Supporting skin health in older adults at home
As the ageing population continues to increase, more older adults are living at home and there is a need for evidence to support dermatological care and improved skin health in community settings. The authors of this study highlight that, while home and community settings are where most care is delivered worldwide, most dermatological studies are carried out in secondary and tertiary care settings.
A scoping review, recently published in the Archives of Dermatological Research, sought to map the available evidence on the most frequent skin conditions affecting older people living in the community (Kottner et al, 2024). Guided by the PRISMA guidelines, this study included the knowledge base surrounding the epidemiology and burden of these conditions, as well as the effects of screening, risk assessment, diagnosis, prevention and treatment. The authors systematically searched Medline, Embase and Epistemonikos to identify clinical practice guidelines, reviews and primary research studies, as well as Grey Matters and EASY for grey literature between January 2010 and March 2023. Inclusion criteria included studies conducted in community or primary care settings; people living at home who were aged 60 years or older; reporting of numerators/denominators/time period; descriptive and interventional study designs, as well as systematic reviews and clinical practice guidelines (not editorials, opinion papers or case reports); and publication from January 2010 onwards.
A total of 97 publications were included after screening, with sun-exposure and age-related conditions such as androgenic alopecia, seborrheic and actinic keratoses, lentigo, benign skin tumours, xerosis cutis, neoplasms and inflammatory skin diseases or fungal skin infections being the most frequently identified dermatoses. Age ranges varied widely and reporting was frequently unclear. There was a low number of studies presenting empirical evidence regarding epidemiology, burden and treatment effectiveness, as well as intervention effects. Most of the evidence related to community settings included prevalence and incidence estimates. Kottner et al (2024) concluded that best practices for the improvement of skin health in older people remain unclear and there is a strong need for interventional studies, in particular to support and improve skin health in older adults at home.
Influence of age on vitamin D3 metabolism
In a comparative study, published in Nutrients, the influence of age on the early stage of vitamin D3 metabolism was examined (Borecka et al, 2024). Vitamin D3 synthesis in human skin is initiated by solar ultraviolet radiation (UVR) exposure to 7-dehydrocholesterol (7DHC).
This prospective standardised study compared healthy, ambulant adults aged 65 years and over (65–89 years) with adults aged 40 years and younger (18–40 years) to determine whether baseline skin 7DHC concentration differs between younger and older adults, as well as what the impact is of older age on serum vitamin D3 response to solar simulated UVR. In this study, 11 younger and 10 older adults with phototypes I–III received low-dose UVR to 35% of the body surface area.
Biopsies were then taken for 7DHC assay from skin that was not exposed immediately after UVR, as well as 24 hours later. According to findings once samples were analysed via high-performance liquid chromatography mass spectometry, baseline skin 7DHC (mean+SD) was 0.22+0.07µg/mg in younger people and 0.25+0.08 µg/mg in older people, though there was no significant difference. Participants’ blood was also sampled at baseline, at 24 hours, and 7 days post UVR exposure for vitamin D3 assay. Baseline serum vitamin D3 concentrations were 1.5 ± 1.5 nmol/litre in the younger adult group and 1.5 ± 1.7 nmol/L litre in older adults, showing a significant increase in both groups post UVR exposure, but no significant difference between the two age groups.
In this particular study, age was not found to be a limiting factor for vitamin D3 production in older people when compared with younger adults. These findings may assist community nurses advising their patients on sun exposure and vitamin D nutrition, of particular relevance to the growing numbers of healthy, ambulant adults aged 65 years and older, as well as support public health guidance in these areas.
Gel treatment for non-healing diabetic foot ulcer
The BMJ Open Journal of Diabetes Research and Care has recently published a study aiming to assess whether chitosan-based gel, known as ChitoCare, may help to treat non-healing diabetic foot ulcers (Slivnik et al, 2024). Researchers evaluated the efficacy of the gel in 42 patients with non-healing diabetic foot ulcers. Each participant either had the ChitoCare gel or the placebo, and the outcomes from both were compared. The treatment duration was 10 weeks with a follow-up at 4 weeks. The researchers evaluated the rate of complete wound closure by the tenth week.
In total, 30 patients completed the 10-week duration of treatment and 28 engaged in follow-up at 4 weeks. The results were significant, with the participants who received the ChitoCare gel having a rate of 16.7% complete wound closure by the final week compared with 4.2% in the placebo arm of the trial. The ChitoCare group also had a 92% median relative reduction in the surface area of their wounds throughout the 10-week study duration, compared with 37% in the placebo group. The group receiving the ChitoCare also were 4.62 times more likely than the placebo participants to achieve a 75% wound closure by week 10.
The researchers also assessed the wound with the Bates-Jensen Wound Assessment Tool to determine the condition of wounds in all participants throughout the duration of the trial. Using this assessment tool, the team found that the wound state at week 10 and the wound healing rate since baseline were significantly improved in the group receiving ChitoCare.
The authors concluded that the ChitoCare gel significantly improved outcomes in patients with non-healing diabetic foot ulcers, improving the rate of the healing process and leading to some complete wound closures by week 10. The wound state and healing were improved with the gel when compared with effects of the placebo gel. This research may benefit nurses by contributing to the treatment toolkit for people in the community with non-healing diabetic foot ulcers.