Frailty and functional dependency affect treatment satisfaction and may require tailored care for older adults with psoriasis, researchers report.
Assessing frailty and functionality dependency in older adults with psoriasis has important implications in treatment decision-making, according to findings reported in the Journal of the American Academy of Dermatology.
For the multicenter cohort study, Elke L. M. ter Haar, MD, PhD candidate, and colleagues investigated the prevalence and extent of frailty and functional dependency and their outcomes for psoriasis management in 102 adults aged at least 65. The Geriatric-eight (G8), Groningen Frailty Indicator (GFI), and Clinical Frailty Scale (CFS) were used to assess frailty. The (instrumental) activities of daily living (ADL) indices were used to measure functional status.
The G8, GFI, and CFS classified 42.2%, 26.0%, and 13.7% of patients as frail, respectively. Additionally, 14.9% of patients were ADL-dependent, and 37.6% were (instrumental) ADL-dependent. Furthermore, 27% of all patients needed assistance with their psoriasis treatment.
More specifically, the researchers found that requiring treatment assistance with psoriasis therapy was more common in patients who were frail versus patients who were not frail (G8, 41.5% vs 16.9%, respectively; P=0.007; CFS, 57.1% vs 22.1%; respectively; P=0.019), and in ADL-dependent versus ADL-independent patients (53.3% vs 21.4%, respectively; P=0.021).
According to CFS and the Treatment Satisfaction Questionnaire for Medication, patients who were frail were less satisfied with psoriasis therapy compared with patients who were not frail (20.0% vs 68.1%, respectively; P=0.005 and 60.0% vs 95.8%, respectively; P=0.004).
Frailty Requires a Different Approach
The authors cited study limitations such as small sample sizes and variations among frailty screening tools.
“Overall, these findings suggest that frail or functionally dependent older patients with psoriasis may require a different approach in clinical practice, for example focusing on individual unmet needs, consultation with geriatric specialists or general practitioner,” Dr. ter Haar and coauthors wrote. “Therefore, addressing frailty and functional dependency in daily clinical practice could be valuable for personalizing psoriasis care.”
The researchers noted that the CFS shows promise for treatment decision-making and identifying patients requiring tailored management since it identified most management implications compared with other screening tools. Additionally, the CFS is easy to use and can be quickly deployed, which is essential for dermatology consultations. The researchers recommended larger-scale research on the consequences of daily practice implementation of the CFS among this patient population.
