Nails undergo a significant number of changes in elderly patients, including discoloration, increased curvature and a 40 percent reduction in the growth rate, according to Richard K. Scher, M.D., professor emeritus, dermatology, Columbia University, New York, and the University of North Carolina, Chapel Hill.
"The nails also become very brittle, and they peel, split, crack and/or become ridged. Sometimes, the moons will disappear and the blood vessels become thickened and undergo elastosis, or a degeneration of the elastic fibers in the nail bed and matrix," Dr. Scher says.
"As a person ages, water content of the nails decreases. So, the elderly often get brittle nail syndrome," Dr. Scher says. "One of the ways to help is to suggest they moisturize the nails just as they moisturize dry skin, which also occurs in the older patient population. Patients can be instructed to use any kind of hand moisturizer. A lot of people use moisturizer for their hands, and if they rub it on their nails, it is very helpful."
Dermatologists also may want to remind their patients that the dryness is made worse with excessive hand washing, exposure to chemicals and undergoing manicures too frequently.
Patients also can be encouraged to wear gloves while washing the dishes or gardening, he says, in order to help protect the nails.
In addition, Dr. Scher suggests that female patients avoid growing overly long nails, which can act as a lever or fulcrum and cause injury to the digit and the nail. He also recommends patients use both formaldehyde-free nail polish and acetone-free nail polish remover to avoid drying out the nails.
Dr. Scher also says patients should take care not to have their nails manicured too often.
"In general, nail polish is beneficial to the nails, even in the elderly, because nail polish retards or slows the loss of moisture," Dr. Scher says. "However, if women have the nails done too often, the polish must be removed frequently and the acetone and acetone-free products are very dehydrating. That is why over-manicuring has a negative effect."
Slower nail growth
One of the consequences of the very slow growth rate is that fungus is able to get into the nails much more readily.
"We do see a 40 to 60 percent increase in the prevalence of onychomycosis in the elderly," Dr. Scher says.
A study conducted in 2006 that evaluated all new skin disease in patients over age 65 found that 16.9 percent were due to fungus infections, mainly of the nails, according to Dr. Scher.
Treatment for onychomycosis is dependent on the severity of the infection.
"If the fungus infection is very mild, topical antifungals may be helpful. If it is more severe, oral treatment, such as terbinafine, may be required," he says.
Because many elderly patients take other medications as well, Dr. Scher says the dermatologist must evaluate the potential drug interactions and side effects before prescribing antifungals or other medications for addressing nail infections.
The slow growth rate also contributes to thickening of the nails. Frequently, those in the older age group have nails that get increasingly thicker.
"There is no medication or treatment that will get rid of the lines or ridges in the nails. The only way to improve these issues cosmetically is to lightly buff them. However, excessive buffing is not advisable because it makes the nails too thin and that can be harmful," Dr. Scher says.