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Care home residents with scabies going undiagnosed due to different symptoms

Prof Jackie Cassell, BSMS

Elderly residents in residential and nursing care are missing out on being diagnosed with scabies because their symptoms differ from what doctors and nurses expect in younger people. As a result, vulnerable patients are not getting the necessary treatment, suffering with this infectious skin condition for long periods of time and passing it on to other residents and staff.

Researchers at Brighton and Sussex Medical School (BSMS) studied outbreaks in 10 care homes for the elderly in the South East of England. They found that among older people scabies symptoms tended to be found on parts of the body normally covered by clothes, rather than on the hands, where healthcare professionals would tend to look for them. In addition, many residents who have dementia may not be able to complain of itching, so this symptom was also being missed.

Scabies is a WHO designated Neglected Tropical Disease which remains a public health challenge in the UK. It is mainly transmitted through skin to skin contact, which may include care activities such as washing or dressing. Outbreaks regularly occur in residential and nursing care homes for the elderly, and can be difficult to manage, distressing and highly stigmatising.

First author and Head of the Department of Primary Care and Public Health at BSMS, Professor Jackie Cassell, said: “Although scabies has long been known to be a problem in residential care for the elderly, our study has shown why it has been so difficult to recognised and control in this setting.

"Symptoms in this vulnerable population are typically very different from what doctors have been taught to expect, which makes it harder for care home staff and clinicians to diagnosis scabies. What’s more, those with dementia are particularly at risk of being left undiagnosed, given their difficulties with communicating discomfort and itching.”

During 10 outbreaks in care homes over a period of 15 months, dermatology-trained physicians examined 230 residents with a median age of 86·9 years, 157 of whom had dementia. Over a quarter of residents examined (26·5%) were diagnosed with scabies, and more than half of those diagnosed (57·4%) only had signs on areas of the body that are normally covered. The odds of receiving a scabies diagnosis were increased 2.4 times for residents with dementia.

Professor Cassell added: “We believe our findings will make it easier for doctors and care home staff to recognise scabies outbreaks quicker, by showing how scabies presents differently in this elderly and vulnerable population. It’s important that they undertake thorough examinations of patients, particularly in those with dementia.

"By putting these practices into place through guidelines and educational material, we hope to see a reduction in the number of outbreaks in such residential settings, and quicker diagnosis and treatment.”

The study was conducted in collaboration with the London School of Hygiene & Tropical Medicine and Public Health England, and has been published in The Lancet Infectious Diseases.

Brighton and Sussex Medical School (BSMS) is a partnership between the Universities of Sussex and Brighton and  the local NHS health community. 


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Posted on behalf of: BSMS
Last updated: Friday, 3 August 2018