Title : The clinical and system-level benefits of teledermatology in geriatric nursing home populations: A scoping review
Abstract:
Background:
Teledermatology (TD) is the remote delivery of dermatology services including diagnosis and management. TD has grown drastically as a result of the COVID-19 pandemic and has since become an integral means of providing dermatologic care, especially to geriatric populations. Specifically, nursing home residents who often face physical and cognitive limitations, multimorbidity and an increased risk of complications can benefit from remote visits. TD can provide earlier diagnoses, timely management and improved access to care and quality of life (QoL). Overall, this review will provide a comprehensive analysis of the benefits of TD in the diagnosis and management of dermatologic conditions in the elderly nursing home populations.
Objectives:
The purpose of this scoping review was twofold: to identify the most common dermatologic diagnoses in the nursing home population and to evaluate the benefits of TD in addressing these concerns.
Methods:
A scoping review was conducted to identify the most prevalent dermatologic diagnoses amongst nursing home facilities and to synthesize the benefits of TD in diagnosing and managing these conditions. A comprehensive search was conducted by three independent researchers using multiple databases, including Ovid MEDLINE, EMBASE, and Web of Science. For top dermatology diagnoses in elderly nursing home patients, a total of 118 articles were identified. After screening, 23 articles were selected for full-text review, with four articles meeting the inclusion criteria for this review. Regarding the benefits of TD, a total of 639 articles were discovered. After screening, 57 articles satisfied the eligibility criteria, and 21 relevant articles were included for analysis.
Results:
Across the diagnosis-related studies, the five most frequent diagnoses included xerosis cutis (78-99%), tinea unguium (59-62%), seborrheic keratosis (31-56%), lentigo (35-90%), and eczema (17-37%). Across the TD-benefit studies, cost-effectiveness, accessibility, accuracy, patient satisfaction, and clinical outcomes were found to be consistently reported.
Conclusions:
Our findings revealed that TD enhanced diagnostic accuracy, accessibility, and continued care among elderly patients. Rapid diagnoses allow for faster relief, decreased in-person referrals, and improved overall clinical outcomes. In nursing home settings, TD offers a cost-effective approach to managing dermatological conditions without the added burden of travel and allows for in-person follow-up only when needed. In terms of access to care, more efficient triage may reduce wait times for patients. In addition, clinical outcomes, including disease activity, have been reported to be equivalent among the two modalities. These findings align with current literature highlighting the growing utility of TD among geriatric patients while emphasizing the specific benefits for nursing home patients. As telehealth regulations evolve, it is essential to highlight the wide range of benefits TD provides. Recognizing these advantages will help sustain and expand its use, ultimately improving access to high-quality dermatologic care for nursing home residents and other vulnerable populations.
