As the population ages, the burden of cutaneous infections in older adults is rising and poses a significant challenge for UK primary care. Older individuals are particularly susceptible to skin and soft-tissue infections (SSTIs) due to age-related skin changes, comorbidities, polypharmacy, and immune system changes. For the primary care team, recognising these risks, implementing preventative strategies, and managing infections early can reduce morbidity, avoid hospital admissions, and support quality of life for older patients.
Why Older Adults Are at Higher Risk
Ageing skin undergoes structural changes: thinning of the epidermis, reduced collagen and elastin, diminished blood supply, and decreased sweat and oil gland activity. These changes impair the skin’s barrier and repair functions. In combination with common comorbidities such as heart failure, peripheral oedema, diabetes, and nutritional deficiencies, older adults are more prone to infections, particularly in the lower limbs.
Common Skin Infections and Presentation in Older Adults
In older patients, SSTIs commonly include cellulitis, erysipelas, infected leg ulcers, fungal intertrigo, and pressure-area skin breakdown. Presentation may be atypical: classical signs such as warmth, redness, and fever may be muted or absent. In primary care, clinicians need a high index of suspicion when older patients present with new leg swelling, changes in mobility, confusion, or unexplained deterioration. Early assessment is vital.
Prevention and Management Strategies in Primary Care
Prevention goals focus on optimising skin integrity and identifying modifiable risk factors. Encourage moisturisation for dry or atrophic skin, minimise trauma, manage oedema, optimise glycaemic control, ensure good nutrition, and review footwear and mobility aids. Regular skin inspections, especially in housebound older adults, can help detect early changes.
When infection is suspected, primary care practitioners should assess severity, check for complicating factors such as immunosuppression or resistant organisms, and follow local antimicrobial guidance. Diagnosis in older adults often requires careful clinical judgement, monitoring, and early referral to specialist care when needed.
Role of Primary Care Coordination
Primary care clinicians are well-placed to lead care for older adults with skin infections. Coordinating with community nursing, dermatology, vascular services, and pharmacy is important, especially given polypharmacy issues. Follow-up after treatment is key: reviewing progress, reassessing for underlying risk factors, and reinforcing preventative strategies.
Training to Enhance Practice
To support primary care teams in enhancing diagnostic accuracy, prevention, and management of skin infections in older adults, there are two CPD-accredited courses offered by Practitioner Development UK (PDUK):
- “Recognising and Managing Acute Skin Conditions in Primary Care” (Course Link)
- “Dermatological Conditions in the Older Adult” (Course Link)
These courses provide practical frameworks, case-based learning, and updates tailored for primary care settings, helping clinicians build confidence in managing skin infections and complex dermatological needs in older adults.
Conclusion
Skin infections in older adults are common and often under-recognised. They may present atypically, requiring careful assessment and early intervention in primary care. By adopting a proactive approach-focusing on prevention, risk-factor modification, timely diagnosis, and coordinated management-clinicians can significantly improve outcomes. Investing in training and applying evidence-based strategies further enhances care for this growing patient population.
References
Falcone, M. and Tiseo, G. (2023) ‘Skin and soft tissue infections in the elderly’, Current Opinion in Infectious Diseases, 36(2), pp. 102‑108.
Kottner, J., Beeckman, D., Bliss, D., et al. (2024) ‘Skin health of community‑living older people: a scoping review’, BMC Geriatrics, 24, Article e.11144137.
