FOCUSED ASSESSMENT OF FOOT CARE IN OLDER ADULTS

OBJECTIVES: The purpose of this study was to investigate the prevalenc e and characteristics of foot problems in nondiabetic individuals comp ared with those in a diabetic population in order to develop recommend ations for preventive foot care in older people. DESIGN: Retrospective review of a convenience sample of all patients referred to a Foot Car e Service during a 24-month period. SETTING: University Health Science s Center. PARTICIPANTS: A total of 308 patients aged 33 to 95 years (1 76 women and 132 men), of whom 183 had diabetes mellitus (DM) and 125 were without DM. INTERVENTION: Each subject had a detailed history of foot care behavior and a thorough foot examination for peripheral neur opathy (PN), peripheral vascular disease (PVD), and foot deformities. PN was evaluated using the Semmes-Weinstein monofilament test. PVD was graded by clinical measures and Doppler examination (ankle: brachial index < 0.8). MEASUREMENTS: Forty-three percent of subjects with diabe tes had PN, 32% had PVD, and 19% had both conditions. Eighteen percent of subjects without diabetes had PN, 21% had PVD, and 6% had both. Th e risk of foot abnormalities in those without DM increased with age (r = .99, P = .0002). Thirty-eight percent of non-diabetic patients olde r than age 60 had one or more of these major risk factors and would be considered at high risk for the development of foot ulcers or amputat ion. Ninety percent of the subjects reported inappropriate foot care p ractices. Forty-seven percent of nondiabetic individuals with PN or PV D wore inappropriate shoes. CONCLUSION: Older individuals without DM a re at high risk for foot-related disease and should receive the same f oot care screening, education, and follow-up as those with DM. Older p eople who have PN, PVD, or physical and psychosocial limitations, may require referral to foot care specialists.