The ElderDerm: Episode 2, Aging and Geriatric Evaluation in Dermatology

In this episode of the ElderDerm Podcast, co-hosts Dr. Adam Friedman and Jaya Manjunath discuss the Aging and Geriatric Evaluation in Dermatology (AGED) workgroup, a new task force that is part of the International Dermatology Outcome Measures (IDEOM) organization. Get excited to hear about what is currently in the works, including the development of new outcome measures such as a quality of life questionnaire, inclusive to older adults. 

Adam Friedman, MD, FAAD, is the Chair of Dermatology at GW School of Medicine and Health Sciences.

Jaya Manjunath, is a third-year medical student at GW and the founder of the 501(c)(3) nonprofit organization, Seniors with Skills, an international nonprofit with a mission to end social isolation amongst senior citizens.

ElderDerm 2024 is the first conference uniquely dedicated to highlighting the complexities in medical treatment and social considerations in older adult patients. The conference will be held on June 6, 2024, at George Washington University in DC. In addition to addressing these important topics, the conference will foster collaborations between clinical researchers and practitioners and will fuel the development of future research studies and clinical trials in the field of geriatric dermatology. We hope you choose to attend and support this conference! 

Transcript:

Dr Friedman: Welcome back to the Elder Derm Podcast, supported by The Dermatologist magazine. I'm Dr Adam Friedman, and I'm joined by my co -host, Jaya Manjunath, and we're going to be talking about all things related to geriatric dermatology over the course of several podcasts.

Now, with the first edition of our podcast, Jaya, you know, we kind of got into the nitty gritty of how to approach and how to consider unique issues pertaining to the wiser and more mature patient. But I think now we're going to get a little more granular with respect to how do we move the needle in order to really make a difference and be purposeful when managing these patients.

And for the purpose of this addition, I'd like to focus in a little bit on the new aging and geriatric evaluation dermatology workgroup that's part of the IDEOM [International Dermatology Outcome Measure]. And I know you've played a kind of pivotal role in developing this workgroup. So why don't we start from the very beginning: how and when was this workgroup formed?

Jaya Manjunath: Thank you so much for having me today to Dr Friedman. The workgroup was originally started by Dr Daniel Butler, and we had our inaugural involvement at IDEOM in June 2023, where we discussed the importance of developing unique outcome measures in the geriatric population.

After the conclusion of this meeting, we developed our workgroup listserv, consisting of about 25 people, including residents, and students. students, and faculty. And we look forward to hosting our next workgroup meeting in February over Zoom.

Dr Friedman: So, what is the goal of the workgroup and what are you guys currently working on?

Jaya Manjunath: Yeah, so our main goal is really to create outcome measures in dermatology that are inclusive for older adults. And for older adult dermatology patients, there are unique considerations to keep in mind, including in risk of polypharmacy and baseline sleep disturbance. Outcome measures, for example, measures of quality of life in younger or middle -aged patients may not be as inclusive in older adults and our workgroup really strives to create these inclusive outcome measures.

So, we currently have several works in progress. First, our team is currently drafting a white paper which will be our call to action for specific outcome measures inclusive for the older adult patient population. And second, we are actively investigating outcome measures such as the DLQI, which is the Dermatology of Life Quality Index, to understand what questions and what parts of these measures are not inclusive to older adults.

And when thinking about quality of life at measures, such as a DLQI, we really want the input of real patient perspectives. So, we are planning to set up a series of patient interviews to guide us in understanding which questions from the DLQI per se are already useful in assessing quality of life in older adults and which items should be modified. And I'm happy to talk more about that today in the podcast.

And really, we're planning on modifying the data the QOL and presenting an updated quality of life measure to our workgroup, which will then complete workgroup voting.

Dr Friedman: Yeah, I think that's so hugely important because if we look at, or forget even to investigate, or initiate type work in dermatology and beyond. But if we look at our clinical trial programs, often those above a certain age are not as necessarily included in high numbers in these clinical trials for one reason or another. And for those who are, it's very possible, especially when you think about patient record outcomes, the questions may not necessarily be as relevant for them. Would you mind, and, you kind of already alluded to your willingness to go deeper into this, could you maybe give some examples of how some of the current questions aren't necessarily inclusive or really thoughtful when it comes to this patient population?

Jaya Manjunath: Of course. So, the first questionnaire that we really wanted to tackle was the DLQI and I can provide some sample items now.

The first item is over the last week: how much has your skin interfered with you going shopping or looking after your home or garden? And there is a portion of the older adult population who may not be completing these activities, especially those who are in long -term care facilities. And hence we feel it would be more representative to ask a broad question such as over the last week, how much has your skin made it difficult for you to leave your primary residence? Another example of a sample item is over the last week, how much has your skin made it difficult for you to do any sport? And for sort of a similar reasoning, we would want to modify that to a question such as, over the last week, how much have you required assistance from others, such as family caretaker or staff members to treat your skin? And really, in the older adult population, understanding how much extra care and extra support is needed from, say, a caretaker can really help us establish how much that dermatology condition may be impacting their quality of life. And then lastly, another question, over the last week, has your skin prevented you from working or studying? And of course, we would want to modify this and some additional categories of questions to consider include, you know, how often are you worried about remembering medications to take for skin conditions, worried about side effects for medications for skin conditions, and how often have you had difficulty falling asleep from your skin condition?

Dr Friedman:Yeah, I mean, I know for me, personally given I am going to work until I die and plan on being a baller till I'm 85, this question will be very pertinent for me.But I can see clearly how our current survey questions may really disenfranchise a growing and absolutely enlarging population that we all need to be prepared to manage and understand their needs and also how our management strategies impact because that's part of you know these DLQI questionnaires is not just to assess how bad are things going right now but are our interventions actually making a difference and even going you know a little more focused to the kind of FDA pipeline to getting approval for medications understanding the impact of an evolving or experimental medication on this enlarging population is of the utmost importance. And I would say, even taking a step back, those types of questions in our own day -to -day in terms of how do we typically screen our patients? How do we talk to them? Are we thoughtful about the questions we ask as it relates to the patients? I think that's really important. So, I think the evolution that you guys are putting forward when it comes to these questions will be impactful at a very large level from clinical research to drug development, but even may give clinicians some more ammo to better partner with their patients and get to the bottom of how they're actually doing.

So that's great work and I look forward to getting an update on the evolution of this questionnaire. What are some of the future directions of the work group?

Jaya Manjunath: Yeah, so since this is new it's always exciting and there's a lot going on but really our next step is to complete this this tool and complete workgroup voting of the tool and work towards validating the tool through IDEOM.

And then, once we have this baseline tool, we hope to partner with other workgroups and integrate this tool with specific dermatologic conditions such as psoriasis, prurigo nodularis, etc. So really there's a lot of other outcome measures we can delve into after that. And then the other future step of the work group is actually in the development of an aged dermatology fellowship.

And we're hoping to get funding for this through IDEOM and it would be a student or postdoctoral fellow who would really focus on this work group and ensuring that the task force grows for many years to come.

Dr Friedman: Great, well, I know you are tenacious, and all these things will come to fruition. So certainly, very exciting and we can, of course, keep everyone loop through this podcast. And also, for all those listening, ensure you save the date for the first official Elder Derm Conference to be held on June 6th at the GW School of Medicine and Health Sciences in beautiful Washington, DC. So, if you want to learn more face -to -face, you know, voice -to -ear and interface with, of course, experts in the field, that would be a great opportunity to do so.

Well, Jaya, thank you so much for sharing some of the work you've been doing with IDEOM and the new work group. And I'm a big fan of acronyms, you know, aging and geriatric evaluation, Derm aged so appropriately acronym-d, if that's even a word. So, keep up all the great work. And everyone stay tuned for the next podcast. I'll see you in the next podcast.