Scabies and people with dementia in care homes

[Bettusboo]

Scabies can have a devastating impact on the quality of life of people with dementia. Important research highlights the difficulties with diagnosing scabies for people with dementia and care homes having difficulty accepting when there may be a scabies outbreak. New Government guidance sets out a clear response for care settings.

My father’s devastating experience of developing scabies and it not being recognised or acted upon quickly is absolutely in line with some of this findings of this research.

Scabies can present differently in elderly people with scabies and may even be asymptomatic. It can be extremely distressing and the impact on the quality of life for many should not be underestimated.

I feel there needs to be much greater awareness of this issue which may be impacting negatively on the lives of many more people with dementia in care homes than is recognised.

Scabies outbreaks in ten care homes for elderly people: a prospective study of clinical features, epidemiology, and treatment outcomes

Clinical presentation of scabies in elderly residents of care homes differs from classic descriptions familiar to clinicians. This difference probably contributes to delayed recognition and suboptimal management in this vulnerable group. Dermatoscopy and microscopy were of little value...

www.thelancet.com

UKHSA guidance on the management of scabies cases and outbreaks in long-term care facilities and other closed settings

www.gov.uk

 

[Palerider]

Scabies can have a devastating impact on the quality of life of people with dementia. Important research highlights the difficulties with diagnosing scabies for people with dementia and care homes having difficulty accepting when there may be a scabies outbreak. New Government guidance sets out a clear response for care settings.

My father’s devastating experience of developing scabies and it not being recognised or acted upon quickly is absolutely in line with some of this findings of this research.

Scabies can present differently in elderly people with scabies and may even be asymptomatic. It can be extremely distressing and the impact on the quality of life for many should not be underestimated.

I feel there needs to be much greater awareness of this issue which may be impacting negatively on the lives of many more people with dementia in care homes than is recognised.

Scabies outbreaks in ten care homes for elderly people: a prospective study of clinical features, epidemiology, and treatment outcomes

Clinical presentation of scabies in elderly residents of care homes differs from classic descriptions familiar to clinicians. This difference probably contributes to delayed recognition and suboptimal management in this vulnerable group. Dermatoscopy and microscopy were of little value...

www.thelancet.com

UKHSA guidance on the management of scabies cases and outbreaks in long-term care facilities and other closed settings

www.gov.uk

I don't like this studies reporting in inter quartile range (IQR) which does not reflect the reality on the ground in the way it seems to come over without any recognition what IQR means in context. Published in the Lancet in 2018 with no compelling factors for the study in the first place.

Scabies in the UK (not the USA) in the elderly population is quite rare unless there has been some type of close physical contact with someone infected with scabies and if that has happened it would be quite concerning because it is usually through sexual contact or close prolonged contact.

 

[HardToLetGo]

Scabies can have a devastating impact on the quality of life of people with dementia. Important research highlights the difficulties with diagnosing scabies for people with dementia and care homes having difficulty accepting when there may be a scabies outbreak. New Government guidance sets out a clear response for care settings.

My father’s devastating experience of developing scabies and it not being recognised or acted upon quickly is absolutely in line with some of this findings of this research.

Scabies can present differently in elderly people with scabies and may even be asymptomatic. It can be extremely distressing and the impact on the quality of life for many should not be underestimated.

I feel there needs to be much greater awareness of this issue which may be impacting negatively on the lives of many more people with dementia in care homes than is recognised.

Scabies outbreaks in ten care homes for elderly people: a prospective study of clinical features, epidemiology, and treatment outcomes

Clinical presentation of scabies in elderly residents of care homes differs from classic descriptions familiar to clinicians. This difference probably contributes to delayed recognition and suboptimal management in this vulnerable group. Dermatoscopy and microscopy were of little value...

www.thelancet.com

UKHSA guidance on the management of scabies cases and outbreaks in long-term care facilities and other closed settings

www.gov.uk

Exceent

I don't like this studies reporting in inter quartile range (IQR) which does not reflect the reality on the ground in the way it seems to come over without any recognition what IQR means in context. Published in the Lancet in 2018 with no compelling factors for the study in the first place.

Scabies in the UK (not the USA) in the elderly population is quite rare unless there has been some type of close physical contact with someone infected with scabies and if that has happened it would be quite concerning because it is usually through sexual contact or close prolonged contact.

Not sure Palerider, spread quickly through my Mum's care home. Similar to Bettusboo the early case and the chance to nip it in the bud was missed which feels consistent with the study, I welcome the clear guidance from UKSHA

 

[Palerider]

Not sure Palerider, spread quickly through my Mum's care home. Similar to Bettusboo the early case and the chance to nip it in the bud was missed which feels consistent with the study, I welcome the clear guidance from UKSHA

I agree with you, I was a bit hasty purely because I don't like IQR being used in research statistics -it shows something had to be modified to make the research workable (put simply). That'll teach me to knee jerk react

 

[Bettusboo]

I don't like this studies reporting in inter quartile range (IQR) which does not reflect the reality on the ground in the way it seems to come over without any recognition what IQR means in context. Published in the Lancet in 2018 with no compelling factors for the study in the first place.

Scabies in the UK (not the USA) in the elderly population is quite rare unless there has been some type of close physical contact with someone infected with scabies and if that has happened it would be quite concerning because it is usually through sexual contact or close prolonged contact.

I have recent personal experience of this issue and based on this I can see why there may be lack of recognition or understanding of the scale of the problem. My dad has been in distress for months with an itchy skin condition and in spite of being seen by the GP and other health professionals, no one recognised that he had scabies until I took him to a private dermatologist. Even then I encountered a lot of resistance from the care home to accepting that as well as my dad needing treatment, his close contacts also did. I believe this is important research and it helped me to understand why we have had the difficulties we have in resolving something that should have been more straightforward with greater knowledge and awareness.

 

[Palerider]

I have recent personal experience of this issue and based on this I can see why there may be lack of recognition or understanding of the scale of the problem. My dad has been in distress for months with an itchy skin condition and in spite of being seen by the GP and other health professionals, no one recognised that he had scabies until I took him to a private dermatologist. Even then I encountered a lot of resistance from the care home to accepting that as well as my dad needing treatment, his close contacts also did. I believe this is important research and it helped me to understand why we have had the difficulties we have in resolving something that should have been more straightforward with greater knowledge and awareness.

I think it shows how sometimes we have to persevere and often the mindset in healthcare is one of becoming fixed on only one possibility and not considering others. To be fair it's not something many people see these days so recognition is not going to be instant but that doesn't defend ignoring when someone questions the status quo and maybe at least checking it out to see if it is scabies. I can appreciate how distressing this infection can be having seen it first hand.

Finally I am sorry for reacting to the research which was my knee jerk reaction to research with not the best statistical methodology. I think the second link you posted was more useful and if you read down it gives a more useful picture of the situation in the UK: 'Reliable estimates of scabies incidence are not possible, but it has been estimated that 1 in 50 long-term care facilities will experience an outbreak each year (4).'

 

[Bettusboo]

I think the key phrase here is reliable estimates are not possible. I’d hazard a guess that it is higher than the 1 in 50 outbreaks per year given the difficulties with identification and accepting there is a problem. The two care homes where my father has stayed and where he was examined by a GP did not recognise or accept the problem. I suspect a degree of under identification based on my experience but also the findings of the research. While I dont have sufficient knowledge of research methods to critique it, I do know that the researchers are reputable in their field and contributed to the guidance also.

 

[Palerider]

I think the key phrase here is reliable estimates are not possible. I’d hazard a guess that it is higher than the 1 in 50 outbreaks per year given the difficulties with identification and accepting there is a problem. The two care homes where my father has stayed and where he was examined by a GP did not recognise or accept the problem. I suspect a degree of under identification based on my experience but also the findings of the research. While I dont have sufficient knowledge of research methods to critique it, I do know that the researchers are reputable in their field and contributed to the guidance also.

Some things will always remain an approximation unfortunately.

I think the research paper is reputable that's not really what I was getting at, but more the way how the results were likely skewed or there were outliers that needed to be explained.

Research papers are highly useful especially peer reviewed, but they only offer one view of what is a more complex problem if broken down. How does someone with a transmissible disease before getting into a care home go unchecked? So care homes might improve their practice because of this, but what happens pre-care home how can that be managed and is it even researched? Its not so easy when the whole picture is considered.