A decade of developments in dermatological care within Dutch nursing homes: a repeated cross-sectional study
This repeated cross-sectional study comparing Dutch nursing home physicians from 2013–2014 and 2024 reveals that while the use of teleconsultation and availability of diagnostic tools have significantly increased over the past decade, the rising burden of cutaneous (pre)malignancies highlights an urgent need for targeted education and skills training to bridge the gap between available resources and physician competence.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Skin is the body's largest organ, and for people living in nursing homes, it is often the site of their most persistent and difficult health challenges. As the population ages, the skin becomes more fragile, prone to slow-healing sores, infections, and growths that can turn dangerous. In the Netherlands, where a specialized type of doctor known as an elderly care physician works directly within these facilities, managing these conditions is a daily reality. These doctors are the first line of defense, responsible for diagnosing rashes, treating wounds, and deciding when a patient needs to see a skin specialist. However, the landscape of care is shifting. The population is getting older, medical technology is changing, and the way doctors communicate with one another is evolving. Understanding how these changes affect the quality of care for the most vulnerable residents is essential, not just for the Netherlands, but for any society facing a similar demographic future.
To track these changes, researchers conducted a large-scale survey of elderly care physicians across the Netherlands, comparing data from two distinct moments in time: a decade ago in 2013 and 2024. The goal was to see how the daily reality of skin care had transformed over ten years. The study asked these doctors about the skin problems they saw most often, the tools they had available to treat them, and how they worked with hospital-based skin specialists. The findings reveal a picture of progress mixed with persistent gaps. While the doctors now have access to better equipment and are using modern digital tools to consult with specialists, they still feel they lack the specific training needed to handle the most complex cases, particularly those involving skin cancers.
The survey included hundreds of physicians, revealing that skin diseases are an almost universal part of nursing home life. Nearly every doctor reported seeing patients with skin issues in the last three months. The most common problems remained consistent over the decade: eczema, pressure ulcers, and fungal infections. However, one specific type of problem grew significantly more common. The doctors reported encountering pre-cancerous and cancerous skin growths far more frequently in 2024 than they did ten years prior. This increase in skin cancer cases has become the primary reason these doctors call in a specialist for help. It appears that as the population ages, the risk of these growths rises, and the doctors are seeing them with greater regularity.
In response to these challenges, the tools available to the doctors have improved. Ten years ago, many nursing homes lacked basic diagnostic equipment. Now, there is a noticeable increase in the availability of devices that allow doctors to examine skin lesions more closely, such as dermoscopy, which uses a magnifying light to see beneath the skin's surface. There is also better access to procedures like punch biopsies, where a small sample of skin is taken for testing, and cryotherapy, which uses extreme cold to treat growths. Despite having these tools, the doctors do not always use them with the same frequency they have access to them. While more doctors are performing biopsies and using cold treatments, many still feel hesitant or untrained in using the more advanced diagnostic devices. This suggests that simply providing the equipment is not enough; the doctors need more hands-on practice to feel confident using it.
The way these doctors communicate with skin specialists has also undergone a dramatic shift. Ten years ago, consultations often happened over the phone or required the specialist to travel to the nursing home. Today, the vast majority of consultations happen through telemedicine, where images and patient details are sent digitally for a remote review. This shift has made communication faster and more efficient, aligning with broader trends in healthcare. However, the study notes a downside to this digital shift. While digital tools work well for many conditions, they are less effective for complex cases that require a physical touch or a closer look that a camera cannot capture. The decline in specialists visiting the nursing homes in person means that some patients might miss out on the nuanced care that only a physical examination can provide.
The doctors themselves identified a clear need for better education. When asked what would improve their work, the most common request was for targeted training on specific diseases, especially skin cancers, and practical skills training on how to use the new diagnostic tools. They also expressed a desire for better collaboration with specialists, asking that doctors consider the overall health and daily life of the elderly patient when making treatment decisions, rather than focusing solely on the skin condition. The study concludes that while the infrastructure for care has improved, the bridge between having the tools and knowing how to use them effectively remains incomplete. To truly improve care for nursing home residents, future efforts must focus on combining better education with a collaborative approach that respects the unique needs of the elderly.
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