Psoriasis can begin as early as age 60 and is often associated with other conditions such as obesity, type 2 diabetes, hypertriglyceridemia and cardiovascular disease. Psoriasis is a skin condition in which the surface layers of skin rapidly build up cells to form thick, tough patches that could resemble scales. Psoriasis is a chronic condition as the symptoms can be persistent. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, psoriasis begins with the immune system. T cells, which are a kind of white blood cell, are activated by mistake. Under normal conditions, they’re only activated when there’s a threat to the immune system. When they act erratically, the skin cells begin to die and reproduce at a rapid rate, causing the tissue to pile up on top of itself in the form of scales.
For a significant portion of older adults with late-onset psoriasis, the symptoms are severe and usually require a systemic therapeutic plan. Older adults with psoriasis are at a greater risk of further complications due to medication intake. Aging, as well as existing medications for complex and chronic conditions often make therapeutic decision-making difficult. Having more than one medication and a potential drug interaction may cause a relatively mild case of psoriasis to worsen.
It’s important to recognize that there are different types of psoriasis and that each strain can cause varying symptoms. The most prominent symptoms of the disease, besides the scales, are ridged nails, stiff joints and extremely dry skin. Older patients are at a greater risk for psoriasis and arthritis which discolors the nails and causes painful joint movement. Aging reduces the skin’s ability to protect itself as collagen in the outer layer lowers by about 1-2% per year. This can cause thin skin, decreased blood supply and severe dryness. The outer layer of the skin is more prone to damage, increased risks for infection, and slowed healing exacerbating the condition.
As psoriasis is a chronic condition, older patients, and their caregivers can benefit from Chronic Care Management (CCM). Care Managers can remind older patients on a monthly basis to be mindful and away of the risks and symptoms for psoriasis and to take some preventive measures such as moisturizing the skin regularly. Those older patients in discharge or return home can be particularly mindful of risk for skin infections and severely dried skin from having been in a hospital or skilled nursing facility. Transitional Care Management (TCM) teams can assess these risks and help older patients and their healthcare providers avoid overuse of prescription drugs. CCM and TCM care Managers can remind patients and their healthcare providers of topical ointments and other therapies. Ultraviolet (UV) light therapy, steroid creams, and other topical treatments may alone or in combination present the right solution avoiding adding to polypharmacy use.
It is very important for older adults to take care of their skin. Late-onset psoriasis can present very different challenges ranging from disease severity to the heightened caution required when choosing systemic therapies. CCM and TCM Care Managers can monitor for risks such as stress, medications, infections, and particularly environmental exposure that can negatively affect the severity of the disease. The aging process contributes to skin changes in older adults. With routine monitoring, planned diets, and appropriate levels of care, older patients can keep their skin healthy for a long time.
Written by Joseph F. West, ScD on Wednesday, 02 November 2016. Posted in Skin Health, Psoriasis, Immune Disease, TCM, CCM