Introduction

Geriatric Treatment is a branch of medicine which deals with problems of the elderly ranging from cognition, memory, assisted living, to diseases of the skin. Age is something which we do not have a control over. With age, various problems arise both internally within the body as well as externally with regard to the skin. Elderly population is most vulnerable to skin infection and other dermatological diseases due to the changes that occur with age. The skin becomes tight, dry, and thin.

The chances of injuring the skin in the elderly gets easier and it takes more time than normal for them to heal. Elderly people are prone to problems like persistent skin itching, infections, and even ulcerations. In some cases, some of these ulcerations can be quite serious and potentially life threatening.

What Are The Common Skin Conditions Seen In The Elderly?

Senile Purpura:This is a condition commonly seen in the elderly population where purple colored spots appear on the skin surface in the upper and lower extremities. It is mainly caused due to the skin becoming thin and the fragile nature of the capillaries and vessels beneath the skin surface due to age.

Stasis Dermatitis: This condition causes dry skin. There is also heightened itching sensation seen more in elderly females than males.

Exfoliative Dermatitis: This form of dermatitis is more severe in nature than stasis dermatitis where there is shedding and peeling of the skin. The excessive itching sensation hat this condition causes can lead to frequent infections in the elderly population.

Bacterial Skin Infections: Age is not a factor when it comes to bacterial skin infections. However, the elderly people are more susceptible to it than the younger population because of the sensitive nature of the skin in the age group above 70 years. Scabies and ringworm are the most common infections that are seen in the elderly population.

Viral Skin Conditions: Shingles and Herpes Zoster are some of the viral infections that are quite common in people above the age of 70 due to the immune system being compromised. This makes them vulnerable to viral infections more than the normal population.

How To Take Care Of Skin In The Elderly?

Generally speaking, the skin of elderly people requires more care and attention due to the frailty and dryness that is associated with it. If the skin becomes excessively dry then the likelihood of the skin surface cracking increases which makes it easier for bacteria to enter the body and cause infections.

Mentioned below are some easy techniques to take care of the skin in the elderly.

• It is always recommended to avoid any hot baths frequently. It is best to heat water not to excessively so that it can be easy on the skin.
• It is better to try and avoid soaps with chemicals and fragrances as it can do more harm than good. Additionally, it is recommended to apply moisturizers after every bath to keep the skin moist and prevent any cracking or peeling of the skin.
• Ensure that the person does not spend excessive time in a bed or a wheelchair, as it may lead to bedsores. If the individual cannot be moved about in the room, it is best to change their positions every hour or so to prevent pressure ulcers from developing. Equipment like catheters should also be changed on a regular basis to prevent the skin from getting infected at the entry site of the catheter.
• Abstaining from smoking completely helps a great deal in keeping the skin healthy
• Double chin reduction
• Avoid over exposure to sunlight or always apply sunscreen when venturing out in the sun to prevent the skin from getting dry and cracked
• It is essential to stay hydrated to keep the skin moist and prevent scaling of the skin

In conclusion, skin care is extremely essential for the elderly population. This is because a dry cracked skin opens the doorway for various bacterial and viral infections, aside from becoming vulnerable to various skin disorders. Stasis dermatitis and senile purpura are the most common skin conditions that are seen in the elderly population. They can be taken care of by applying moisturizers, lotions, and gels. However, it is highly recommended for caregivers to pay special attention to skin care for any elderly patient.

It should be a regular practice to avoid excessive hot water when bathing and using soaps and creams with chemicals to prevent the skin from getting adversely affected. Bedsores which is extremely common in the elderly population is also something that caregivers should be wary about, especially in patients who cannot move about on their own an are pretty much bedridden.

For such patients, it is important to change positions regularly to prevent formation of pressure ulcers. For a bacterial or vial skin infection, it is best to seek consultation with a physician for prompt treatment and prevent complications in an elderly patient.

What Causes Hair Loss?

What exactly causes disruption of hair growth resulting in Hair Loss is not known but many physicians are of the opinion that it occurs due to the following reasons:
Hereditary Factors: This is perhaps the most common cause of Hair Loss. The process begins with recession of the hairline in males and hair thinning in females. This is followed by baldness in specific areas of the scalp. This is in majority of the cases seen in males. As the individual ages, the thinning increases and by the time he is 50 or 60 years of age there is visible baldness that is seen.
Hormonal Changes: Hormonal changes, especially during pregnancy, postpartum, or when the female attains menopause also at times causes temporary hair loss. An underactive or an overactive thyroid, which controls the production of hormones in the body, is also one of the reasons for Hair Loss in females.
Medical Conditions: In addition, there are also certain medical conditions which induce Hair Loss. Alopecia Areata is one such medical conditions and a common cause for Hair Loss/. It is an autoimmune disorder in which the immune system of the body attacks the hair follicles damaging them and causing Hair Loss. The presenting feature of Alopecia Areata is the presence of bald patches on the scalp and other areas of the body where hairs are normally seen such as the chest. Other than this,
Infections: Fungal Infections affecting the scalp are also one of the common causes for Hair Loss albeit temporarily. Once the infection is treated then the hair starts growing back normally. Additionally dermatological conditions like lichen planus and even at times lupus is also believed to cause Hair Loss. Trichotillomania, commonly called as Hair Pulling, which is a behavioral disorder, is also one of the common causes for Hair Loss.
Medications: There are also certain medications that are responsible for causing Hair Loss. Among the various classes of medications, chemotherapy drugs are the most common in causing Hair Loss. Other than this, antidepressants, cardiovascular medications, antihypertensives all have a tendency to cause Hair Loss.
Other than the primary causes mentioned above of Hair Loss, there are also some secondary causes like exposure to radiation therapy for treatment of some form of cancer is one of the causes for Hair Loss. There have been cases reported where stress has played a role in an individual having hair loss. This usually occurs after a physical or an emotional shock.
Hair Loss occurring due to stress is generally temporary with the hair growing back once the trigger is removed. It has also been observed that certain hair care treatments instead of doing good have resulted in further hair loss. Even some form of hairstyles like the ponytail is well known for its tendency to cause Hair Loss.

What are the Symptoms of Hair Loss?

The presenting features of Hair Loss are different in cases of males and females, and children. However, among all three the primary symptom is that of clumps of hair coming out with combing or washing the hair. In cases of males, the symptoms of Hair Loss include loss of hair along the anterior portion of the hairline. There is also thinning of hairs around the crown area. The hair loss continues to such an extent where the scalp becomes visible with not even a strand of hair left.
In cases of females, the hair loss is more diffuse and spread across the entire scalp. There is visible widening of the hair partition, especially along the center. In cases of children, there will be patches of hair loss over the scalp for no known reason that presents abruptly. There will also be lack of hairs on the eyebrows and other parts of the body.

How is Hair Loss Diagnosed?

For a definitive diagnosis of the cause of the Hair Loss, the physician will first take a detailed history of the patient, including personal and family history. Once history taking is done then certain investigative tests will be ordered to come to the bottom of the cause of the Hair Loss. These tests include:
Pull Test: This test involves pulling of a few strands of hair forcefully to check whether any hairs come out of their groove. This gives the physician an idea of whether the quality of hair of the patient is healthy and strong.
Skin Lesion KOH Test: This test involves scraping some samples from the scalp of the patient to observe the hair roots. This gives the physician an idea as to whether there is an infection responsible for Hair Loss.
Blood Test: These are done to identify any underlying medical condition like a thyroid disorder that may be responsible for Hair Loss in the patient.
Microscopy: This is done to observe the hair shaft and see whether there is any abnormality there that may be causing the Hair Loss.

How is Hair Loss Treated ?

While some cases of Hair Loss are permanent and cannot be treated, in many instances Hair Loss is temporary and hair growth comes back to normal once the offending condition or trigger is taken care of. In people with Alopecia Areata, there is spontaneous regrowth of hairs after about a year once the condition resolves without the need for any specific treatment. In other cases, however, there are certain treatments that are required to stimulate hair growth. These treatments include medications, Laser treatments, and surgery in the form of hair transplantation.
Based on the history of the patient, the cause and extent of Hair Loss, the physician will formulate the best treatment plan for the patient. The primary aim of the treatment is to delay the progression of hair loss and stimulate new hair growth. The treatment options for Hair Loss include
Medications: If a medical condition is believed to be a cause for Hair Loss then, to begin with, a treatment for the medical condition will be done. This will require use of medications and other therapies as and when required. In case if a medication is responsible for Hair Loss then it is advisable to stop the medication and go for an alternative to prevent further loss of hair.
As of now, there are two FDA approved drugs effective for Hair Loss. They include Minoxidil and Finasteride. Minoxidil comes in the form of a liquid which can be applied directly on the scalp at least twice daily to prevent further hair loss and stimulate new growth of hair. The medication usually takes about four months to completely kick in. It has a side effect profile of abnormal hair growth surrounding the area of application and scalp irritation.
Finasteride is available only on a written prescription by the physician and is taken orally. The main aim of this medication is to prevent hair loss. In some cases, people have observed growth of new hair on this medication but this need to be verified with more research. Finasteride has a side effect profile of alteration in sexual function and an increased risk of prostate cancer.
Hair Transplant Surgery: This is perhaps the most effective treatment for Hair Loss as of now. This is recommended for people with extensive hair loss who have failed all other forms of treatment. This surgery involves extracting hair from other areas of the body and placing them on the scalp where there is thinning of the hair.
After successful transplantation, the physician may prescribe certain medications to be used for some time till new hair grows. It normally takes up to one year for normal hairs to grow back and see the results of the surgery. However, initial improvements can be observed from the fourth month post-transplant.
There are two methods of doing a hair transplant surgery, namely the FUT (Follicular Unit Transplantation) and FUE (Follicular Unit Extraction) techniques. The FUE method of transplantation is the most preferred one, as it is minimally invasive and has the maximum success rate. More research is being done in this sphere to come up with more advanced procedures and much better results for people with Hair Loss.

Can Hair Loss be Prevented?

Hair Loss caused due to the normal process of aging cannot be prevented. However, steps can be taken to prevent loss and damage by avoiding chemical use in the hair like hair color and hair dyes. It is also recommended not to use hair dryers for long periods of time as it literally pulls the hair out from their shafts thereby damaging it. This makes the hair weak and brittle.
For healthy hair, it is always best to practice good hair hygiene by shampooing it regularly. Additionally, eating a diet rich in proteins, vitamin B, and iron is also quite effective in preventing hair loss. Keeping the thyroid levels under control and seeking immediate levels if diagnosed with an underactive or overactive thyroid is also recommended to prevent Hair Loss.