الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The skin is a complex organ covering the whole surface of the body and it is continuous with the mucous membranes lining the body’s orifices. It accounts for about 15% of the total adult body weight, and is therefore the largest organ of the body.
Skin problems are prevalent among the elderly. The most common of which are eczema, psoriasis and fungal infections. Eczematous dermatitis is the most frequent skin problem among the elderly due to several factors, increased sensitivity to the irritants and allergens and epidermal barrier dysfunction. Besides, the eczematous lesions are medically resistant and chronic.
Although mortality rates are generally low, skin conditions could have a negative impact on one’s QOL, affecting his physical, social and psychological well-being. The disability-adjusted life years associated with skin diseases have been reported to be similar to those of other medical conditions.
An increasing rate of prevailing psychological disorders among patients with dermatological diseases has been reported. Due to their chronic nature, their effects on the individuals’ self- image, losing hope of total recovery and their frequent recurrences, dermatological diseases are considered one of the predisposing factors causing depression. Many of such patients either do not go for remedy due to their depression or do not carry on the treatment because of losing hope. Some may even commit suicide if they feel very depressed and hopeless.
Physical impact of skin problems depends on the extent of the problem, how active the lesion is, its area and associated symptoms, such as itching and flaking. The social impact of the disease is evident in situations that involve closeness and exposure of the skin.
The aim of the present work was to study skin problems and quality of life among the elderly patients attending the dermatology outpatient clinics in Alexandria.
The study was a cross sectional study carried out in two dermatology outpatient clinics; the outpatient clinic in Alexandria Main University Hospital and an outpatient clinic affiliated to the Ministry of Health (dermatology clinic in Bakous) targeting elderly patients 60 years and more attending the previously mentioned settings, accepting to participate in the study and having no communication problems.
The minimum calculated sample size was 250 based on a prevalence of skin diseases among elders of 20.5% using margin of error 5% and alpha error of 0.05. The sample was selected from the previously mentioned clinics using equal allocation. The clinics were visited 4 days per week on alternative basis and patients who accepted to participate in the study were interviewed after diagnosis by the specialist.
Data collection was conducted using the following tools and techniques:
A) A pre-designed structured interview questionnaire to collect the following data:
1. Socio-demographic data
2. Personal habits and hygiene
3. Medical history
4. Skin care and intention to do cosmetic procedures
B) The Arabic version of Dermatology Life Quality Index (DLQI)
C) Daily registers and/or patients’ prescriptions to confirm the diagnosis and the treatment.
Data entry and statistical analysis were conducted using the software SPSS (Statistical Package for Social Science) version 21.
The main results of this study could be summarized as follows:
• The study sample included 250 elders; 147 females (58.8%) and 103 males (41.2%).
• The age of the study sample ranged from 60 to 80 years with a mean age of (64.9±4.0 years).
• The highest percentage of the elders of both sexes (76.8%) were married. Regarding education, the highest percentage (42.0%) were illiterate or could only read and write while only 5.6% were university graduates or postgraduates.
• 38.4% of the elders were retired and they were depending on their pension as their source of income. On the other hand, the source of income of 51.6% of the study sample was the familial and social aids. Nearly half of the study sample (53.2%) mentioned that their income wasn’t enough and that they even borrowed.
• The majority of the elders (81.6%) never smoked before and only 8.4% quitted smoking. Most of the study sample (96.8%) didn’t practice any sports.
• The modal frequency of bathing during summer was once every 3 days represented by 44.4% and once per week in winter represented by 59.2%
• Most of the elders (90.0%) washed their hands after subjective feeling of being dirty and 41.2% of them after eating. More than half of the study sample (58.0%) changed their under-clothes once every 2 days while only 7.2% changed their under-clothes once per week.
• The most prevalent skin problem among the study sample was eczema (24.4%) followed by psoriasis (12.4%) and fungal infections (12.0%).
• The highest percentage of elders (33.2%) suffered from the present skin problem for one year or more while the least percentage (3.6%) suffered for less than 1 week.
• More than half of the study sample (55.6%) suffered from the symptoms of the problem more than once.
• The majority of the study sample (76.8%) visited a dermatologist twice or more and their last visit was since less than 6 months (75.6%).
• Most of the elders (97.6%) had no family history of the skin problem.
• Patients suffering from xerosis, psoriasis, fungal infections and eczema reported increase in the flare in winter represented by 77.3%, 67.7%, 40.0% and 25.5% respectively. On the other hand, fungal infections flared in summer represented by 33.4%.
• Most of the study sample (94.0%) got topical treatment and 38.8% got oral treatment while only 10.0% had phototherapy and laser sessions.
• Only 20.8 % of the elders were non-compliant with the treatment. The highest cause of non-compliance was getting bored due to chronicity of the condition (44.4%) followed by high cost of the treatment (33.3%).
• Most of the study sample (88.0%) didn’t perform a daily skin care regimen.
• Patients suffering from eczema, psoriasis and vitiligo represented by 23.2%,18.8% and 15.2% respectively feared mostly of disfigurement.
• The highest percentage of elders suffered from diabetes mellitus, hypertension and cardiac diseases (57.2%, 54.4% and 46.4%) respectively.
• Half of the study sample (50.4%) took two or three medications per day, while 33.2% of them took four or more medications.
• All patients suffering from psoriasis and the majority of the patients suffering from bacterial infections (76.9%) were found to be diabetics. It was also found that more than half of the patients suffering from viral infections, xerosis and fungal infections were diabetics represented by 61.1%, 59.1% and 56.7% respectively.
• More than half of the study sample (55.6%) were ‘‘very largely’’ affected regarding their quality of life and 34.4% were ‘‘moderately’’ affected. The DLQI had a mean of 11.2±4.1and a range of (0-26).
• Based on the specific responses of DLQI, the ‘‘physical’’ domain was the most affected among the study sample as the highest affection was found in the interference of treatment with the time needed for house tidying and shopping or looking after home or garden representing 46.0% and 44.0% respectively.
• ‘‘Very large’’ effect on the quality of life was higher among males (59.2%) while ‘‘moderate’’ effect was higher among females (36.1%). However, the result was not statistically significant (p=0.90)
• The older age group were more affected than their younger counterparts regarding their quality of life (61.2% and 54.7% respectively).
• ‘‘Very large’’ effect on the quality of life was found to be the highest among those suffering from psoriasis and eczema (83.8% and 75.4% respectively).
• The longer the duration of the problem, the more the effect on the quality of life. ‘‘Very large’’ effect on the quality of life was found among elders suffering from the problem since 6 months to less than 1 year and among those suffering from the problem since one year or more representing 66.6% and 60.3% respectively.
• The more frequent the problem, the higher the effect on the quality of life. QOL was ‘‘very largely’’ affected among elders whose skin problems recurred once (58.8%) or more than once (59.0%).
• The more the number of medications taken by the study sample was, the larger the affected the quality of life. Patients who had 4 or more and 2-3 medications had a ‘‘very large’’ effect on their quality of life represented by 61.5% and 50.8% respectively.
• The ‘‘very much’’ interference of treatment with the time needed for house tidying was higher among elders suffering from bacterial infection, psoriasis and eczema (77.0%, 64.5% and 57.3%) respectively.
• The ‘‘very much’’ interference with shopping was higher among elders suffering from bacterial, fungal infection and xerosis (76.9%, 53.3% and 54.5%) respectively.
• The ‘‘very much’’ influence on the type of clothes worn was higher among elders suffering from psoriasis, bacterial infection and eczema (71.0%, 69.2% and 69.0%) respectively.
• The ‘‘very much’’ affection of the QOL among psoriasis patients was higher on the type of clothes worn, treatment effect on the time needed for house tidying, problems with the partner or close friends or relatives and interference with social or leisure activities (71.0%,64.5%,45.2% and 38.7%) respectively. ‘‘A lot’’ affection was found to have a higher influence on shopping or looking after home or garden. (51.6%).
• The ‘‘very much’’ affection of the QOL among eczema patients was higher on the type of clothes worn, treatment effect on the time needed for house tidying, problems with the partner or close friends or relatives, interference with social or leisure activities and interference with shopping or looking after home or garden (69.0%, 57.3%, 47.5%, 46.0 and 44.3%) respectively. ‘‘A lot’’ affection was found to be the highest in embarrassment (36.1%).
Based on these results the following are recommended:
• Quality of life of patients with skin problems should be considered when dealing with chronic skin diseases.
• More time for the dermatologists is needed to be spent with patients to explain for them the nature of the problem, the medications’ way of application, possible side effects and specific skin care.
• Cooperation between the dermatologists and other physicians to ensure proper medication prescription to prevent drug interactions.
• Training of the dermatologists and other health care professionals on the application of the QOL assessment tools is mandatory for selection of the most suitable treatment regimen for each patient individually.
• Health education for the elderly about aging changes of the skin, probable skin problems, how to deal with and self-skin care.