermal water loss, stratum corneum hydration, and pH) were measured and dermatological examinations were performed. Nursing home residents were randomized to one of three groups with an eight-week skin care regimen. The endpoint skin dryness was diagnosed using the Overall Dry Skin Score. The results were described descriptively. Bi- and multivariate correlations were performed to detect possible associations. The Kruskal-Wallis test with post-hoc pairwise twosample Mann-Whitney U-test was performed to detect group differences. Results. The systematic literature search resulted in 74 analyzed full texts, which reported prevalence and/or incidence data of more than 20 skin diseases. In the descriptive cross-sectional study, n = 223 nursing home residents (67.7% female, mean age 83.6 years (SD 8.0)) participated. Sixty dermatological diseases were diagnosed,including xerosis cutis (99.1%, 95% CI 97.7% to 100.0%). Only few bivariate associations between skin disease and demographic characteristics have been detected. N = 133 nursing home residents (65.4% female, mean age 83.8 years (SD 8.3)) participated in the clinical study. There were statistically significant improvements of skin dryness in both intervention groups compared to the control group over time. The skin physiological function parameters showed slightly changed values compared to the baseline values. Discussion. Results indicate that skin diseases are highly frequent in the elderly population. Dermatological findings range from highly prevalent xerosis cutis and cutaneous infection up to skin cancer. Not all conditions require immediate dermatological treatment. A structured skin care regimen is effective in reducing skin dryness in aged nursing home residents. Caregivers should have the needed knowledge and diagnostic skills to make appropriate clinical decisions, since it is unlikely that specialized dermatological care will be delivered widely in the growing long-term care sector

Prevalence and associated factors of skin cancer in aged nursing home residents: A multicenter prevalence study

Non-melanoma-skin cancer is an emerging clinical problem in the elderly, fair skinned population which predominantly affects patients aged older than 70 years. Its steady increase in incidence rates and morbidity is paralleled by related medical costs. Despite the fact that many elderly patients are in need of care and are living in nursing homes, specific data on the prevalence of skin cancer in home care and the institutional long-term care setting is currently lacking. A representative multicenter prevalence study was conducted in a random sample of ten institutional long-term care facilities in the federal state of Berlin, Germany. In total, n = 223 residents were included. Actinic keratoses, the precursor lesions of invasive cutaneous squamous cell carcinoma were the most common epithelial skin lesions (21.1%, 95% CI 16.2 to 26.9). Non-melanoma skin cancer was diagnosed in 16 residents (7.2%, 95% CI 4.5 to 11.3). None of the residents had a malignant melanoma. Only few bivariate associations were detected between non-melanoma skin cancer and demographic, biographic and functional characteristics. Male sex was significantly associated with actinic keratosis whereas female sex was associated with non-melanoma skin cancer. Smoking was associated with an increased occurrence of non-melanoma skin cancer. Regular dermatology check-ups in nursing homes would be needed but already now due to financial limitations, lack of time in daily clinical practice and limited number of practising dermatologists, it is not the current standard. With respect to the worldwide growing aging population new programs and decisions are required. Overall, primary health care professionals should play a more active role in early diagnosis of skin cancer in nursing home residents. Dermoscopy courses, web-based or smartphone-based applications and teledermatology may support health care professionals to provide elderly nursing home residents an early diagnosis of skin cancer

Enhancing SKIN health and safety in aged CARE (SKINCARE Trial): a study protocol for an exploratory cluster-randomized pragmatic trial

Background: Aged long-term care receivers are affected by various adverse skin conditions like pressure ulcers, incontinence-associated dermatitis, dryness, intertrigo, and many more. Prevention of these skin problems and the provision of general hygiene and skin care activities are key areas of nursing practice. Numerous condition-specific guidelines are available and are implemented separately. On the other hand, there is huge overlap in terms of etiology, pathogenesis, and prevention of the skin conditions mentioned above. This leads to fragmented practice neglecting shared etiologies and prevention and treatment principles. Methods: The overall aims of this trial are to test the feasibility and to estimate possible effects of the implementation of a comprehensive skin care and prevention strategy targeting main nursing-relevant skin problems at the same time. A two-arm cluster-randomized controlled trial will be performed in 20 nursing homes randomly selected from the population of nursing homes of the state of Berlin, comparing skin care according to the skin care and prevention strategy with standard skin care. Discussion: It is expected that the implementation of this evidence-based skin care and prevention strategy will reduce the incidence of pressure ulcers, incontinence dermatitis, and other skin problems frequently related to care dependency. This trial will benefit individual patients and aged nursing home residents in general given the high prevalence and incidence of the addressed skin conditions. Findings of this exploratory trial may lay the foundation for a change in the development and evaluation of clinical standards and practices in general as it moves the perspective from individual conditions to a more comprehensive view on overlapping or coexisting health problems, in this case common skin conditions, in old-age long-term care receivers

Two-Year Longevity of Posterior Zirconia Multi-Unit Fixed Dental Prostheses with Monolithic Occlusal Surface

In this prospective clinical trial we observed the 2-year clinical performance of posterior tooth-supported multi-unit fixed dental prostheses (FDP) fabricated from zirconia with monolithic occlusal surfaces. Fifty multi-unit FDPs were inserted in 50 patients. After two years of clinical service, 43 restorations were reexamined as one patient had died and six patients were not available for recall. Two biological (root canal treatment: 12 and 14 months) and one technical (debonding: 12 months) complications occurred. According to the Kaplan–Meier analysis, the success rate was 93.7%, and the survival rate was 100%. The six patients who were not available for regular 2-year follow-up were examined after the official 2-year recall interval, and none of the FDPs presented complications or failures. Within the limitations of the current study, the use of multi-unit FDPs with monolithic occlusal surfaces fabricated from zirconia can be recommended for short-term use in the posterior area

Clinical Follow-Up in Orofacial Clefts—Why Multidisciplinary Care Is the Key

(1) Background: Although most clinicians involved in the treatment of cleft patients agree upon the major importance of interdisciplinary cooperation and many protocols and concepts have been discussed in the literature, there is little evidence of the relevance of continuous interdisciplinary care. We aimed to objectify the type and number of therapeutic decisions resulting from an annual multidisciplinary follow-up. (2) Methods: We retrospectively analyzed the data of all 1126 patients followed up in the weekly consultation hours for cleft patients at university clinics in Leipzig for the years 2005–2020. We assessed the clinical data of every patient and specifically evaluated the treatment decisions taken at different points in time by the participating experts of different specialties. (3) Results: In total, 3470 consultations were included in the evaluation, and in 70% of those, a therapeutic recommendation was given. Each specialty showed certain time frames with intense treatment demand, which partially overlapped. Nearly all therapy recommendations were statistically attached to a certain age (p < 0.001). (4) Conclusions: There is an exceptionally high need for the interdisciplinary assessment of patients with cleft formation. Some developmental phases are of particular importance with regard to regular follow-up and initiation of different treatment protocols. The therapy and checkup of cleft patients should be concentrated in specialized centers

Cost‐effectiveness of multi‐layered silicone foam dressings for prevention of sacral and heel pressure ulcers in high‐risk intensive care unit patients: An economic analysis of a randomised controlled trial

Pressure ulcer incidence is high in intensive care units. This causes a serious financial burden to healthcare systems. We evaluated the cost-effectiveness of multi-layered silicone foam dressings for prevention of sacral and heel pressure ulcers in addition to standard prevention in high-risk intensive care units patients. A randomised controlled trial to assess the efficacy of multi-layered silicone foam dressings to prevent the development of pressure ulcers on heels and sacrum among 422 intensive care unit patients was conducted. Direct costs for preventive dressings in the intervention group and costs for treatment of incident pressure ulcers in both groups were measured using a bottom-up approach. A cost-effectiveness analysis by calculating the incremental cost-effectiveness ratio using different assumptions was performed. Additional dressing and labour costs of €150.81 (€116.45 heels; €34.36 sacrum) per patient occurred in the intervention group. Treatment costs were €569.49 in the control group and €134.88 in the intervention group. The incremental cost-effectiveness ratio was €1945.30 per PU avoided (€8144.72 on heels; €701.54 sacrum) in the intervention group. We conclude that application of preventive dressings is cost-effective for the sacral area, but only marginal on heels for critically ill patients

a multicentre prevalence study

Objectives: The aim of this study was to measure the prevalence of skin diseases in aged nursing home residents and to explore possible associations with demographic and medical characteristics. Design: Descriptive multicentre prevalence study. Setting and participants: The study was conducted in a random sample of ten institutional long-term care facilities in the federal state of Berlin, Germany. In total, n=223 residents were included. Results: In total, 60 dermatological diseases were diagnosed. The most frequently diagnosed skin disease was xerosis cutis (99.1%, 95% CI 97.7% to 100.0%) followed by tinea ungium (62.3%, 95% CI 56.0% to 69.1%) and seborrheic keratosis (56.5%, 95% CI 50.2% to 63.0%). Only few bivariate associations have been detected between skin diseases and demographic and medical characteristics. Conclusion: Study results indicate that almost every resident living in residential care has at least one dermatological diagnosis. Dermatological findings range from highly prevalent xerosis and cutaneous infection up to skin cancer. Not all conditions require immediate dermatological treatment and can be managed by targeted skin care interventions. Caregivers need knowledge and diagnostic skills to make appropriate clinical decisions. It is unlikely that specialised dermatological care will be delivered widely in the growing long-term care sector. Trial registration number: This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526

Observations, knowledge, and attitude towards treatment options in patients with dry mouth: a survey among German dentists

Objectives The aim of this study was to investigate the attitude, observations, and knowledge of German dentists regarding the management of dry mouth. Materials and methods A questionnaire including queries about attitudes, observations, and treatment options in patients with dry mouth was developed and sent to all 1251 dentist members of a regional German dental association. Results An overall total of 284 returned questionnaires were included in the analyses, which relates to a response rate of 22.7%. Dentists infrequently encountered dry mouth in their clinical routine, yet were well aware that patients suffer from the symptoms of dry mouth; for affected patients, the majority of participating dentists provided specific dental prophylaxis measures. Drug side effects, neoplasia, and psychological disorders were regarded as the primary etiological factors for dry mouth, and caries, increased plaque formation, and rhagades as the most frequently observed clinical symptoms. While the majority of participating dentists was of the opinion that saliva substitutes are useful treatment options in patients with dry mouth, only few frequently recommended their use. Mechanical and gustatory stimulation of salivary flow as well as the advice to rinse with water were the most frequently pursued treatment options. Conclusions Despite the high prevalence of dry mouth identified in epidemiological studies, it appears to be an infrequent observation in clinical routine

Prevalence and associated factors of intertrigo in aged nursing home residents: a multi-center cross-sectional prevalence study

Abstract Background In geriatric and long-term care settings, intertrigo seems to be common, but generalizable epidemiological estimates are lacking. Aim of this study was to measure the prevalence of intertrigo in aged nursing home residents and to identify possible relationships with demographic and health characteristics. Methods A cross-sectional prevalence study was conducted between September 2014 and May 2015 in a random sample of ten institutional long-term care facilities in Berlin, Germany. In total 223, aged long-term care residents were included. Mean age was 83.6 (SD 8.0) years and mean Barthel score was 45.1 (SD 23.8). Board certified dermatologists and study assistants performed skin assessments and measurements according to standard operating procedures. Mean differences and odds ratios between residents with and without intertrigo were calculated. Results The prevalence of intertrigo was 16.1% (95% CI 11.6 to 21.2%). The submammary fold was most often affected (9.9%), followed by the inguinal region (9.4%), axilla (0.5%) and abdominal region (0.5%). Increased age was statistically significantly associated with the presence of intertrigo (OR 1.05; 95% CI 1.00 to 1.10). Care dependency in bathing activities was associated with intertrigo. Obesity, sex and skin functional parameters were not associated with intertrigo. Conclusions Every sixth nursing home resident was affected by intertrigo indicating the high load of this skin condition in this population. Older age seems to be associated with intertrigo. Care dependency in bathing activities was likely to be associated with intertrigo. Structured skin care regimens are needed to prevent and treat intertrigo in this population. Trial registration This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526. Registration date: 8th November 2014

Reliability and agreement of skin barrier measurements in a geriatric care setting

Background: The non-invasive skin barrier measurements transepidermal water loss, stratum corneum hydration and the skin surface pH are widely used in clinical skin research. Relative and absolute measurement errors of these measurements are unknown in geriatric care settings. Material and methods: Transepidermal water loss, stratum corneum hydration, skin surface pH and temperature were measured on the volar forearm and lower leg twice by trained raters within a cross-sectional study in ten nursing homes. Intrarater reliability was calculated using the ICC (1,1). Intrarater agreement was analyzed using Bland Altman Plots with limits of agreement. Results: Two hundred twenty-three residents were included and mean age was 84.2 years. The highest ICC was found for transepidermal water loss and skin surface temperature of the leg with 0.95 (95% CI 0.93 to 0.96). The ICC of the stratum corneum was 0.91 (95% CI 0.88 to 0.93) for both investigated skin areas. The measurement of the pH at the lower leg had the lowest ICC with 0.73 (95% CI 0.66 to 0.78). Highest limits of agreement of approximately 8 a.u. were calculated for stratum corneum hydration and lowest limits of agreement of approximately 1 degrees C were calculated for skin surface pH. Conclusion: Relative measurement errors of transepidermal water loss and stratum corneum hydration were very low indicating that single measurements provide reliable estimates in this population and setting. However, the absolute measurement errors were high for both of these parameters. To increase reliability of skin surface pH we recommend at least two repeated measurements