Health Problems of the Elderly

Scabies is an infectious skin disease caused by a barely visible mite. It affects people of all ages. However due to weakened immunity, elderly are more susceptible to scabies. Outbreaks of scabies have been reported in hospitals, hostels and old age homes.

Route of infection

Scabies spreads through direct contact with an infected person. As mites and their eggs can be left on clothing and bed-linen, contact with clothing or bed-linen of the infected person can lead to infection.

The scabies mite

The mite is too small to be visible by naked eye. The female mite penetrates into the skin by its forelegs and mouth. It digs tunnels and lays down its eggs. The eggs hatch in 3 to 4 days. The mites mature in about 10 days, and then start to breed the next generation.

Symptoms of scabies

1. The main symptom is intensive itchiness in the infected areas, which is more severe at night and after hot bath.
   
2. The usual affected areas are the finger webs and the flexural areas of wrists, elbows, armpits, nipples, lower abdomen and external genitalia. The face and scalp of elderly are usually spared.
   
3. Rash develops at the point where the mite penetrates the skin. Thread like tunnel (usually less than 1 cm) can be seen as they dig tunnels under the skin.
   
4. If the infected person is allergic to the mite or its excreta, he or she may develop blisters.
   
   

Management of scabies

Management of residents and staff for old age home

1. Staff should closely monitor the conditions of themselves and their residents. Immediate medical advice should be sought when a person have symptoms suggestive of scabies infection. If there are several residents and staff confirmed to have scabies, the staff should report to the Centre for Health Protection.
   
2. During a scabies outbreak, people who are in close contact with the patient, eg. roommates and staff, should apply the anti-scabies medication to prevent the spread of the disease.
   
3. Staff should wear gloves and apron when doing cleansing and taking care of the infected patient. Staff should also wash their hands thoroughly and change the uniforms after taking care of the infected patient.

Management of the clothing and bed-linen

1. Patient¡¦s clothing, bed-linen, pillowcase, etc., should be washed separately from those of their family members or other old age home residents.
   
2. Patient¡¦s clothing, bed-linen, pillowcase, etc., must be boiled in hot water (60„aC or above, for not less than 10 minutes) to get rid of the mite and their eggs.
   
3. Place all non-washable personal items such as shoes, mattress, etc. in a plastic bag and seal them up for at least 14 days before they can be used as usual.

Medical treatment

1. Effective medical treatment for scabies include anti-scabies agents (e.g. Benzyl Benzoate Emulsion) and drugs to control itchiness.
   
   

Method to apply Benzyl Benzoate Emulsion

1. In the evening after taking a bath, scrub and dry the body thoroughly. With the help of another person, use a brush to paint the emulsion from the neck downwards to cover the whole body (fingers webs and toe webs should be included, but not the head). Then put back the same clothes.
   
2. On the next morning, repeat the application without taking a bath. Then put back the same clothes.
   
3. On the next evening, take a hot bath and clean the whole body with soap and put on clean clothes afterwards.
   
4. In between the two applications of the emulsion, no need to change the clothing or bed linen.
   
5. Please note that two applications of the emulsion suffice to kill the mite. Over treatment gives rise to irritation and causes contact dermatitis. Re-apply the emulsion to the hands after washing since the previous coating has been removed by water.
   
6. After treatment, the itching may persist for one to two weeks. If the itchiness lasts for more than two weeks or if there are other changes in the skin, consult your doctor again.
   
   

Related topics

Skin care for the elderly

Topical medicines