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The University of Southampton
Medicine

Incidents of scabies in care homes are going undiagnosed

Published: 9 July 2018
scabies
Undiagnosed scabies in care homes

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, according to a new study involving the University of Southampton.

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. 

In collaboration with Brighton and Sussex Medical School (BSMS), Southampton researchers 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.

The study has been published in The Lancet Infectious Diseases and also involved the London School of Hygiene & Tropical Medicine and Public Health England.

Dr Michael Head, Senior Research Fellow at the University of Southampton, said: “The results show that care home residents with dementia are at increased risk of scabies, that the symptoms such as a rash are often hidden underneath clothing, and that these residents did not always complain about itching. Thus, there is significant misdiagnosis and delayed diagnosis in an especially-vulnerable population, and this can have a huge impact on thier quality of life.

“We are now developing new public health guidelines to deal with scabies outbreaks in this setting (with Public Health England and the British Skin Foundation), in order to help care homes be more confident in managing this common but highly-stigmatised problem.”

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 per cent) were diagnosed with scabies, and more than half of those diagnosed (57·4 per cent) 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 Jackie Cassell, First Author of the paper and Head of the Department of Primary Care and Public Health at BSMS, 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.

“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.” 

 

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