Geriatric Dermatology

R.A. Norman, R.A. Norman

• Publisher: CRC Press
• Year: 2020
• ISBN:
  9781000161564
• Edition: 1
• Topic: Medicina
• Subtopic: Teoria, pratica e riferimenti medici

Over the past few years the world's population has continued on its remarkable transition from a state of high birth and death rates to one characterized by low birth and death rates. Consequently, primary care physicians and dermatologists will see more elderly patients presenting age-related dermatological conditions. There has never been a better time for a book devoted entirely to skin care in the elderly.Geriatric Dermatology draws together a panel of experts who provide an overview of the diagnosis and treatment of geriatric skin diseases. It begins with a general review of the aging of the world's population and the major dermatological problems that often arise in elderly patients. An added benefit is the book's coverage of geriatric skin care in nursing homes, adult congregate living, and subacute and home health settings, a subject not always found in conventional dermatology texts.The book includes:

• A summary of the dermatological disorders frequently encountered in the elderly, including eczematous dermatitis, skin infections, and neoplasias
  
• A description of the most common geriatric hair and scalp disorders, including graying, alopecia, and scalp psoriasis
  
• Comprehensive coverage of the diagnosis and treatment of leg, foot, and nail diseases
  
• Detailed discussion of the treatment of superficial mycoses, scabies, and pediculosis
  
• Less common geriatric conditions such as blistering diseases
  
• Major adverse drug reactions on the skin
  
• Leg ulcers due to venous insufficiency, arterial diseases, and diabetic nephropathy
  
• Diagnosis and treatment of diabetic complications of dermatology, such scleroderma and dermopathyThe study of diseases that impact the elderly population is a crucial and growing area of interest in medicine. Geriatricians, primary care physicians, dermatologists, and others involved in the care of the elderly will inevitably see an increase in skin diseases specific to aging. The comprehensive coverage provided by Geriatric Dermatology facilitates the diagnosis and management of these geriatric skin diseases from the common to the rare and unusual.

The aging of the world’s population

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R. A. Norman

INTRODUCTION

Over the past few years the world’s population has continued on its remarkable transition path from a state of high birth and death rates to one characterized by low birth and death rates. At the heart of that transition has been the growth in the number and proportion of older persons. The size of the world’s elderly population has been growing for centuries; what is new is its current rapid acceleration. The increase in the 60-and-over population in the industrialized nations of Europe and North America has generally outpaced total population growth in recent decades. Such a rapid, large and ubiquitous growth has never been seen in the history of civilization (www.un.org; www.who.org; www.popin.org).

The current demographic revolution is predicted to continue well into the coming centuries. Its major features include the following:

(1) One of every ten persons is now aged 60 years or older; by 2050, one out of five will be 60 years or older; and by 2150, one out of three persons will be 60 years or older.

(2) The older population itself is aging. The number of very old people (aged 80+ years) is projected to grow by a factor of from 8 to 10 times on the global scale, between 1950 and 2050. By 2150, about a third of the older population will be 80 years or older.

(3) The majority of older persons (55%) are women. Among the oldest old (85 years or older), 65% are women.

(4) Striking differences exist between regions. One out of five Europeans, but one out of twenty Africans, is aged 60 years or older.

(5) As the tempo of aging in developing countries is more rapid than in developed countries, developing countries will have less time than the developed countries to adapt to the consequences of an aging population.

(6) By the end of year 2000, the majority of the world’s older persons (51%) will be living in urban areas. It is projected that by the end of the year 2000, almost 78% of older women and more than 75% of older men in more developed regions will be living in urban areas. The majority of older persons of both sexes in developing regions are expected to remain in rural areas¹,².

The number of elderly is expected soon to increase steeply, with implications for a vast increase in the numbers of persons requiring special services (health, recreation, housing, nutrition, etc.) There must be a recognition of the possible implications of an aging society for the whole range of social institutions, from education and family to business and government. It is well known that the number of people aged over 80 is set to increase dramatically this century. It is less appreciated, however, that this demographic change will be most significant in less developed countries. The world’s population aged 60 and over increased by more than 12 million in 1995, 80% of this increase occurring in less-developed countries, and this trend is expected to continue in the future. For example, over the next 50 years the elderly population is projected to increase by 23% in the UK, but by 292% in Brazil, 324% in Mexico and 414% in Indonesia. Poorer and less developed countries are in the main totally unprepared for this phenomenon, and their problems will be exacerbated by social change, including urbanization with breakdown of family support, a trend towards nuclear families, work outside the home for women, and (to some extent) a change in the traditional values of reverence for older people (www.un.org; www.who.org; www.popin.org).

A CASE STUDY — JAPAN

No other population in the world is aging as quickly as that of Japan. By the year 2020, according to Japan’s Institute for Population Problems, an organ of the Ministry of Health and Welfare, people aged 65 and over will account for 25.5% of the nation’s population; this will be more than double the 12.1% of 1990. Because elderly Japanese have the longest life spans among any developed nation in the world, daily care for many infirm people can last 10 years or more. This places great stress on both professional caregivers and the bedridden person’s family.

In Japan, unlike the US and many European countries, an individual’s health care continues to be covered completely by social insurance, no matter how old the person is, and in the fiscal year 1995 various union and government health insurance plans covered about 71 million Japanese. But even though most Japanese are covered by medical insurance, a severe imbalance is putting enormous financial pressure on this system (www.un.org; www.who.org; www.popin.org).

FEMALE ADVANTAGE IN LIFE EXPECTANCY PARTIALLY OFFSET BY DISABILITY

As life expectancy at birth and at older ages increases, the quality of that longer life becomes a major issue. The concept of healthy life expectancy (also called active life expectancy or disability-free life expectancy) refers to the average number of years that persons may expect to be free of limitations of function due to one or more chronic disease conditions. It is difficult to precisely compare measures of healthy life expectancy among nations because of computational and conceptual differences.

Various studies show that women who reach 65 can expect to live more disability-free years than their male counterparts (except in the Netherlands). However, because women have higher life expectancy than do men at age 65, the proportion of disability-free remaining life at age 65 tends to be greater for men.

THE OLDEST OLD

In many countries of the world, the oldest old (those 85 years and older) are the fastest growing portion of the elderly population. The oldest old constituted 23% of the world’s 60-and-over population in 1996, 30% in more-developed countries and 19% in less-developed countries. More than 43% of the world’s oldest old in 1996 lived in just four countries: the People’s Republic of China, the United States, India and Japan. In some African and Asian nations the population age 75 and over at present constitutes less than 1% of the total population. This contrasts sharply with the situation in Europe and North America, where the proportion of the oldest old reaches as high as 8.5% (Sweden). The numerical growth and increasing heterogeneity of the oldest old challenge social planners to seek further information about this group, since the oldest old consume disproportionate amounts of health and long-term care services.

The growth in the number of the oldest old (aged 85 and over) is of great public concern. During 1995 to 2010, this population is expected to grow by 56%, as compared with 13% for the populations aged 65 to 84. In subsequent decades, especially between 2030 and 2050, the 85-and-over age group will grow sharply as the ‘baby-boom’ cohorts age. The 85-and-over age group is expected to increase from 3.6 million in 1995 to 5.7 million in 2010, to 8.5 million in 2030, and to 18.2 million in 2050. Thus, while the expected increase from 2010 to 2030 is just less than 50%, the increase from 2030 to 2050 is 114%. The cumulative growth in the 85-and-over population from 1995 to 2050 is anticipated to be more than 400%, and the proportion of that group in the total population is likely to increase from 1.4% in 1995 to 4.6% in 2050.

Changes in the proportion of elderly in the total population have a different causal basis. The projections of a very high and increasing proportion of elderly from 2010 to 2030 are accounted for by three factors: (1) declining and low fertility in the past and the prospect of continuing low fertility up to 2030 (and beyond); (2) maturing of the baby-boom cohorts; and (3) sharp declines in mortality at the adult and older ages in the recent past and the prospect of continuing low mortality up to 2030 (and beyond). Once the baby-boom influx is over (i.e., has completely passed age 65) in 2030, the proportion of elderly in the total population is expected to stabilize³.

The figures for all race groups combined tend to reflect mainly the changes in the white elderly population. Blacks, Asian and Pacific Islanders and Hispanics will share in the main trends described, but to a more intensive degree. Between 2010 and 2030, the size of these racial/ethnic groups will increase dramatically. Similarly, dramatic increases are projected between 2030 and 2050 for the 85-and-over age group in these populations. The rates of growth for Asian and Pacific Islanders (the main component of the ‘other races’ group) and Hispanics far exceed those for whites in all periods⁴.

References

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1. Manton KG, Liu K. The future growth of the long-term care populations: projections based on the 1977 National Nursing Home Survey and the 1982 Long-Term Care Survey. Presented at the Third National Leadership Conference on Long-Term Care Issues, Washington, DC, March 1984

2. Kunkel SR, Applebaum RA. Estimating the prevalence of long-term disability for an aging society. J Gerontol: Social Sciences 1992;475: S253–S260

3. Zedlewski SR, Barnes RO, Burt MK, et al. The Needs of the Elderly in the 21st Century. Washington, DC: Urban Institute, 1989

4. US Bureau of the Census. Population projections of the United States by age, sex, race, and Hispanic origin: 1995 to 2050. Curr Pop Reports. Washington, DC: US Government Printing Office, 1996a:25–1130

Dermatological problems and treatment in long-term/nursing-home care

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R. A. Norman

INTRODUCTION

There is a growing need for expertise in dermatological consultations in the long-term care ...