The High Prevalence of Skin Diseases in Adults Aged 70 and Older

Suvi-Päivikki Sinikumpu, MD, PhD; Jari Jokelainen, MSc; Anna K. Haarala, MD; Maija-Helena Keränen, MD; Sirkka Keinänen-Kiukaanniemi, MD, PhD; Laura Huilaja, MD, PhD


J Am Geriatr Soc. 2020;68(11):2565-2571. 

In This Article


Study Cohort and Dermatological Examination

The Northern Finland Birth Cohort 1966 (NFBC1966) is an epidemiological and longitudinal research program in the two northernmost provinces in Finland (Oulu and Lapland). The NFBC1966 is composed of the offspring of the mothers who lived in either province and whose expected delivery date fell between January 1 and December 31, 1966.[12] The 12,058 subjects belonging to the NFBC1966 have been followed regularly since their birth, and their mothers were followed during the pregnancy.[13] The surviving mothers and fathers of the subjects in the NFBC1966 have participated in a comprehensive health study (Keränen et al., unpublished observations) including a skin examination.

By the end of the skin study, a total of 12,027 parents of members of the NFBC1966 were sent a diverse health questionnaire. Of these, 5,559 (46%) responded. All responders who were living in the Oulu area (n = 1,239) were invited to participate in the clinical examination. A whole-body skin examination was performed on 552 people (346 women and 206 men), and this subpopulation was included in the final skin study analysis. The skin data were collected between May 2018 and March 2019 on the premises of the Faculty of Medicine of the University of Oulu.

All areas of the skin including the nails, hair, and scalp were observed during a 20-minute visit. All skin diseases that were observable at the time of the study were recorded. Numbers of skin tumors were calculated, and skin tumors were further observed using a dermatoscope. Diagnoses of skin disorders were based on internationally accepted criteria and classified by the International Classification of Diseases, Tenth Revision. The international classification was utilized for rosacea.[14,15] Participants were notified of the presence of moisture-associated skin damage (MASD) that included incontinence-associated dermatitis, intertriginous dermatitis, periwound moisture-associated dermatitis, and peristomal moisture-associated dermatitis[16] Diagnoses of fungal, bacterial, and viral skin infections were based on clinical findings and partly on microbiological diagnostics.

Analytical Methodology for the Present Study

To analyze the severity of skin diseases or skin findings, study subjects with such findings were classified into three subgroups according to their need for further intervention: (1) no further care needed, (2) expected to recover with self-treatment, and (3) need medical care by physician. If a study case showed any skin disease that required treatment (e.g., untreated eczema) or had any suspected skin malignancy, the subject was referred to a primary healthcare unit. The group "no further care needed" included those with benign skin tumors or male/female pattern hair loss and no other diagnosis.

The SES of the study subjects was defined by their educational level.[17] Individuals were classified into three subgroups of education: primary school, secondary school, and postsecondary-level education/vocational college/university. The information on subjects' level of education and living status (living alone or with a spouse/other family member) was self-reported.

Statistical Methods

The data gathered from the clinical examination were used to calculate the overall prevalence of all common skin diseases as well as the prevalence of each individual condition. The chi-square test or Fisher exact test were used appropriately to test the difference in categorial variables. Logistic regression analysis was used to estimate crude and adjusted odds ratios (ORs) and their 95% confidence intervals. The adjusted model included sex, SES, and level of education as variables. All statistical analyses were performed with SAS v.9.4 for Windows (SAS Institute, Cary, NC, USA). All significance tests were two-tailed, and values of P < .05 were considered statistically significant.

Ethical Approval

The Ethical Committee of the Northern Ostrobothnia Hospital District approved the study (115/2012) that was performed according to the principles of the 1983 Helsinki Declaration.